Cardiac Catheterization

Read about one man's experience with cardiac catheterization, click here.
Read about one woman's experience with cardiac catheterization, click here.

Cardiac catheterization is a procedure used to diagnose heart problems. Catheterization requires a team made up of a cardiologist, registered nurses, radiology technicians, and patient care technicians. An operating room is not required; the procedure is done in the hospital's cardiac catheterization laboratory.
The cardiologist makes a small opening in an artery in the groin or arm and places a sheath (a short plastic tube) in the incision so the catheter can properly enter the artery. Watching carefully on the monitor, the cardiologist threads the catheter through the sheath, up the arteries into the aorta and on to the heart. (Since there are no nerves in blood vessels, the passage of the catheter is painless.) Once at the heart, the catheter can be guided into the chambers of the heart itself, or into the arteries that supply blood to the heart. The cardiologist uses x-ray equipment to take ../images/HeartInstitute that provide a view of the heart.

Angiography
The most common catheterization procedure is angiography, which can be used to locate blocked heart arteries. When the catheter reaches the correct artery, the cardiologist injects x-ray dye through the catheter in order to see the arteries and track the blood flow through the heart and vessels. In this way the cardiologist can see which heart artery is involved, and where the blockage lies. This image is called an angiogram.

Angioplasty
If the blocked artery lies on a part of the heart that can be reached by the catheter, angioplasty can be performed. In angioplasty, an interventional cardiologist passes a guide wire through the catheter up to the heart. Next a catheter tipped with a slender balloon is threaded over the guide wire. When the balloon reaches the site of the blockage, the cardiologist inflates it with a small amount of liquid, pushing the plaque aside and opening the artery.

The physicians then inject dye through the catheter again, to make sure the artery is open.

To be sure the artery does not close up, cardiologists may also slide a stent through the catheter and place it at the site of the blockage.

Stents
The stent, a stainless steel mesh tube, serves as a scaffold to hold the artery open permanently. (Angioplasty and stent placement may be done immediately after the initial catheterization or at a later date.)

Drug-Eluting Stents
Even when working at their best, plain stents alone are not always effective. Sometimes scar tissue or blood clots can form in or around the stent, again causing the artery to become blocked. In 2003, the Heart Institute at Bridgeport Hospital became the first hospital in Fairfield County to make drug-eluting stents available for general use. In clinical trials, drug-eluting (drug-dispensing) stents almost totally eliminated the incidence of restenosis (re-blockage) in cleared arteries and the need for follow-up procedures, including bypass surgery.

While the stent—a tiny metal mesh tube about a half-inch long—holds the artery open, the medication is continuously released at the site of the blockage, preventing the excess cell growth and scarring that can cause restenosis.

When the procedure is complete, the next step, for continuing heart health, is Healthy Heart Program (formerly Outpatient Cardiac Rehab).