Cardiac catheterization involves inserting thin plastic tubes called catheters into arteries and veins in the heart to take X-ray images and measure pressures. It can be used for diagnostic or therapeutic purposes to evaluate conditions like coronary artery disease. The history of the procedure began in the 1920s and it has evolved with developments like balloon angioplasty. It involves accessing the arteries or veins to pass catheters into the heart chambers and coronary arteries to visualize structures and take measurements. Potential complications include infection, bleeding, reaction to contrast dye, and damage to blood vessels or heart. The procedure ends with removing the catheters and closing the arterial access point.

1. CARDIAC CATHETERIZATION
OIH
28/02/2022

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WHAT IS A CARDIAC CATHETERIZATION
Cardiac Catheterization is the insertion and passage of small plastic
tubes ( catheters ) into the arteries & veins up to the heart to obtain X-
ray pictures of coronary arteries and cardiac chambers as well as to
measure pressures in the heart ( intra-cardiac hemodynamics ).
A diagnostic cardiac catheterization procedure is made up of a left heart
catheterization (LHC), a right heart catheterization (RHC), or both.
.

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HISTORY AND EVOLUTION
This amazing history started with Dr Wenner Frossman
in 1929, passed a ureteral catheter into his left antecubital
vein under local anesthesia, and with fluoroscopic
guidance advanced until the right atrium.

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HISTORY AND EVOLUTION
 1941 – Right Heart Catheterization in Humans to
study cardiac physiology
 1950 – First retrograde left heart catheterization,
by Zimerman & co-workers and late the selective
coronary angiography

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HISTORY AND EVOLUTION
 1960s(Late) – Development of aorto-pulmonary bypass surgery
 1970 – Balloon tipped flow directed catheters introduced by Swan & Ganz
 1977 – Percutaneous transluminal balloon angioplasty, by Gruntzig
 In the 1980s , the scope of interventional Cardiology increased with the
introduction of new therapeutic modalities( Valvuloplasty,Stent etc. )

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RIGHT HEART CATHETERIZATION
In Right Heart Catheterization , the right heart and pulmonary system are accessed
via the body’s venous system, usually through the femoral vein.
This procedure serve to pressure measurements,
but cardiac and pulmonary structures can also
be visualized by using angiography.

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LEFT HEART CATHETERIZATION
Left Heart Catheterization is accomplished by
accessing the arterial system and navigating
in a retrograde fashion to the heart.
Is used to visualize the coronary arteries and
the pumping action of the left ventricle (LV).

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INDICATIONS FOR PROCEDURE
Cardiac catheterization can be either a diagnostic or a therapeutic procedure. The
procedure is done in the evaluation and the treatment of the following conditions.
 Coronary artery disease
 Measuring the hemodynamics in the right and left side of the heart
 Evaluate the left ventricular function
 Evaluation and treatment of cardiac arrhythmias
 Evaluation and treatment of valvular heart disease

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INDICATIONS FOR PROCEDURE
 Assessment pericardial and myocardial diseases
 Assessment of the congenital heart diseases
 Evaluation of heart failure

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INDICATIONS
 Shock
 Sudden cardiovascular arrest
 Positive exercice tolerance test
 Aortic dissection
 Aortic aneurysm
 Pericardial constriction or tamponade
 Initial and follow-up assessment for heart transplantation

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CONTRAINDICATIONS
By definition, a contraindication means that a procedure should not be performed.
Absolute Contraindications
 Inadequate equipment or catheterization facility
 Patient refusal
Relative Contraindications
 Uncontrolled hypertension
 Severe anemia
 Ventricular fibrillations

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CONTRAINDICATIONS
 Acute stroke
 GI bleeds
 Allergy to contrast
 Renal failure
 Uncompensated congestive failure
 Active infection or febrile illness
 Electrolyte abnormalities
 Severe coagulopathy

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PERSONNEL
A cardiac catheterization procedure is usually performed in a cardiac
catheterization laboratory with the help of fluoroscopy to guide and
position the catheters in the appropriate position.
Along with the experienced operator, support from registered nurses
and radiologic technologists is needed for safely performing the
procedure.
Most of the procedures can be performed with minimal or moderate
sedation with the help of a local anaesthetic,.

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PREPARATION
 Preparation for the cardiac catheterization procedure starts with a thorough history of the
patient along with a detailed examination.
 After defining the clinical question, the performing interventional cardiologist will decide
on the access for the procedure. These procedures may need either arterial or venous
access or both.
 Physical examination should specifically focus on assessing the suitability of the patient for
the planned procedure.
 Special attention has to be paid to reviewing drug allergies of the patient and routine lab
work.

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PREPARATION
 Basic workup includes a complete blood count (CBC), basic metabolic panel (BMP),
prothrombin time, electrocardiogram, and chest X-ray.
 Patients with documented allergy to radio-iodinated contrast material will need
premedication with corticosteroids and antihistamines.
 Patients with chronic kidney disease will also need adequate planning and pre-
hydration to reduce the risk of worsening renal function.

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PROCEDURE – ARTERIAL ACESS
The choice of vascular access is dependent on the patient’s anatomy
In our days , puncture is generally done via right radial artery
Alternative sites ( vascular anomalies or medical reasons ) include femoral and brachial
arteries

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ARTERY PUNCTURE

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ARTERY PUNCTURE

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INSERTING CATHETER
 The catheter is then inserted over the guidewire
but through the sheet and advanced into
placement via the inferior vena cava to the aorta
 Movement of catheter is monitored under
fluoroscopy (x-ray movies) with the cardiologist
manipulating its movements
 When catheter is in place , wire can be removed
and contrast administered (ANGIOGRAPHY)

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CORONARY ANGIOGRAPHY
• Coronary angiography remains the gold standard for detecting clinically
significant atherosclerotic coronary artery disease
• To visualize coronary arteries, branches, collaterals and anomalies
• Precise localization relative to major and minor side branches, thrombi and areas
of calcification
• To visualize vessel bifurcations, origin of side branches and specific lesion
characteristics (length, eccentricity, calcium etc)

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CORONARY ANGIOGRAPHY
Left coronary artery
shown with contrast

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CORONARY ANGIOGRAPHY

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CORONARY ANGIOGRAFY

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COMPLICATIONS
Many factors contribute to complications, including procedural length, contrast dose,
equipment available, radiation exposure, extent of cardiovascular disease, and
comorbidities
 Cardiac arrest
 Cerebrovascular accident
 Myocardial infarction
 Respiratory arrest
 Ventricular tachycardia, fibrillation , or serious arrythmia
 Death

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OTHER COMPLICATIONS
 A hole going through your blood vessel (perforation)
 Air embolism (when air gets into your blood vessel)
 Allergic reaction to dye
 Bleeding
 Blood clots
 Infection
 Kidney damage from the dye

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FINISHED PROCEDURE
The procedure is complete when the cardiologist has seen all the view
and anatomy desired and all pressures recorded
The catheter can be removed and could be used two ways to closed the
artery:
Manual pressure must be applied at entry site for for 15 minutes or a
closure device applied ( Angio seal for femoral and Triband for radial )
The experience say that for radial we will used Triband and for femoral ,
manual pressure

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ARTERIAL CLOSURE
Applying Trband Manual pressure

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• After the recovery room, the patient should be transferred to his room.
• The length of the patient’s stay will be dependent on their condition.
• Some patients who have had a straightforward procedure may even be
discharged on the same day, whereas others who have had an additional
procedure such as an angioplasty or insertion of a stent will be required
to stay overnight.
Conclusion

29. THANK YOU
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‫شكرا‬
29
ISABEL PAULO