From the Guidelines
Cardiac catheterization is a crucial diagnostic and therapeutic procedure for congenital heart disease, providing detailed information about structural abnormalities and enabling minimally invasive treatments that can improve patient outcomes and quality of life. It is an invasive procedure where thin, flexible tubes (catheters) are inserted into blood vessels and guided to the heart to evaluate heart function and anatomy. During the procedure, physicians can measure pressures in different heart chambers, oxygen levels in the blood, cardiac output, and visualize the heart's structures through angiography (injecting contrast dye) 1.
Indications for Cardiac Catheterization
The procedure is necessary for congenital heart disease because it provides detailed information about structural abnormalities that cannot be obtained through non-invasive methods alone. Some indications for cardiac catheterization include:
- High-flow or low-flow physiology associated with semilunar valve stenosis
- Calculation of pressures and resistances
- Physiological or anatomic simulation to allow additional calculation or anatomic visualization
- When diagnosis, prognosis, or management require a more precise definition of anatomy than is achievable via advanced noninvasive imaging 1.
Diagnostic and Therapeutic Purposes
For patients with congenital heart defects, cardiac catheterization serves both diagnostic and therapeutic purposes - allowing doctors to precisely identify the nature and severity of defects while also enabling interventional procedures such as closing holes between heart chambers, opening narrowed valves, or placing stents in narrowed vessels 1. The procedure typically takes 1-3 hours under sedation or general anesthesia, with patients usually able to go home the same day for diagnostic procedures or after overnight observation for interventional cases.
Limitations and Noninvasive Alternatives
Although cardiac catheterization has its limitations, advances in noninvasive imaging have allowed it to become increasingly a catheter-based therapeutic option rather than a diagnostic tool 1. Two-dimensional echocardiography and 3-dimensional imaging by echocardiography, magnetic resonance imaging (MRI), and computed tomography (CT) in many cases has replaced the need for cardiac catheterization. However, cardiac catheterization remains essential for hemodynamic assessments and as a platform for minimally invasive treatments that can sometimes replace open-heart surgery 1.
From the Research
Definition and Purpose of Cardiac Catheterization
- Cardiac catheterization is a medical procedure used to diagnose and treat certain heart conditions, including congenital heart disease 2, 3, 4.
- It involves inserting a catheter (a thin, flexible tube) into an artery or vein in the leg or arm and guiding it to the heart to perform various tests and procedures.
Importance of Cardiac Catheterization in Congenital Heart Disease
- Cardiac catheterization plays a crucial role in the diagnosis and treatment of congenital heart disease, allowing for the visualization of the heart's structure and function 3, 4.
- It is used to detect shunts, calculate flow, and perform ventricular angiography and coronary angiography, among other procedures 3.
- The procedure is essential for planning and performing interventional catheter techniques, which can help to widen narrowed arteries or close holes in the heart 2, 4.
Evolution and Current Role of Cardiac Catheterization
- The role of cardiac catheterization has evolved over time, with advancements in cardiac MRI and CT improving its sophistication and widening its applications 2.
- Despite the development of non-invasive imaging techniques, cardiac catheterization remains a valuable tool in the diagnosis and treatment of congenital heart disease 4.
- New and emerging interventions are continually being developed, and the future role of diagnostic heart catheterization in patients with adult congenital heart disease is expected to continue to expand 2.
Sedation and Anesthesia in Cardiac Catheterization
- Sedation and anesthesia are critical components of cardiac catheterization procedures, particularly in pediatric patients 5, 6.
- The choice of sedation or anesthesia depends on the individual patient's needs and the specific procedure being performed 6.
- Expert consensus statements provide guidance on the use of sedation and anesthesia in pediatric and congenital cardiac catheterization laboratory procedures 6.