Cardiac Catheterization

The German specialists offer cardiac catheterization both for diagnostic and treatment of cardiac problems. Our heart is a muscle which functions uninterruptedly and thus needs abundant supply of blood and oxygen. Although the heart is constantly pumping blood, vascular plexus provides the cardiac muscle with blood and oxygen accomplishes a very important function.

Vascular plexus (coronary artery) is formed by two branches of arteries. X-ray engineering and cardiac catheter. Coronary arteries are so small. While radiopaque substance is inserted into coronary artery through a thin plastic tube, radiologists use X-ray to watch the substance. This helps not only to capture the spots of coronary vessels, but also to detect the spots of their constriction and occlusion.

According to the results of the examination, doctors select the method of treatment: artery dilatation by means of balloon catheter, removing the clots by medical treatment or heart surgery. The surgeon gains access to the coronary vessels under local anesthesia through the right side of the inguinal region or through the vascular plexus near the wrist. From there cardiac catheter approaches to the coronary vessels.

Cardiac catheterization is the optimal and often life-saving treatment for most heart attack patients. The statistics of the hospitals show that in Germany more than 715,000 people undergo cardiac catheterization per year, so the level of care can be described as very good. In Germany (2018), a total of 715,391 patients in 841 hospitals performed 745,247 cardiac catheterizations. 64.3 percent of the patients are men. 60.4 percent of the procedures were performed for diagnostic purposes. In summary, one can say that the situation in Germany is good and the quality of the cardiac catheterization is good.

Cardiac catheterization, as the current evaluations show, is very safe in Germany. Depending on the risk in the different clusters, the proportion of adverse events during the intervention ranged from 0.38 to 1.57 percent, with patients with acute coronary syndrome being five times more likely than patients without this.

Cardiac catheterization: minimally invasive method

Cardiac catheterization is a minimally invasive type of cardiac examination. Cardiac catheter can be inserted through a venous or arterial blood vessel in inguinal region, crook of the arm or the wrist. There are different methods of gaining access depending on the aim of the examination. Examination of vessels in venous heart is called right heart catheterization and examination of systemic heart is, correspondingly, called left heart catheterization. Left heart catheterization is performed more often than the right one. Venous heart catheterization is mainly conducted for visualization of coronary vessels and enlargement of their lumen by means of balloon dilatation.

Catheter ablation: cardiac catheter to fight arrhythmia

Catheter ablation is a special kind of surgical treatment by means of a cardiac catheter. During the procedure electric current can be used to treat heart rhythm disturbance (tachycardia). Nowadays catheter ablation is considered a standard therapy method for some forms of tachycardia. While medication only suppresses the symptoms of tachycardia, catheter ablation can treat the disease. This treatment method has a quite high success rate; for example, treatment of atrial fibrillation, re-entry in arteriovenous node or Wolff-Parkinson-White syndrome (preexcitation syndrome) has success rate of more than 90%.

At cardiology centres of Germany cardiac catheterization is conducted using the latest technology.

What happens during a cardiac catheterization?

A cardiac catheterization study can visualize a disease of the heart, heart valves, or coronary arteries on a screen. A cardiac catheter is a fine, flexible plastic tube that is advanced through a blood vessel to the heart during X-ray inspection.

Intravenous access to your arm is provided for the examination, so you can administer medication quickly in an emergency. In the cardiac catheterization lab, they are then stored on the examination table, so that the doctor can work well with the C-shaped X-ray arc. The groin or arm is then disinfected for vascular puncture and locally anesthetized - general anesthesia is not necessary. Subsequently, the vessel is then punctured by means of the so-called Seldinger technique. After the puncture, various wires and fine tubes are passed over the vessel to the heart. The doctor can then use the X-ray machine to assess the position of the catheter. The examination is not painful. Sometimes patients feel a slight haul or a warm sensation when injecting the contrast agent.

There are two types of cardiac catheterization:

1. Right Heart Catheter (Venous or Injection Catheter): In this exam, the catheter is advanced over a vein in the groin or crook of the arm to the right ventricle and pulmonary artery. Injection catheters have a small inflatable balloon at the tip and so become lodged with the bloodstream. In this case, for example, the pressure in the right ventricle and the pulmonary artery can be measured. To assess the right ventricle, the blood flow and the function of the heart valves, a contrast agent is injected via the catheter.
2. Left-handed catheter (arterial or large catheter): this catheter is advanced over a pharynx (artery) in the groin, crook of the arm or in the wrist to the left ventricle. After injecting contrast media, the left ventricle, aorta, blood flow and heart valve function can be assessed.

In both types of examination, tissue samples can also be taken. A clarification of possible causes of cardiac arrhythmias is possible. Special catheters are used to measure how many liters of blood are pumped through the heart in one minute. This allows the doctor to assess whether cardiac output is limited.

