Cardiac Catheterisation in Delhi, India

Cardiac catheterisation is a standard procedure to diagnose or treat various heart ailments. For instance, arrhythmias, chest pain, or heart valve problems can be diagnosed and treated by this procedure. Cardiac catheterisation may be carried out during the diagnosis or treatment of:

• Coronary artery disease
• Congenital heart disease
• Heart failure
• Heart valve disease
• Microvascular heart disease

Cardiac catheterisation enables a doctor to:

• Locating blockages or narrowing in the blood vessels causing chest pain 
• Measuring the pressure and oxygen levels in different parts of the heart, called hemodynamic assessment
• Right or left ventriculogram
• Biopsy for certain disease evaluations and post-heart transplant
• Diagnosing congenital heart defects and heart valve disease
• Examine the blood vessels for blood clots
  
  

Cardiac catheterisation is done at the same time as other heart procedures, like:

• Opening a blocked or narrowed artery with or without stent placement, a procedure called angioplasty
• Treatment of irregular heart rhythms with cold or heat energy, a procedure called cardiac ablation
• Opening narrowed heart valves, called balloon valvuloplasty
• Closing holes and repairing other congenital heart defects
• Repairing or replacing heart valves, a procedure called heart valve surgery

The doctor first evaluates the overall health, records a medical history, and performs a physical examination. Then, they may advise undergoing some tests to confirm that the procedure is safe. 

• Angiogram: This test is an invasive diagnostic test that gives clear x-ray images of the blood vessels of the heart.
• CT or MR angiography can be additionally ordered.

Other tests: Routine blood tests like CBC (complete blood count), kidney function test, urine analysis, haemoglobin, and platelets count are also advised.

Cardiac catheterisation is helpful for diagnostic and therapeutic purposes. Some indications include the following:

• Evaluating and treating coronary artery disease, cardiac arrhythmias
• Assessment of grafts of coronary artery bypass 
• Evaluation and treatment in patients with chest pain of uncertain origin when non-invasive tests are not diagnostic or suggest artery blockage
• To assess the severity of valvular or myocardial disorders. For instance, aortic stenosis, aortic insufficiency, mitral stenosis, mitral insufficiency, and cardiomyopathies. 
• To determine the requirement for surgical correction when there is a discrepancy between signs and symptoms and echocardiographic findings.
• To percutaneously close the congenital cardiac defects, like atrial septal defect (ASD), patent ductus arteriosus (PDA), and ventricular septal defect (VSD)
• To treat valvular heart diseases such as valvuloplasty or percutaneous transcatheter valve replacement.

There are no absolute contraindications of cardiac catheterisation. However, it cannot be done when the patient refuses treatment.

The relative contraindications are:

• Severe uncontrolled hypertension
• Renal dysfunction
• Untreated active infection/Sepsis
• Encephalopathy
• Acute cerebrovascular accidents
• Active bleeding
• Unstable arrhythmias
• Significant peripheral vascular disease
• Allergy to radiographic contrast
• Acute pulmonary oedema (patient unable to lie flat)
• Severe coagulopathy

Some pre-operative preparation recommended by doctors include:

• At least six hours before the procedure, avoid eating or drinking: Food and fluids can cause complications from anaesthesia. If diabetic, the doctor will instruct about taking insulin and other medicines. One can eat or drink after the procedure.
• Inform the doctor about regular medicines: The doctor may recommend stopping blood thinning and NSAID medications since they may interfere with the procedure. Certain dyes may react with diabetes medicines such as metformin.
• Take all the medications and supplements to the test.
• Allergies: Inform the doctor about any allergies, especially:
  • IVP Dye/Contrast Agent Allergy, Iodine Allergy
  • Latex/Rubber Products Allergy

Cardiac catheterisation requires special X-ray and imaging machines. The procedure is done in the cardiac catheterisation lab. A specialist inserts an IV into the forearm or hand for any injections required and administers a sedative. The patient may be fully awake, lightly sedated, or fully asleep Local anaesthesia is administered with a small needle. Once the anaesthesia takes effect, one or more catheters are inserted through a blood vessel in the wrist, groin, or neck, based on the reason for the procedure. Then, the catheter is guided to the heart. The doctor then performs the required surgery, for instance, angioplasty, cardiac ablation, closing holes present in the heart, repairing other congenital heart defects, heart valve surgery, and balloon valvuloplasty. Cardiac catheterisation is also performed for diagnostic purposes.

As with most procedures related to the heart and blood vessels, cardiac catheterisation carries some risks. However, major complications are rare.

Possible risks of cardiac catheterisation include:

• Bleeding
• Allergy to the contrast dye or medication
• Bruising
• Infection
• Irregular heart rhythms (arrhythmias)
• Damage at the site of catheter insertion or to the artery or heart
• Heart attack
• Blood clots
• Kidney damage
• Stroke
• Congestive heart failure

Post-operatively, the patient stays in the recovery room, where their vital signs are continuously monitored.

Once the vital signs are normal and no signs of any risk are evident, the patient is moved to the ICU or normal ward. After removing the catheter, a technician or nurse applies pressure to the insertion sites. For example, if the catheter was placed in the groin area, one must lie flat to prevent excessive bleeding. This permits the healing of the artery.

The number of days one has to stay at the hospital depends on the overall health of the patient and the motive for the catheterisation. The site of catheter insertion may feel sore for a few days. Inform the doctor in case of bleeding or new or increased swelling, or pain at or near the access site.

Reviewed by Dr. Anupam Goel, Director - Interventional Cardiology, Cardiac Sciences, Cardiology on 02-Dec-2022.