Cardiac Catheterization

What Is Cardiac Catheterization?

Cardiac catheterization describes a thin, flexible plastic tube inserted through an arterial blood vessel to the heart. The insertion site is usually at the wrist or groin. Cardiac catheterization can be used to carry out various examinations and therapies on the heart. For example, pressure and flow velocities can be measured, or the coronary vessels' blood flow can be examined.

Which Heart Diseases Can Be Detected or Treated with Cardiac Catheterization?

Most commonly, cardiac catheterization is ordered to carry out coronary angiography, where coronary arteries are examined. It is about calcifications or constrictions that can reduce the blood supply to the heart. In such cases, the term coronary artery disease (CHD) is used. Depending on its extent, CHD can be completely asymptomatic or, in severe cases, cause pain in the chest and arm area, even at rest. It is referred to as a myocardial infarction if complete occlusion of a coronary artery is involved.

In coronary angiography, a contrast agent is injected into the coronary artery via the cardiac catheter, and X-ray images of the heart are taken at the same time. In this way, constrictions can be revealed and, if necessary, immediately treated, also with cardiac catheterization. For this, a folded balloon is advanced to the narrow point from the insertion site over the artery. Then the balloon is expanded so that the constriction regains a sufficient diameter. After that, a strutting shaped like a hollow cylinder (stent) is inserted.

In another variant of cardiac catheterization, the left ventricle and the function of its valves are evaluated. For this purpose, a contrast agent is injected into the ventricle via the cardiac catheter with simultaneous X-ray imaging. The contrast medium is ejected from the heart with the next heartbeats. During these visualized procedures, the physician can assess the heart's beating force and the "tightness" and opening ability of the heart valves.

In other words, the following diseases, among others, can be examined with cardiac catheterization:

• Coronary heart disease (CHD)
• Myocardial infarction
• Congenital heart defects
• Diseases of the heart valves
• After heart transplantation
• Diseases of the heart muscle (cardiomyopathies)

For some years now, cardiac catheterization has been used not only for heart examination or stent implantation. Some heart valve defects can also be operated on directly through the groin. The most common procedures include aortic valve surgery, transcatheter aortic valve implantation, and Mitraclip, a mitral valve surgery.

What Are the Advantages of Cardiac Catheterization Surgery?

The advantage of cardiac catheterization is not only providing very accurate examination results. As already mentioned, immediately after a diagnosis, therapy can also be carried out, e.g., by dilating the constriction in the case of CHD. Cardiac catheterization is a very gentle procedure and is also well suited for elderly patients or those with many diseases at the same time.

Duration and Procedure of Cardiac Catheterization?

In the cardiac catheterization laboratory, the patient lies awake on an examination table. The insertion site on the arm or groin is sterilely covered, disinfected, and locally anesthetized. The physician punctures the selected vessel and inserts the necessary wires and tubes. The position of the wires can be checked with the help of X-rays. The examination is not painful, and the wires and tubes are not felt. In case of excitement, a mild sedative can be given upon request and prior clarification. The duration of the examination depends on the examination and any subsequent therapy. It can last from 30 minutes to several hours. After the examination, all tubes and wires are removed, and the puncture site is dressed with a pressure bandage.

Risks and Aftercare

Complications are possible with cardiac catheterization, as with any medical procedure. However, serious complications are rare and occur primarily in emergency patients and patients with severe medical conditions. Possible complications include:

• Puncture of the heart
• Heart attack
• Cardiac arrhythmia
• Reduced blood flow to the brain
• Contrast agent intolerance
• Bleeding, inflammation, dilatation at the puncture site

Cardiac Catheterization Alternative

As an alternative to cardiac catheterization, a cardiac CT can be carried out to assess the coronary arteries. However, if there is a strong suspicion that there is a distinct coronary artery disease, cardiac catheterization should be preferred to eliminate the narrowing already during the examination.

Which Doctors and Clinics Are Specialized in Cardiac Catheterization Surgery?

Even though cardiac catheterization is an invasive procedure, it is not formally a surgery but is categorized as interventional cardiology. Therefore, the examination is performed by specialists in cardiology and does not fall within the scope of cardiac surgeons. In planned cases, the examination can be carried out in a cardiology practice or cardiology clinic. In emergency cases, such as an urgent suspicion of a heart attack, the examination is carried out in a clinic.

We will help you find an expert for your condition. All listed doctors and clinics have been checked by us for their outstanding specialization in the field of cardiac catheterization surgeries and are awaiting your inquiry or treatment request.

Sources:

• 1. Klein et al.: Fahreignung bei kardiovaskulären Erkrankungen. Deutschen Gesellschaft für Kardiologie. Stand April 2018. Abgerufen am 30.05.2018.
• Herold et al.: Innere Medizin. Eigenverlag 2012, ISBN 978-3-981-46602-7.
• Hahn: Checkliste Innere Medizin. 6. Auflage. Thieme 2010, ISBN 978-3-131-07246-7.