Cardiac catheterization

Cardiac catheterization involves insertion of catheters into the heart through cannulae in a peripheral artery or vein. The most common access sites are the right femoral artery and vein. The brachial artery cut-down technique is now rarely used due to its complexity and potentially far higher complication rates. The radial artery approach is the safest but is associated with an important learning curve. It is nonetheless, the preferred technique for a rapidly expanding group of cardiologists. Left heart catheterization is used to diagnose or evaluate coronary artery disease and aortic valve disease. Left ventriculography, selective coronary angiography and measurement of pressure in the left ventricle (LV) are routinely performed. Aortography is performed in those with aortic regurgitation or aortic root dilatation. Left ventriculography allows visual assessment of LV size and function as well as measurement of LV end-diastolic pressure and systolic pressure gradient across the aortic valve. Coronary angiography provides information on coronary anatomy. Right heart catheterization allows measurement of haemodynamic data and oxygen saturations from the right heart chambers and pulmonary circulation. It provides information on right ventricular function, pulmonary artery pressure, right-sided and left-sided filling pressures, cardiac output and left-to-right shunts. Patients with mitral valve disease, heart failure, pericardial constriction, suspected intracardiac shunts or those being assessed for cardiac transplantation usually undergo right and left cardiac catheterization. Some of the haemodynamic data obtained rely on several assumptions, and so must be interpreted together with information from other sources and assessment of the patient’s clinical condition.