Heart Catheterization

A right cardiac or heart catheterization is a method used to diagnose primary pulmonary hypertension. A cardiac cath will usually be required to establish a definitive PH diagnosis and clear the way for many of the treatments discussed on this web site, such as prostacyclin.

A heart catheterization is performed by passing a narrow, flexible tube called a Swan-Ganz catheter through a vein, and into the chamber of the patient's heart. A catheterzation is generally only performed after an echocardiography, an ultrasound image, has failed to reveal evidence of primary pulmonary hypertension when it is strongly suspected.

First the skin at the site for the catheter placement is cleaned with disinfectant and local anesthesia is given. Then the catheter is inserted through a blood vessel usually in the arm, groin, or neck, and under x ray guidance, threaded into the pulmonary artery. Doctors sometimes use catheters equipped with small balloons that use blood flow to help direct them. Other doctors use catheters directed by advanced flexible guide wires. Other catheters are guided simply by twisting or turning the catheter. Once inside the artery the catheter may conduct extremely precise hemodynamic measurements.

These measurements include pressure tracings of blood vessel or chambers of the heart. The blood flow through the heart and blood vessels can also be determined by measuring the oxygen level in all the chambers of the heart and in various vessels. In addition, small blood samples may be taken so that blood oxygen level can be measured. The results of these tests will indicate how effectively the cardiopulmonary system is working.

The catheterization procedure is also an opportunity to perform an Angiography (x-rays taken during a heart catheterization). Since the inside of the heart or a blood vessel is not visible by Angiography unless a dye called contrast is injected into the structure, a catheter is positioned to deliver the dye. Once the dye is present in the structure, images of the moving heart and its blood vessels can be examined to determine if a narrowing or blockage of vessels is occurring. Eventually, the harmless iodine based dye is excreted by the kidneys.

After completion of the procedure, the catheters are removed, pressure is applied at the insertion site and the site is bandaged. If the catheter was passed through the groin, the patient's legs must be kept straight for several hours so that the vessels may heal.

Unlike an echocardiography, a cardiac catheterization is an invasive procedure and is potentially risky. However, it is by far the most definitive method of diagnosing pulmonary hypertension. Additionally, physicians often use the catheterization as an opportunity to test the patient's pulmonary response to vasodilators. Since the patient's vasodilator status is of extreme importance in determining a treatment plan, it is not uncommon for physicians to order a second catheterization, if the vasodilator status could not be determine during the first one.


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