Left heart catheterization

You may be given a mild medicine (sedative) before the procedure starts. The medicine is to help you relax. The health care provider will place an IV into your arm to give medicines. You will lie on a padded table. Your doctor may make a small surgical cut on your body. A flexible tube (catheter) is inserted through the cut into an artery. It will be placed in your wrist, arm or your upper leg (groin). You will most likely be awake during the procedure.

Live x-ray pictures are used to help guide the catheters up into your heart and arteries. Dye (sometimes called "contrast") will be injected into your body. This dye will highlight blood flow through the arteries. This helps show blockages in the blood vessels that lead to your heart.

The catheter is then moved through the aortic valve into the left side of your heart. The pressure is measured in the heart in this position. Other procedures, can also be done at this time, such as:

• Ventriculography to check the heart’s pumping function
• Coronary angiography to look at the coronary arteries
• Angioplasty with or without stenting: to correct blockages in the arteries are then performed.

The procedure may last from less than 1 hour to several hours.

In most cases, you should not eat or drink for 8 hours before the test. (Your provider may give you different directions.)

The procedure will take place in the hospital. You may be admitted the night before the test, but it is common to come to the hospital the morning of the procedure.

Your provider will explain the procedure and its risks. You must sign a consent form.

The sedative will help you relax before the procedure. However, you will be awake and able to follow instructions during the test.

You will be given local numbing medicine (anesthesia) before the catheter is inserted. You will feel some pressure as the catheter is inserted. However, you should not feel any pain. You may have some discomfort from lying still for a long period of time.

The procedure is done to look for:

• Cardiac valve disease
• Cardiac tumors
• Heart defects (such as ventricular septal defects)
• Problems with heart function

The procedure may also be done to evaluate and possibly repair certain types of heart defects, or to open a narrowed heart valve.

When this procedure is done with coronary angiography, it can open blocked arteries or bypass grafts.

 

The procedure can also be used to:

• Collect blood samples from the heart
• Determine pressure and blood flow in the heart’s chambers
• Examine the arteries of the heart (coronary angiography)
• Take x-ray pictures of the left ventricle (main pumping chamber) of the heart (ventriculography)

A normal result means the heart is normal in:

• Size
• Motion
• Thickness
• Pressure

The normal result also means arteries are normal.

Abnormal results may be a sign of cardiac disease or heart defects, including:

• Aortic insufficiency
• Aortic stenosis
• Coronary artery disease
• Heart enlargement
• Mitral regurgitation
• Mitral stenosis
• Ventricular aneurysms
• Atrial septal defect
• Ventricular septal defect
• Heart failure
• Cardiomyopathy

Complications may include:

• Cardiac arrhythmias
• Cardiac tamponade
• Embolism from blood clots at the tip of the catheter to the brain or other organs
• Heart attack
• Injury to the artery
• Infection
• Low blood pressure
• Reaction to the contrast material
• Stroke

American Heart Association. Cardiac catheterization. Updated September 2, 2015. www.heart.org/HEARTORG/Conditions/HeartAttack/SymptomsDiagnosisofHeartAttack/Cardiac-Catheterization_UCM_451486_Article.jsp#.WMarWW8rJQJ. Accessed August 23, 2016.

Davidson CJ, Bonow RO. Cardiac catheterization. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 19.

Goff DC Jr, Lloyd-Jones DM, Bennett G, et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. Circulation. 2014;129(Suppl 2):S49-S73. PMID: 24222018 www.ncbi.nlm.nih.gov/pubmed/24222018.

Kern M. Catheterization and angiography. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 57.

Popma JJ, Kinlay S, Bhatt DL. Coronary arteriography and intracoronary imaging.  In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 20.