Type of Surgery
Information
Last updated: 11/24/2009
Cardiac anatomy
The heart consists of four chambers separated by valves. The right side of the heart, which consists of the right atrium (upper chamber; sometimes called the right auricle) and the right ventricle (lower chamber), pumps...
blood to the lungs. The left side of the heart, which consists of the left atrium and the left ventricle, simultaneously pumps blood to the rest of the body. The right and left coronary arteries, which are the first vessels to branch off from the aorta, supply blood to the heart. The left anterior descending coronary artery supplies the front of the heart; the left circumflex coronary artery wraps around and supplies the left side and the back of the heart; and the right coronary artery supplies the back of the heart. There is, however, a considerable amount of variation in the anatomy of the coronary arteries.
Catheterization procedure
The patient lies face up on a table during the catheterization procedure, and is connected to a cardiac monitor. The insertion site is numbed with a local anesthetic, and access to the vein or artery is obtained using a needle. A sheath, a rigid plastic tube that facilitates insertion of catheters and infusion of drugs, is placed in the puncture site. Under fluoroscopic guidance, a guide-wire (a thin wire that guides the catheter insertion) is threaded through a brachial or femoral artery to the heart. The catheter, a flexible or preshaped tube approximately 32–43 in (80–110 cm) long, is then inserted over the wire and threaded to the arterial side of the heart. The patient may experience pressure as the catheter is threaded into the heart. The contrast agent, or dye, used for imaging is then injected so that the physician can view the heart and surrounding vessels. The patient may experience a hot, flushed feeling or slight nausea following injection of the contrast medium. Depending on the type of catheterization (left or right heart) and the area being imaged, different catheters with various shapes and ends are used.
The radiographic/fluoroscopic system has an x-ray subsystem and video system with viewing monitors that allow the physician to observe the procedure in real time using fluoroscopy as well as taking still x rays for documentation purposes. Most newer systems use a digital angiography system that allows images to be recorded, manipulated, and stored digitally on a computer.
The procedure usually lasts about two or three hours. If further intervention is necessary, an angioplasty, stent implantation, or other procedure can be performed. At the end of the catheterization, the catheter and sheath are removed, and the puncture site is closed using a sealing device or manual compression to stop the bleeding. One commonly used sealing device is called Perclose, which allows the doctor to sew up the hole in the groin. Other devices use collagen seals to close the hole in the femoral artery.
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This animation shows what angioplasty and stent deployment look like if you could see inside of the blood vessels, up close. There is no narration, but the "balloon" being opened is the angioplasty procedure while the "chicken-wire" cylinder is the stent.
During cardiac catherization, a catheter is fed into the femoral artery of the upper leg (A). The catheter is fed up to coronary arteries to an area of blockage (B). A dye is released, allowing visualization of the blockage (C). (Illustration by GGS Inc.)
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Other Information
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.
A small puncture is made in a vessel in the groin, the inner bend of the elbow, or neck area (the femoral vessels or the carotid/jugular vessels), then a guidewire is inserted into the incision and threaded through the vessel into the area of the heart that requires treatment, visualized by fluoroscopy or echocardiogram, and a catheter is then threaded over the guidewire. If X-ray fluoroscopy is used, a radiocontrast agent will be administered to the patient during the procedure. 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. 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, and balloon septostomy.
Other Information
In 2005, an estimated 6,989,000 inpatient cardiovascular operations and procedures were performed in the United States; 4.1 million were performed on males and 2.9 million were performed on females.
From: American Heart Association
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