Cardiac catheterizations and angiographic procedures are relatively safe, with few problems. The risk of a major complication, such as stroke, heart attack, or death, with cardiac catheterization and angiography, is one in 1,000. Fewer than one in every 10,000 persons who undergo these surgeries die, and the majority of those who die already have a significant cardiac condition or other problems. The risk of complications and mortality increases with age.
Cardiac catheterization
Cardiac catheterization is widely utilized in the diagnosis and treatment of many heart conditions. Cardiac catheterization can be performed to monitor how much blood the heart pumps out per minute (cardiac output), discover heart birth abnormalities, and detect and biopsy heart malignancies.
This is the sole means to directly monitor blood pressure in each chamber of the heart as well as the major blood arteries leading from the heart to the lungs.
A thin catheter (a tiny, flexible, hollow plastic tube) is introduced into an artery or vein in the neck, arm, or groin/upper thigh by a needle puncture during cardiac catheterization. The insertion location is numbed using a local anesthetic. The catheter is subsequently passed into the main blood channels and into the heart chambers and/or coronary arteries. The surgery is performed in a hospital and takes between 40 and 60 minutes.
Various tiny tools can be sent through the tube to the catheter's tip. They include instruments for measuring blood pressure in each heart chamber and in blood vessels connected to the heart, viewing or taking ultrasound images of the interior of blood vessels, taking blood samples from various parts of the heart, and removing a tissue sample from inside the heart for examination under a microscope (biopsy). The following are examples of common catheter procedures:
- Coronary angiography: Using a catheter, the coronary arteries—the blood vessels that supply the heart—are injected with a radiopaque contrast agent that makes them visible on x-rays.
- Ventriculography: This procedure involves inserting a catheter-based radiopaque contrast agent into one or more heart chambers to enable x-ray visualization.
- Percutaneous coronary intervention (PCI): A catheter with a balloon connected to the tip is inserted into a coronary artery that has been constricted, and the balloon is inflated to widen the passageway. In order to keep the artery open, doctors frequently use the catheter to place a wire mesh tube (a stent) into the vessel.
- Valvuloplasty: A constricted heart valve opening is widened using a catheter during valvuloplasty.
- Heart valve replacement: Using a catheter, a heart valve can be changed without the need for surgery or removal of the old valve.
Ventriculography: In ventricular angiography, a radiopaque contrast agent is injected into the left or right ventricle of the heart via a catheter while x-rays are being obtained. During cardiac catheterization, it is carried out. With this treatment, medical professionals may see the motion of the left or right ventricle and assess the heart's capacity to pump blood. Doctors can determine the ejection fraction by calculating the heart's capacity to pump blood (the percentage of blood pumped out by the left ventricle with each heartbeat). Determining how well the heart pumps aids in estimating the extent of cardiac damage.
When a catheter is inserted into an artery, the puncture site needs to be continuously squeezed for 10 to 20 minutes following the removal of all the tools. Blood loss and bruise development are stopped by compression. However, bleeding can occasionally happen at the puncture site, creating a noticeable bruise that often goes away on its own but might last for weeks.
Electrocardiography is used to monitor the heart since putting a catheter into the heart may result in aberrant cardiac rhythms (ECG). Most of the time, physicians can restore a normal rhythm by repositioning the catheter. The catheter is withdrawn if this procedure is ineffective. Very infrequently, when a catheter is implanted, the heart wall may be damaged or pierced, necessitating emergency surgical repair.
On either the right or left side of the heart, cardiac catheterization can be performed.
The right side of the heart is catheterized to assess the volume of blood the heart is pumping, learn more about the right atrium and right ventricle, and the tricuspid valve, which is situated between these two chambers. The right ventricle pumps blood into the lungs, where it picks up oxygen and lets go of carbon dioxide. The right atrium gets blood low in oxygen from the body's veins. The catheter is placed during this surgery into a vein, often in the neck, arm, or groin. When the right side of the heart is catheterized during certain major operations and in intensive care units, pulmonary artery catheterization—in which a balloon at the catheter's tip is passed through the right atrium and ventricle and lodged in the pulmonary artery (which connects the right ventricle to the lungs)—might be performed. An improper connection between the right and left sides of the heart can be found and measured by right-side catheterization. In addition, right-side catheterization is used by medical professionals to diagnose and treat heart failure and pulmonary hypertension, as well as to place a mechanical device to assist in blood pumping.
