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cardiac catheterization

Passage of a catheter into the heart through a blood vessel leading to the heart for the purpose of measuring intracardiac pressure abnormalities, obtaining cardiac blood samples, &/or imaging cardiac structures by injection of radio- opaque dye. Indications: (applications) 1) treatment of coronary stenosis/occlusions a) percutaneous transluminal coronary angioplasty (PTCA) b) laser techniques c) intravascular coronary stents d) atherectomy 2) treatment of valvular stenoses -> balloon valvuloplasty (aortic, mitral, pulmonic) 3) treatment of congenital heart disease a) atrial septostomy b) umbrella closure of patent ductus arteriosus & defects in atrial or ventricular septum c) coil closure of undesired collateral vessels Contraindications: (relative) 1) uncontrolled ventricular irritability -> increased risk of ventricular tachycardia & fibrillation 2) uncorrected hypokalemia or digitalis toxicity 3) uncorrected hypertension -> predisposes to myocardial ischemia &/or heart failure 4) intercurrent febrile illness 5) decompenstated heart failure, especially pulmonary edema unless catheterization can be done with patient sitting up 6) anticoagulation; PT > 18 seconds 7) severe allergy to radiographic contrast agent 8) severe renal insufficiency &/or anuria, unless dialysis is planned to remove fluid & radiographic contrast load Advantages: 1) direct measurement of intracardiac pressures, gradients & shunts 2) contrast angiography provides visualization of cardiac anatomy 3) allows percutaneous intervention for structure heart disease with intracardiac echocardiographic guidance [1] Disadvantages: 1) invasive 2) radiation exposure - radiation exposure risk for health care workers in cardiac catheterization labs [3] 3) images are not tomographic, limiting 3-dimensional visualization [1] Notes: - inappropriated cardiac catheterizations nearly eliminated with education & screening confirming catheterization appropriateness on day of procedure [4]

Specific

cardiac catheterization for congenital heart disease coronary angiography hemodynamic monitoring percutaneous coronary intervention (PCI) Swan-Ganz catheter (pulmonary artery catheter)

General

catheterization

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, 15, 17. American College of Physicians, Philadelphia 1998, 2009, 2015
  2. Harrison's Principles of Internal Medicine, 13th ed. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 980, 986
  3. Andreassi MG, Piccaluga E, Guagliumi G et al Occupational Health Risks in Cardiac Catheterization Laboratory Workers. Circulation: Cardiovascular Interventions. 2016; 9: e003273 PMID: 27072525 http://circinterventions.ahajournals.org/content/9/4/e003273
  4. Lou N. Inappropriate Caths Nearly Eliminated With Education, Screening Program - Center's program for primary, specialty care 'may serve as a template' MedPage Today. October 17, 2017 https://www.medpagetoday.com/PracticeManagement/PracticeManagement/68609