What is cardiac catheterization ?
Cardiac catheterization or coronary angiography (CAG), it is by means of a catheter and contrast mapping (angiography) of the coronary arteries of the heart. In addition, pressures in the heart can be measured by means of a right-catheterization.
The heart is supplied with oxygen by surrounding capillaries heart or coronary arteries (coronary).
There are two coronary arteries (arteries coronariae) which includes the left and right side of the heart with oxygen-rich blood. The left coronary artery branches into the circumflex ramus and the anterior interventricular (also referred to as the English name left anterior descending (LAD)). In the groin, after local anesthesia using a first injection needle the left or right femoral artery (arteria femoralis) punctured. Through this an introducer needle is inserted. Through this introducer can escape no blood, but it could be what pushed inwards. It is through this system with a catheter guide wire inserted through the artery to the heart.
The catheter is a type of plastic tube with holes at the tip. The guidewire serves to control and to prevent damage to the aorta. In most cases, one will first display the right coronary artery. The cardiologist moves the catheter up to the inmonding of this artery. The guide wire is removed, so that there is now contrast agent can be injected. Through the catheter to slide on as far as the inmonding, then (almost) all of the contrast in the right artery and not immediately via the aorta to the rest of the body. Different recordings are made with X-ray radiation, each time in a different direction.
It then follows the opacified artery. When there are constrictions are present, they may properly be imaged. At the location of a stenosis is the vascular lumen of the coronary artery very small; in the event of a blockage of the vessel, the cavity does not run further.
After the burst one wants to portray the left coronary artery. The guide wire is increased through the catheter. The catheter is then taken out, so that the guide wire remains. Over the guidewire is a different catheter pushed inwards as far as the inmonding of the linkerkranslagader. The guide wire is removed and then X-rays are again made with contrast agent.
When a patient diversions, these diversions will also recordings are made with dye.
After this series, if necessary, made a recording of the left chamber (ventricle). This is now rarely needed. There is then a catheter inserted into the apex (center point), therefore, in the left ventricle. In a short time the chamber is filled with contrast agent, which is then pumped away by the pump function. In this way, one can get an impression of the pumping function of the heart. The catheter is removed and the introducer as well. The wound is squeezed and there is a pressure bandage around the leg. Alternatively, an angio seal, a kind of hypodermic cork, the femoral artery seal.
The patient has six hours of bed rest and may go home the next day. There are variations in the underlying assumptions; Nowadays there are techniques to close the artery in the groin quickly so the patient after a short time back in the leg. Most patients today are, therefore, no more a night to stay in the hospital. Nowadays it is also very common to carry out via the wrist (the arteria radialis), the investigation. The risk of post-operative bleeding is clear, therefore, smaller.
Indication for research
- unstable angina pectoris
- angina after a heart attack (myocardial infarction), PTCA or CABG
- diagnostic (exclude coronary artery disease)
- heart valve abnormality
- disease of the heart muscle
Contraindications
- infections
- fever
- too high INR
- severe renal impairment
Cardiac catheterization complications
- a bleeding at the site of the puncture site
- a false aneurysm at the site of the puncture site
- an arteriovenous shunt at the location of the puncture site
- contrast nephropathy
- a dissection of the wall of the ostium of the coronary artery probed, possibly resulting in an iatrogenic myocardial infarction, ventricular fibrillation and death
- a complete occlusion of the left main stem at the time when the catheter is placed in the mouth (ostium) of the vessel. This only occurs after a severe stenosis which sits at the very beginning of the vessel (ostiumstenose). In the case of the left main stem, this may, by acute lack of oxygen of about 70% of the heart muscle, leading to therapy resistant ventricular fibrillation, and death.