The mitral valve, which is situated between the left atrium and left ventricle, the aortic valve, and the left atrium and left ventricle of the heart are all studied during catheterization of the left side of the heart (located between the left ventricle and the aorta). The left ventricle circulates the blood to the body after the left atrium gets oxygen-rich blood from the lungs. This treatment is typically paired with coronary angiography to learn more about the coronary arteries.
In order to catheterize the left side of the heart, a catheter must first be put into an artery, often in the arm or groin, and then carried from that artery into the aorta, which is the major artery that delivers blood out from the heart.
Coronary angiography
During an angiogram, a radiopaque contrast agent—a liquid that can be seen on x-rays—is injected into a blood artery, and x-rays are then collected to provide fine-grained pictures of the blood vessel. Coronary angiography offers details on the coronary arteries, which deliver oxygen-rich blood to the heart. Because the coronary arteries branch from the aorta shortly after they exit the left side of the heart, coronary angiography is performed during cardiac catheterization of the left side of the heart. Almost usually, the two operations are carried out simultaneously.
A doctor makes an incision in the arm, neck, or groin, administers a local anesthetic, and then inserts a thin catheter into an artery. The catheter is inserted into the coronary arteries before being threaded toward the heart. Fluoroscopy, a continuous x-ray technique, is used by the physician to monitor the catheter's advancement during insertion.
A radiopaque contrast agent is injected into the coronary arteries through the catheter after the catheter tip is in position. A video screen displays the contour of the coronary arteries while it is being recorded.
These pictures are used by doctors to look for blockages (coronary artery disease) or coronary artery spasms. Images can be used to assess if coronary artery bypass surgery is necessary to flow blood through the region of blockage or whether angioplasty, which involves opening the blockage with a tiny balloon placed by catheters and stent insertion, which uses small, expandable hollow mesh tubes to keep the coronary artery open, are necessary.
Coronary artery catheters with tiny ultrasound transducers attached can create pictures of the walls of the coronary vessels and display blood flow. Intravascular ultrasonography, often known as IVUS, is increasingly utilized in conjunction with coronary angiography. The amount of pressure change before and after a coronary artery constriction may be measured using tiny pressure sensors on the catheter's tip. The degree of blood artery constriction is assessed using a method known as fractional flow reserve, or FFR.
Coronary angiography typically takes 30 to 50 minutes and is rarely painful. The patient can go home shortly after the surgery, barring extreme illness. The patient is often hospitalized overnight in the hospital after having a stent implanted.
The user has a brief sensation of warmth throughout their body as the radiopaque contrast agent circulates through the circulation after being injected into the aorta or heart chambers. Blood pressure may drop a little bit while the heart rate may rise. Rarely, the contrast agent might make the heart temporarily slow or stop. To assist remedy such issues, which are rarely significant, the patient could be instructed to cough a lot while the treatment is being performed. Mild side effects including nausea, vomiting, and coughing are quite rare.
Serious side effects include shock, convulsions, renal issues, and the abrupt heart stopping (cardiac arrest) are extremely uncommon. Aside from allergic responses, radiopaque contrast chemicals can also cause renal injury. The contrast agent can cause allergic responses ranging from skin rashes to uncommon but potentially fatal anaphylaxis. The team doing the operation is equipped to handle any acute problems from coronary angiography. Damage to the kidneys nearly typically resolves on its own. When a patient already has decreased kidney function, clinicians are hesitant to do an angiography.
Although relatively modest, the risk of problems is increased in older adults. When angioplasty or coronary artery bypass operations are being considered, coronary angiography is necessary.