The duration of the examination depends very much on the circumstances and can be between 30 minutes and several hours. If a pure angiography is performed, you are usually done faster than when one or more stents are implanted.

When the cardiac catheterization is complete, remove the catheters and close the vessel. To avoid rebleeding, it is then necessary to close the area for several hours (for example, using special pressure bandages).

Many people are very excited because of the procedure so close to the heart. In this case, they can get a light sedative before starting the examination.

Use of contrast agent

The doctor then injects an X-ray contrast agent through the catheter into the heart chamber to be examined as well as the coronary arteries. In this way he makes the structures visible on the X-ray screen and can examine them thoroughly. For example, it measures the pumping function of the heart chambers and their ejection fraction. Even scarred muscle tissue after a heart attack can be discovered so because it no longer contracts.

If the contrast medium reaches the heart chambers, a feeling of warmth can develop throughout the body for a few seconds. If only the coronary arteries are examined, the patient does not feel anything, since for this purpose smaller amounts of contrast agent are injected.

When the examination is completed, the catheter is usually removed from the blood vessel. So that there is no "rebleeding" at the injection site, the doctor applies a pressure bandage.

Left heart catheter (arterial catheter)

Coronary Angiography

Coronary angiography is the most common reason for a cardiac catheterization. Here, the coronary arteries are examined - those coronary around the heart muscle created vessels that provide the heart. If the coronary arteries are calcified and thereby narrowed (stenosed), the heart muscle is no longer sufficiently supplied with blood and oxygen. One then speaks of coronary heart disease (CHD). CHD often manifests itself in typical chest pain (angina pectoris), which may radiate into the left arm, abdomen, shoulder or jaw, for example. The acute occlusion of a coronary artery is called a heart attack - a life-threatening emergency.

For coronary angiography, the heart catheter is gently advanced over the groin or wrist to the heart. The departure of the coronary arteries from the aorta (body artery, arising from the left ventricle of the heart) is probed. Subsequently, contrast medium is injected into the coronary artery via the catheter and at the same time an x-ray film of the heart is taken (angiography). So you can discover any bottlenecks (stenosis).

The constricted vessel can then be expanded (balloon dilatation) using a balloon inserted into the artery and kept open with a stent.

Laevocardiography / ventriculography

In this variant of the cardiac catheterization, the left ventricle and the function of their heart valves are assessed. For contrast, contrast medium is injected into the heart chamber during simultaneous fluoroscopy. Based on the X-ray film, the doctor can then assess, for example, the impact of the heart.

Right heart catheterization

Right heart catheter is a special, invasive examination of the right heart (right atrium and right ventricle). With this study, one can measure different pressures in the heart and diagnose different diseases. Find out everything important about right heart catheter here!

What is a right heart catheter?

The right-heart catheter is primarily used to measure hemodynamics, ie to determine how well or poorly the heart is pumping blood through the body. To do this, under X-ray control, push a catheter over a venous vessel in the groin or arm into the right ventricle and on to the pulmonary artery. Then you can measure different values, including:

• Central venous pressure (CVD)
• Pressure in the right atrium and in the right ventricle
• Pressure in pulmonary artery and capillaries
• The volume of blood ejected from the heart (cardiac output)

In addition, blood samples can be taken at various points to measure the oxygen content.

The right heart catheter provides information about the pumping function of the heart. In addition, one can assess the pulmonary vessels and thus diagnose pulmonary hypertension (pulmonary hypertension).

The right heart catheter should not be confused with the CVC (Central Venous Catheter). The CVC is a special type of intravenous access, which is pushed over a vein to just before the heart, to introduce fluid and medication. A pressure measurement is not possible. Especially patients in the ICU get a CVC.

When do you perform a right heart catheter?

A right-heart catheter is passed through at ...

• Suspected pulmonary hypertension (pulmonary hypertension).
• Different congenital heart defects affecting the right heart (especially defects of the heart septa).
• Cardiogenic shock (pumping failure of the heart).

Overall, however, the importance of the right-heart catheter has declined in recent years.

What do you do with a right heart catheter?

With the right heart catheter, a catheter is advanced under local anesthesia through a vein (usually in the groin) to the right ventricle and further into the pulmonary artery (pulmonary artery). During the exam, you will be permanently monitored on a monitor for complications such as cardiac arrhythmias. The exam is not painful and takes about an hour.

What are the risks of a right heart catheter?

A right heart catheter has similar risks to a left heart catheter, including:

• Infection at the injection site or at the heart (endocarditis)
• Arrhythmia
• Perforation of vessels or heart structures (such as heart valves)
• Occlusions

Harmless cardiac arrhythmias that disappear on their own are common in right ventricular catheters. The remaining complications are rare, but mostly life-threatening.

