Purpose of Cardiac Catheterization
Cardiac catheterization can be used for the diagnosis and treatment of cardiovascular disease. Diagnostic cardiac catheterization can be utilized to assess the presence and severity of cardiac disease and may help in diagnosis in those patients who present with inconclusive results with noninvasive testing. IV radiopaque contrast dye can be administered just prior to the procedure in order to visualize the coronary vessels and can help determine the severity of coronary artery disease (CAD). During a right heart catheterization, vascular resistance is measured by attaining pressures in the heart, blood oxygen saturations, and the degree of tricuspid/pulmonic stenosis. This can indicate the presence and severity of pulmonary hypertension. During a left heart catheterization, mitral and aortic valvular functions are assessed by measuring the left ventricular pressure, left ventricular function, vascular resistance, and coronary arterial anatomy.
Therapeutic cardiac catheterization, such as percutaneous coronary intervention (PCI) can be used in patients with occluded arteries or blood vessels. Vascular access is obtained percutaneously via the femoral, brachial, or radial vessels. A guidewire is positioned past the stenosis through the lumen and a small angioplasty balloon catheter is advanced over the guidewire. The balloon catheter is then positioned into the artery across the stenotic area and inflated. This inflation expands the stenotic area, thus restoring blood flow. The balloon is then deflated, withdrawn, and exchanged for a stent, which remains in place.
According to the practice guidelines of the American Heart Association (AHA), the American College of Cardiology Foundation (ACCF), and the Society of Cardiovascular Angiography and Interventions (SCAI), PCI is indicated for patients with any of the following cardiac conditions: acute myocardial infarction; stable angina pectoris unrelieved by medical therapy, unstable angina, or angina pectoris following a coronary artery bypass graft (CABG); symptomatic restenosis after previous PCI; and unsuitable or high-risk coronary anatomy that could result in death. PCI is contraindicated in the following patients: those with bleeding disorders, multiple PCI restenosis, noncompliance with pre- and post-PCI instructions, and inability to tolerate dual antiplatelet therapy following the procedure.
Other types of therapeutic cardiac catheterization include those for the treatment of congenital heart defects and for regaining lost hemodialysis access. The use of cardiac catheterization in patients with congenital heart defects may allow for the avoidance of surgery, thus reducing recovery time and duration of hospitalization. Cardiac catheterization can also be used for patients with thrombosed hemodialysis access. The use of this approach can prevent the use of temporary hemodialysis catheters, thus allowing for the preservation of venous segments for future access creation.