Cardiac Catheterization
What is a cardiac catheterization?Cardiac catheterization is a specialized procedure in which a
long, flexible tube (catheter) is inserted into a vein and guided into the
heart, allowing a close look at the structures inside. It may also be
performed for the following reasons:
- to obtain cardiac tissue samples for biopsy
- to open the atrial septum in congenital (present at birth) heart
problems that cause a child to become cyanotic (blue color of the skin,
lips, and nailbeds due to an insufficient supply of oxygen in the blood)
- to place mesh devices that close small holes inside the heart (such
as with atrial septal defect or ventricular septal defect), or
intentionally block blood flow in a blood vessel (such as with patent
ductus arteriosus or pulmonary collateral vessels)
- to place wire devices, called stents, in narrowed arteries to keep
them open
Cardiac catheterization can be performed on children of any age - even
newborns immediately after birth.
How is a cardiac catheterization performed?
The procedure is performed in the hospital by a specially trained
cardiologist. Your child's physician will discuss the risks and benefits
of the procedure with you and will then obtain written permission
(informed consent) from you in order to perform the procedure.
Your child is given a sedative to help him/her relax and possibly even
sleep during the procedure. Once in the "cath lab," he/she
will lie on a small table with a c-shaped x-ray machine surrounding
it. Heart monitors and other equipment are nearby. A specially trained
staff of nurses, technicians, and physicians will monitor your child
and make sure he/she is comfortable during the procedure.
An injection of local anesthetic will be given under the skin where the
catheter is going to be inserted. Next, a thin, flexible tube (catheter)
is inserted into a blood vessel, most often in the groin area (the crease
of the leg where it bends when sitting). The catheter is guided up the
vein towards the heart. The cardiologist uses x-rays, called fluoroscopy,
to help visualize the movement of the catheter. The catheter enters the
right atrium - the top right-hand chamber that receives oxygen-poor (blue)
blood from the body. Eventually, the tube will be guided into the right
ventricle, the pulmonary artery, and perhaps the right and/or left
pulmonary artery branches.
While inside the heart, several things are done to help evaluate the
heart structures, as well as the pattern of blood flow inside the heart,
including the following:
- Blood samples are drawn from each chamber and each blood vessel, and
the oxygen content is measured.
- Blood pressure measurements are made inside each chamber and each
blood vessel.
- Contrast dye is injected into the catheter and, as it flows inside
the heart, x-ray films are made of the path the dye takes throughout the
heart.
X-ray films are made as the catheterization proceeds, enabling your
child's cardiologist to review the data after the procedure. If surgery is
planned, the heart surgeon may also review the data.
What happens after the test?
When the catheterization is complete, the catheter(s) will be withdrawn
from the heart and the blood vessels. Several gauze pads and a large piece
of medical tape will be placed on the site where the catheter was inserted
to prevent bleeding. In some cases, a small, flat weight or sandbag may be
used to help keep pressure on the catheterization site and decrease the
chance of bleeding. If blood vessels in the leg were used, your child will
be told to keep the leg straight for a few hours after the procedure to
minimize the chance of bleeding at the catheterization site.
Your child will be taken to a unit in the hospital where he/she will be
monitored by nursing staff for several hours after the test. The length of
time it takes for your child to wake up after the procedure will depend on
the type of medicine given to your child for relaxation prior to the test,
and also on your child's reaction to the medication.
After the test, your child's nurse will monitor the pulses and skin
temperature in the leg or arm that was used for the procedure.
Your child may be able to go home after a specified period of time,
providing he/she does not need further treatment or monitoring. You will
receive written instructions regarding care of the catheterization site,
bathing, activity restrictions, and any new medications your child may
need to take at home.
Depending on the results of the cardiac catheterization test,
additional tests or procedures may be scheduled to gather further
diagnostic information
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