Cardiac Catheterization: Application & Health Benefits

A cardiac catheter is placed to examine the heart and coronary arteries. The catheter is used to diagnose pathologic changes in the heart valves, heart muscle, or coronary arteries.

What is a cardiac catheter?

A cardiac catheter is placed to examine the heart and coronary arteries. A cardiac catheter is a thin and flexible plastic tube. A distinction can be made between right heart catheter (small heart catheter) and left heart catheter (large catheter). An X-ray contrast medium is injected into the catheter so that the vessels and structures of the heart can be seen. The examination also carries risks. For example, cardiac arrhythmias, strokes, or injury to vessels can occur.

Forms, types, and species

Basically, there are two forms of the catheter. Left heart catheterization is used to diagnose pathologic changes in the heart valves, heart muscle, and coronary arteries of the left heart. Left heart catheterization can be used to examine the left ventricle and left atrium. The puncture site for this examination is usually in the groin. The heart is accessed via an artery. Right heart catheterization measures the heart’s pumping capacity and the pressure in the pulmonary arteries. Right heart catheterization, unlike left heart catheterization, usually does not use X-ray contrast. Access is through the veins. The puncture site is usually in the crook of the arm, in rarer cases in the groin. The right heart catheter is often performed in conjunction with a stress test. In a lying position, the patient steps on bicycle pedals. During this time, the catheter is used to measure the values. These can then be compared with the resting values. With this difference in values, a good overview of cardiac performance can be obtained.

Structure and mode of operation

The primary goal in cardiac catheterization is to guide the catheter into different parts of the heart to take pressure measurements or to visualize certain structures. First, the puncture site is locally anesthetized so that the patient does not feel any pain. If necessary, sedatives can also be administered. Anesthesia is usually not necessary. Then, using the Seldinger technique, a sheath is placed in the blood vessel. This serves as a guide and seal for the puncture site. A guide wire is then pushed through the sheath into the target area. An X-ray machine is used to check the optimal position of the wire. The catheter is then inserted along this wire. If the catheter is seated correctly, the wire is also removed. Under fluoroscopy with X-rays, the position of the cardiac catheter can be corrected if necessary. With right heart catheterization, pressure is now measured in different areas of the heart. In order to assess the heart’s action and visualize the heart’s vessels, the patient must be administered an X-ray contrast medium. If it is necessary to change the position of the catheter, a guide wire is used again. This can be easily inserted via the sheath. After the examination, the cardiac catheter, the guide wire and the sheath are removed again. The puncture site is tightly closed with a vascular closure system or a pressure dressing.

Medical and health benefits

Many examinations of the cardiovascular system are possible with cardiac catheterization. In general, X-ray contrast can be used to visualize blood flow in the heart. The pressure, oxygen level, and temperature in the vessels can also be recorded. In the case of cardiac arrhythmias and disorders of excitation conduction, catheter examination provides information about the electrical activities of the heart muscles. Right heart catheters primarily measure pressure, oxygen and temperature in the right heart. Left heart catheters allow oxygen and pressure measurement in the aorta and left ventricle of the heart. Contrast media can be used to visualize the left ventricle and coronary arteries. Many other treatments can only be performed together with a cardiac catheterization. A narrowing of the coronary vessels can lead to a heart attack. To widen the narrowed or blocked vessels again, balloon dilatation is usually performed. This involves inserting a balloon catheter into the vessels.There is a balloon at the end of the balloon catheter. In the vasoconstriction, this balloon is deployed, thereby dilating the vessel so that the blood can flow more easily again. If widening by means of a balloon catheter does not achieve the desired result, a stent can be implanted. A stent is a small tube made of metal mesh. This tube is folded and placed on a balloon catheter. The cardiac catheter with the stent is then pushed to the narrow spot in the vessel, where it is expanded. The stent remains in the affected vessel. Today, open surgery for congenital heart defects can be avoided with cardiac catheterization. Diseases such as anterior ventricular septal defects, ventricular septal defects or valve stenoses can be removed directly during the examination with the cardiac catheter. Heart valves can also be implanted using cardiac catheterization. Excitation disorders can also be treated with cardiac catheterization. In this case, disturbing tissue is sclerosed. However, cardiac catheterization is not free of risks. Postoperative bleeding around the puncture site is common. Vascular abnormalities at the puncture site are also observed. If contrast media are used during the examination, allergic reactions may occur. In addition, the contrast medium administered is harmful to the kidneys and is only recommended to a limited extent if the kidneys are impaired. In patients with hyperthyroidism, the iodine-containing contrast medium can also lead to a life-threatening thyrotoxic crisis.