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Cardiac catheterization

Last updated: December 18, 2020

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Cardiac catheterization is a procedure used in the diagnosis and treatment of cardiovascular conditions. It involves the insertion of a catheter into a cardiac vessel (coronary catheterization) or chamber by way of a suitable vascular access (usually a femoral or radial artery). Once in position, a cardiac catheter can help evaluate the blood supply to the cardiac musculature (angiography) or open up narrowed or blocked segments of a coronary artery by means of a coronary angioplasty with stenting (percutaneous coronary intervention, or PCI). Additionally, it can be used to perform a cardiac tissue biopsy, open narrowed heart valves via valvuloplasty, examine electrophysiological pathways, or measure pressure and oxygen levels in different chambers (hemodynamic assessment). The procedure is associated with a low rate of complications, with the most common among these being bruising and bleeding at the site of access. Rarer, more severe complications include arrhythmias, cardiac arrest, embolization of existing plaques, and infection.

General

Coronary angiography/ventriculography

Coronary angiography is not a screening method for coronary heart disease in asymptomatic patients!

Percutaneous coronary intervention (PCI)/percutaneous transluminal coronary angioplasty (PTCA)

  • Description: : A therapeutic procedure carried out during cardiac catheterization; in which a blocked coronary vessel is opened and appropriate blood flow is restored. A balloon catheter is used to dilate the narrowed section, with/without the placement of a stent to keep it patent.
  • Indications
  • Procedure: a catheter is inserted through the access site → a deflated balloon catheter is advanced into the obstructed artery → balloon is inflated at the obstructed/narrowed section → the narrowing is relieved → stent may/may not be deployed to keep the blood vessel open
  • Types of stents
    • Bare metal stent (BMS): bare-surfaced, metallic stent that provides a mechanical framework to keep the artery open.
    • Drug-eluting stent (DES): stents that are coated with antiproliferative substances (immunosuppressant drugs, cytostatic drugs) that prevent excessive intimal hyperplasia

Electrophysiological study

  • Description: testing of the electrical conduction system of the heart to assess electrical activity and conduction pathways via a cardiac catheter
  • Indications
    • Diagnostic: to evaluate various, repeat refractory cardiac arrhythmias
    • Therapeutic
      • Radioablation of areas of accessory pathways (areas that generate and conduct the arrhythmias)
      • Placement of intracardiac pacemakers or defibrillators

Right heart catheterization

References:[1][1][2][3][4]

References:[2][5]

We list the most important contraindications. The selection is not exhaustive.

Periprocedural complications

Complications at the site of vascular access

Complications at the cardiac level

Other complications

Delayed complications

  • Most common complication: restenosis
  • Stent thrombosis (0.5–5%)
  • Vascular complications
  • Infection (localized or generalized bacteremia)

We list the most important complications. The selection is not exhaustive.

Coronary artery bypass graft (CABG)/aortocoronary bypass (ACB)

  1. What is Cardiac Catheterization: Indications and Contraindications. https://heart-cardiovascular-health.knoji.com/what-is-cardiac-catheterization-indications-and-contraindications/. Updated: February 18, 2017. Accessed: February 18, 2017.
  2. Olade RB, Safi A, Badero OJ. Cardiac Catheterization of Left Heart. Cardiac Catheterization of Left Heart. New York, NY: WebMD. http://emedicine.medscape.com/article/1819224-overview#a1. Updated: April 13, 2016. Accessed: February 18, 2017.
  3. Kent KC, Moscucci M, Mansour KA. Retroperitoneal hematoma after cardiac catheterization: prevalence, risk factors, and optimal management. J Vasc Surg. 1994; 20 (6): p.905-910.
  4. Chan YC, Morales JP, Reidy JF, Taylor PR. Management of Spontaneous and Iatrogenic Retroperitoneal Haemorrhage: Conservative Management, Endovascular Intervention or Open Surgery?. Int J Clin Pract. 2008; 62 (10): p.1604-1613. doi: 10.1111/j.1742-1241.2007.01494.x . | Open in Read by QxMD
  5. Webber GW, Jang J, Gustavson S, Olin JW. Contemporary management of postcatheterization pseudoaneurysms. Circulation. 2007; 115 (20): p.2666-2674. doi: 10.1161/CIRCULATIONAHA.106.681973 . | Open in Read by QxMD
  6. Kronzon I, Saric M. Cholesterol Embolization Syndrome. Circulation. 2010; 122 (6): p.631-641. doi: 10.1161/circulationaha.109.886465 . | Open in Read by QxMD
  7. Kasper DL, Fauci AS, Hauser SL, Longo DL, Lameson JL, Loscalzo J. Harrison's Principles of Internal Medicine. McGraw-Hill Education ; 2015
  8. Cardiac Catheterization and Coronary Angiogram. http://www.cpmc.org/services/heart/programs/cardiaccath.html. Updated: February 18, 2017. Accessed: February 18, 2017.
  9. Cutlip D, Levin T, Aroesty JM. Revascularization in patients with stable coronary artery disease: Coronary artery bypass graft surgery versus percutaneous coronary intervention. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/revascularization-in-patients-with-stable-coronary-artery-disease-coronary-artery-bypass-graft-surgery-versus-percutaneous-coronary-intervention?source=search_result&search=pci%20vs%20cabg&selectedTitle=1~150.Last updated: December 22, 2016. Accessed: February 18, 2017.