In 1929, Werner Forssman, a resident surgeon at Eberswalde in Germany, inserted a urologic catheter into his right atrium from a left antecubital vein cut down he had performed on himself using a mirror. After walking downstairs to the radiology suite, the position of the catheter tip was verified by a roentgenogram. This was the beginning of cardiac catheterization: the insertion and passage of small plastic catheters into arteries, veins, the heart, and other vascular structures to obtain angiographic images of coronary arteries and cardiac chambers and to measure hemodynamic data (pressure and flow) in the heart. Cardiac angiography images not only diagnose coronary artery disease (CAD) but are used to visualize abnormalities of the aorta as well as the pulmonary and peripheral vessels.
Equally important, the modern cardiac catheterization laboratory is a therapeutic theater of operations for catheter-based interventions (eg, stent implantation, atherectomy, thromboaspiration), collectively called percutaneous coronary intervention [PCI]) or catheter-based treatment of structural heart disease (Table 20–1). Figure 20–1 shows a typical modern cardiac catheterization laboratory.
The modern catheterization laboratory. 1 AP imaging C-arm, with the image intensifier above the patient and the x-ray tube below; 2 lateral imaging C-arm with the x-ray system to the patient’s right; 3 the lateral plane imaging intensifier on the patient’s left side; 4 table pad position for patient’s head; 5 contrast media power injector; 6 angiographic and hemodynamic monitors; 7 crash cart; 8 pressure transducer holders; 9 table controls for integrated intravascular ultrasound and coronary hemodynamics system; 10 control panel for x-ray images; 11 table controls for movement of x-ray system; 12 undertable lead shield; and 13 foot pedal controls for fluoroscopy and cineangiography imaging. Reproduced with permission from Kern MJ, Lim MJ, Sorajja P: The Cardiac Catheterization Handbook, 6th edition. Philadelphia: Elsevier; 2016.1
TABLE 20–1.Diagnostic and Therapeutic Interventional Procedures That May Accompany Coronary Angiography |Favorite Table|Download (.pdf) TABLE 20–1. Diagnostic and Therapeutic Interventional Procedures That May Accompany Coronary Angiography
|Diagnostic Procedures ||Comment |
|Central venous access (femoral, brachial, internal jugular, subclavian) ||Access for emergency medications or fluids, temporary pacemaker |
|Hemodynamic assessment || |
| Left heart pressures (aorta, left ventricle) ||Routine for all studies |
| Right and left heart combined pressures ||Not routine for coronary artery disease; mandatory for valvular heart disease; CHF, right ventricular dysfunction, pericardial diseases, cardiomyopathy, intracardiac shunts, congenital abnormalities |
| Transseptal or LV puncture ||Valvular heart disease |
| Intracoronary pressure/flow ||Coronary lesion assessment |
|Left ventricular angiography ||Routine for all studies; may be excluded with high-risk patients, left main coronary or aortic stenosis, severe CHF, renal failure |
|Internal mammary artery and saphenous vein bypass graft selective angiography ||Routine for coronary bypass conduit assessment |
|Pharmacologic studies || |
| Ergonovine/acetylcholine ||Specialized studies for suspected coronary vasospasm |
Inhaled nitric oxide
Routine for all coronary angiography
Evaluation of pulmonary vasoreactivity...