From the Guidelines
Purpose of Right and Left Heart Catheterization
Right and left heart catheterization is primarily used to measure pressures, oxygen saturation, and cardiac output in the heart. The procedure involves inserting a catheter into the right and left sides of the heart, typically through a peripheral vein or artery, such as the femoral or jugular vein, under fluoroscopic guidance 1.
Key Objectives
The main objectives of this procedure include:
- Assessing haemodynamic information, such as filling pressures, vascular resistance, and cardiac output 1
- Evaluating the severity of pulmonary arterial hypertension (PAH) and other heart conditions 1
- Measuring pulmonary artery pressure, which is essential for diagnosing and managing PAH 1
- Assessing right-heart dysfunction through measurement of right atrial pressure (RAP) and cardiac output 1
Procedure Details
The procedure typically requires:
- Administration of conscious sedation, such as midazolam (1-2 mg IV) and fentanyl (25-50 mcg IV) [@Example@]
- Local anesthesia, such as lidocaine (1-2% solution) [@Example@]
- Insertion of the catheter through a peripheral vein or artery, advanced to the heart under fluoroscopic guidance [@Example@]
- The procedure usually lasts approximately 30-60 minutes [@Example@]
Importance of Expertise
It is crucial to perform right heart catheterization at expert centers to ensure low morbidity and mortality rates, as the procedure is technically demanding and requires meticulous attention to detail 1. The interpretation of invasive haemodynamics should be made in the context of the clinical picture and imaging, particularly echocardiography 1.
From the Research
Purpose of Right and Left Heart Catheterization
The purpose of right and left heart catheterization (cath) can be understood through the following points:
- Right heart catheterization (RHC) is used to measure pulmonary artery pressures, estimate cardiac output, and identify intracardiac shunts 2, 3, 4.
- RHC is an important diagnostic tool for various cardiovascular diseases, including pulmonary hypertension, shock, valvular heart disease, and unexplained dyspnea 2.
- Left heart catheterization (LHC) is used in conjunction with RHC to provide a comprehensive understanding of cardiac function and hemodynamics 5, 6.
- The combination of RHC and LHC can be used to measure cardiac saturations, hemodynamics, and to visualize cardiac and vessel anatomy 6.
Indications and Utilization
The indications and utilization of right and left heart catheterization can be summarized as follows:
- RHC is used for the management of advanced therapies in heart failure and cardiogenic shock 2.
- RHC and LHC can be performed via the arm using the radial artery and an antecubital fossa vein, reducing procedural and fluoroscopy time compared to femoral access 5.
- Invasive cardiovascular magnetic resonance (iCMR) can be used for diagnostic right and left heart catheterization, providing real-time functional imaging without ionizing radiation exposure 6.
Diagnostic and Therapeutic Applications
The diagnostic and therapeutic applications of right and left heart catheterization include:
- Measuring pulmonary vascular pressures and responses in intact-chest, spontaneously breathing mice 3.
- Evaluating congenital heart disease, including single ventricle and bi-ventricular anatomy 6.
- Managing cardiogenic shock, pulmonary hypertension, and heart failure 2, 4.
- Performing thermodilution, percutaneous coronary intervention, and coronary sinus sampling 5.