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Back to Cardiac Imaging

Cardiac catheterization

Involves the introduction of a thin tube (catheter) inside the heart chambers.  It may carry specialized devices on it that help it perform both diagnostic and therapeutic functions (see below).

Indications

  • Cardiac catheters may be used for both diagnostic and therapeutic uses.
  • Measurement of pressure in the heart and great vessels.
  • Injection of a radioopaque contrast medium to visualize the heart chambers and diagnosis of coronary artery disease
  • Stenting and dilatation of coronary artery disease, vulvoplasty and cardiac biopsies.
  • Intracardiac ultrasonographic imaging to quantify arterial narrowing
  • Intracardiac electrophysiology is a technique which can determine types of arrhythmias and locate aberrant pathways and ablate these pathways.

Cardiac catheterization is usually performed as day case procedures provided that the patient can rest lying down at home for four hours.

Technique

Pre-procedure checks

Clinical history and examination should be performed. Full blood counts, kidney and liver function tests as well as coagulation profile must be performed. Chest-xray and ECG. Patient consent should be taken. The patient should be fasting (NBM - nil by mouth) for at least 6 hours prior to the procedure. His daily medication should have been given to him the morning of procedure.

Technique

The catheter is usually introduced through the femoral artery or vein. It passes all the way up to the right atrium and can be pushed all the way through the right ventricle and into the pulmonary artery and then to the pulmonary capillaries.

Post-procedure checks

Patient should avoid dehydration to prevent renal injury by the contrast medium. Patient should be checked for swelling of the puncture site or bleeding. The peripheral pulses should be checked regularly for the rare complication of arterial dissection, thrombosis or arterial spasm.

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Complications

  • Renal insult due to contrast medium (enhanced by patient dehydration). This is rare with modern contrast media.
  • Contrast reaction, which is usually mild with modern agents.
  • Hemorrhage from the puncture site. This may resolve by simple pressure or may require surgery in cases of aneurysmal formation.
  • Loss of peripheral pulses which is rare and due to arterial dissection, thrombosis or arterial spasm.
  • Angina
  • Arrhythmias
  • Pericardial tamponade

Mortality

> 1 in 1000.

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