Radiocontrast in the left ventricle during cardiac catheterization (ventriculogram).

Visualization of the coronary arteries (in this case, the left coronary artery which gives the circumflex branch of left coronary artery).

Cardiac catheterization (heart cath) is the insertion of a catheter into a chamber or vessel of the heart. This is done for both investigational and interventional purposes. Coronary catheterization is a subset of this technique, involving the catheterization of the coronary arteries.

[edit] Procedure

Local anaesthetic is injected into the skin to numb the area. A small puncture is then made with a needle in either the femoral artery in the groin or the radial artery in the wrist, before a guidewire is inserted into the arterial puncture. A plastic sheath (with a stiffer plastic introducer inside it) is then threaded over the wire and pushed into the artery (Seldinger technique). The wire is then removed and the side-port of the sheath is aspirated to ensure arterial blood flows back. It is then flushed with saline.

Catheters are inserted using a long guidwire and moved towards the heart. Once in position above the aortic valve the guidewire is then removed. The catheter is then engaged with the origin of the coronary artery (either left main stem or right coronary artery) and x-ray opaque iodine-based contrast is injected to make the coronary vessels show up on the x-ray fluoroscopy image.

When the necessary procedures are complete, the catheter is removed. Firm pressure is applied to the site to prevent bleeding. This may be done by hand or with a mechanical device. Other closure techniques include an internal suture and plug. If the femoral artery was used, the patient will probably be asked to lie flat for several hours to prevent bleeding or the development of a hematoma. Cardiac interventions such as the insertion of a stent prolong both the procedure itself as well as the post-catheterization time spent in allowing the wound to clot.

A cardiac catheterization is a general term for a group of procedures that are performed using this method, such as coronary angiography, as well as left ventrical angiography. Once the catheter is in place, it can be used to perform a number of procedures including angioplasty, angiography, balloon septostomy, and an Electrophysiology study.

[edit] History

The history of cardiac catheterization dates back to Claude Bernard (1813-1878), who used it on animal models. Clinical application of cardiac catheterization begins with Werner Forssmann in the 1930s, who inserted a catheter into the vein of his own forearm, guided it fluoroscopically into his right atrium, and took an X-ray picture of it. Forssmann won the Nobel Prize in Physiology or Medicine for this achievement. During World War II, André Frédéric Cournand, a professor at Columbia University College of Physicians and Surgeons who also shared the Nobel Prize, and his colleagues developed techniques for left and right heart catheterization.

[edit] Indications for investigational use

This technique has several goals:

• confirm the presence of a suspected heart ailment
• quantify the severity of the disease and its effect on the heart
• seek out the cause of a symptom such as shortness of breath or signs of cardiac insufficiency
• make a patient assessment prior to heart surgery

[edit] Investigative techniques used with cardiac catheterization

A probe that is opaque to X-rays is inserted into the left or right chambers of the heart for the following reasons:

• to measure intracardiac and intravascular blood pressures
• to take tissue samples for biopsy
• to inject various agents for measuring blood flow in the heart; also to detect and quantify the presence of an intracardiac shunt
• to inject contrast agents in order to study the shape of the heart vessels and chambers and how they change as the heart beats

[edit] External links

• Cardiac Catheterization Video
• MedlinePlus Medical Encyclopedia: Cardiac catheterization
• eMedicine: Cardiac Catheterization (Left Heart)