How is cardiac catheterization performed?

Cardiac catheterization is a specialized procedure in which a long, flexible tube (catheter) is inserted into a vein or artery and guided into the heart or surrounding areas. The procedure is performed in the hospital by specially trained pediatric congenital interventional cardiologists and can be used to diagnose or treat congenital heart disease without surgery.

Before the procedure

Patients and family members will meet their interventional cardiologist during a clinic visit or the day of the procedure. The physician will discuss the benefits and risks of the procedure, answer questions and get permission (“consent”) to perform the catheterization. Even if you discussed the procedure before, the cardiologist will review it again to be sure all is well understood.

Before the procedure, an anesthesiologist who specializes in caring for patients with heart disease will share the plan for keeping the patient safe and comfortable. Patients will be given a sedative to help them relax before being taken to the cardiac catheterization laboratory (cath lab). In most cases, patients will be completely asleep but may not need a breathing tube or general anesthetic.

Once in the cath lab, patients will lie on a table with specialized, low-dose X-ray equipment nearby. Heart monitors and other equipment will be there, too, to help assess the patient's condition at all times. Our team of doctors, advanced practice providers, nurses and technicians will make sure the patient is comfortable and safe throughout the experience – this is a top priority for the team.

During the procedure

Once asleep, the patient will be given an injection of local anesthetic where the catheter will be inserted – most often in the upper leg at the crease where it bends when sitting. A small sheath will be inserted to prevent excessive bleeding and serve as the entry point for catheters used during the procedure.

Next, the cardiologist will guide a catheter through the vein or artery toward the heart using briefly-running X-rays, called fluoroscopy, to see the movement of the catheter. As needed, the catheter will be guided to different parts of the heart and into the blood vessels leading in or out of the heart. The catheters specially function to measure pressures inside the veins and arteries, deliver special dye that allows for internal anatomic visualization or correct structural problems.

Diagnostic and treatment options

While the catheters are in place, cardiologists can perform many diagnostic tests to evaluate the heart structures and the pattern of blood flow inside the heart. If treatment (intervention) is needed, this usually takes place during the same procedure. Additional pictures or pressures are often taken after intervention to help evaluate the procedure's success. Learn more about diagnostic and interventional treatments.

Care after the test

When the catheterization is complete, the catheter(s) will be withdrawn while the patient is still in the cath lab. Bleeding is usually stopped by holding pressure on the catheter site for several minutes – longer for large sites. Stitches at the insertion point are rarely needed, but a stitch or two may be used on larger access points in the vein or artery after an intervention, on top of the blood vessel and under the skin. If blood vessels in the leg were used, the patient will need to keep the leg straight for 2-4 hours to minimize the chance of re-bleeding.

Recovery

After the cath, patients will be taken to a specialized nursing unit and monitored for several hours. How long it takes for the patient to wake up after the procedure will depend on the type and dose of relaxation medicine given and on possible reactions to it. For instance, small children may be given extra medication to prevent excessive motion. During recovery, nurses will monitor the patient's pulse and skin temperature in the leg or arm used for the procedure.

Going home

Many patients are able to go home after a few hours as long as they do not need further treatment or monitoring. Most interventional patients will stay at least overnight for monitoring and follow-up testing. Once patients are ready to leave, they will receive written instructions regarding post-catheterization care, bathing, activity and new medications.

Depending on the results of the cardiac cath, more tests or procedures may be scheduled to gain more information. Follow-up is usually with the patient's own cardiologist and can take place closer to home, if traveling from far away.