Cardiac Procedures
A number of cardiac diagnostic and therapeutic procedures can be performed in a catheterization laboratory. These typically include angiograms, percutaneous coronary interventions, closure of some congenital heart defects, treatment of stenotic heart valves, and pacemaker implantations. Many modern cath labs have facilities for performing electrophysiological studies, wherein catheters and wires passed into the heart through blood vessels are used in diagnosing and treating arrhythmias. Most cath lab procedures are performed under local anesthesia. General anesthesia may often be necessary in small children in whom longer procedure times are anticipated.
A coronary angiography is performed when the physician suspects the existence of coronary artery disease, a condition characterized by significant stenoses in the coronary arteries of the heart. The procedure is typically performed through the femoral (groin) artery or the radial (wrist) artery. Pre-shaped or steerable catheters are passed through the arterial access under fluoroscopic guidance and are used to cannulate the openings (ostia) of the coronary arteries. Small quantities of a radiographic contrast medium ('dye') are injected into the coronary arteries through the catheters. The dye passes through the coronary arteries into the coronary venous circulation. During its passage, which typically takes a few cardiac cycles, the anatomy of the coronary arterial tree can be visualized under fluoroscopy due to the radio-opacity of the dye. The X-ray tube is rotated so as to provide specific views (projections) to enable complete visualization of the coronary arterial tree.
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