What do I have to consider after a right heart catheter?

After completion of the examination, remove the right ventricular catheter and compress the puncture site with a compression bandage for a few hours. If there are no complaints then you can leave the hospital.

For whom is a cardiac catheterization useful?

A cardiac catheter examination is especially in question

• For complaints such as shortness of breath, chest pain and tightness or after a heart attack. With the left heart catheter, the location and extent of a possible constriction of the coronary arteries can be determined and a narrowed or occluded blood vessel can be stretched.
• Suspected of morbid alteration or dysfunction of the heart valves.
• Before Cardiac Surgery: If cardiac valve or bypass surgery is planned, cardiac catheterization will be used to check for possible changes in the heart muscle and coronary vessels.
• For a tissue sample: In heart muscle inflammation, some of the myocardial tissue can be withdrawn through the catheter.

What preparations are needed?

In the preliminary discussion with the doctor, other known diseases must be stated, such as diabetes, inflammation, coagulation disorders or an allergy. It is also important which medication you take (such as anticoagulants, beta-blockers or antidiabetics). Before the procedure, a series of examinations is necessary:

• ECG
• Blood pressure measurement
• Blood test: It is used, among other things, to determine the blood count, blood clotting, kidney and thyroid levels. The latter is important if an iodine-containing contrast agent is injected.

Depending on the question, further examinations such as an x-ray of the lungs or an ultrasound examination of the heart (echocardiography) are carried out.

On the eve of the exam, patients may eat something light and drink up to six hours before the procedure.

How is the examination performed?

The procedure takes place in a catheter laboratory - mostly in the hospital, partly in an outpatient clinic. From about six hours before the examination nothing may be eaten. Shortly before the procedure, the skin is shaved at the puncture site (puncture site) in the groin or on the arm as needed and locally anesthetized. If you want, you can get a sedative.

The doctor punctures the vessel, inserts the catheter and pushes it to the heart. This is done under constant visual inspection on the monitor. Because the inner walls of the vessels are not sensitive to pain, you usually feel nothing.

To visualize the heart chambers and coronary vessels, an X-ray contrast agent is injected over the catheter. This can cause a feeling of warmth for a short time. If a constricted blood vessel is distended, a transient cardiac pain may occur. It usually stops when the stretching is over.

During the examination, the images of one's own heart can be followed on the monitor. The examination itself usually takes about 30 minutes. Depending on what is found and whether further measurements, a vessel dilation or stent insertion are necessary, but the procedure can take much longer.

After the examination, a pressure bandage is applied at the puncture site so that it does not bleed. For safety, one then remains in the clinic for about five hours. If the catheter has been inserted on the groin, it will take about four hours to lie down. If a bottleneck has been found and treated, a two-day follow-up at the clinic is usually necessary.

In any case, it is important to look after the procedure at home for several days to protect and, for example, not difficult to lift.

Treatment with the cardiac catheter

The heart catheter is nowadays not only used as a diagnostic method, but also in the therapy of various heart diseases - for example after a heart attack.

The most common procedure is the so-called balloon dilatation. For this purpose, the doctor advances a very thin catheter over a guide wire to the narrowed part of the affected coronary vessel. At the tip of the fine tube is a collapsed balloon, which is deployed at the constriction by the administration of contrast medium with a pressure of 4 to 20 atm. This widens the bottleneck. In most cases, a balloon-applied stent is deployed simultaneously. It is a stent made of stainless steel. This is to prevent the dilated constriction narrows again after removing the balloon. The stents and balloons are often coated with medications designed to prevent the growth of scar tissue into the stent.

Heart valve defects such as narrowing of the aortic valve or the mitral valve can be corrected by catheter. It is also possible to use a cardiac catheter to close a hole in the atrial septum, the dividing wall between the two atria.

Of great importance nowadays is the treatment of certain arrhythmias with the catheter, the so-called catheter ablation. These include atrial fibrillation, atrial flutter and arrhythmias of the ventricles.

What are the risks of having a cardiac catheter exam?

Cardiac catheterization is referred to as minimally invasive because access to the heart does not require large incisions. It is considered a safe method of examination: in total, only about one out of every 100 examinations results in complications. Nevertheless, it is an intervention on the heart - if complications occur, they can be severe. Therefore, if it is not an emergency, the doctor must thoroughly inform about the risks, possible consequences and alternative examination methods one day before at the latest. Thereafter, a written consent will be given.

The risks include:

• Bleeding and bruising at the injection site,
• an allergic reaction to the contrast agent (itching of the skin, swelling, shortness of breath or even circulatory shock),
• mostly transient cardiac arrhythmias,
• injury to vessels or nerves,
• an acute heart attack or stroke.