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Heart Institute at Children’s Hospital of Pittsburgh of UPMC
A cardiac or heart catheterization or “heart cath” is a minimally invasive procedure which uses thin, flexible tubes called “catheters” to look at and get information about the heart from the inside. To get inside the heart, the catheters are inserted into the big blood vessels in the groin, called the femoral (FEM-or-ul) artery and vein, in the same way an intravenous (IV) line is placed. Sometimes other blood vessels in the neck or arm also are used. The catheters are gently pushed through the blood vessels and into the heart using a type of x-ray called fluoroscopy (floor-OS-co-pee) to guide the placement of the catheters. Once the catheters are in position inside the heart, they can be used to gather different types of information depending on what the doctor needs to know.
There are many different types of catheters that can be used during a heart cath, and each catheter serves a different purpose. Some catheters allow the medical team to take blood samples from different parts of the heart and from the lungs to look at oxygen saturation (how much oxygen is in the blood), or they can help measure the blood pressure in the heart and lungs. Others allow the doctor to look at the electrical system of the heart. By inserting a special dye called “contrast” through the catheters and looking at it under fluoroscopy, the doctor can see the heart, and the arteries and veins in the heart and lungs. The doctor can see how well the heart is pumping and take pictures of it so that they can be looked at later.
To complete the evaluation of your child’s heart problem, the cardiologist may need to perform a heart catheterization. Your child will be admitted to the hospital for this procedure.
Who does it?
The heart catheterization is done by a pediatric cardiologist and a team of trained professionals who specialize in the catheterization procedure. Approximately 30 to 40 catheterizations are done in the Heart Institute each month.
Why is it done?
A heart catheterization is the most accurate way to evaluate how the heart is functioning. With the information from the catheterization, physical examination, EKG, ECHO and other diagnostic tests, the cardiologist can plan the best care for your child. A catheterization must be done before some types of operations to provide the information the surgeon needs. For some children, the catheterization may be repeated after surgery to evaluate results of the operation. A catheterization is done only if the cardiologist cannot obtain the information he needs from other diagnostic tests. It is never done unless necessary.
Some children need an additional study of the heart’s electrical conduction system during the catheterization. This electrophysiology study (EP) is performed with an electrode catheter. The catheter senses electrical activity in various areas of the heart and can deliver electrical impulses to pace the heart during the procedure. Information obtained from the EP study can help diagnose arrhythmias and plan a method of treatment.
Increasingly heart catheterization is used as both a diagnostic procedure and a method of treatment. Some treatments are:
- Balloon Atrial Septostomy
- Raskind Procedure
- Balloon Angioplasty
- Balloon Valvuloplasty
- Occluding Devices
- Stenting Procedures
How is it scheduled?
After the cardiologist decides your child needs a heart catheterization, you will be contacted by a scheduling secretary to arrange an admission date. Catheterization dates may be changed for two reasons:
- An emergency catheterization needs to be scheduled for another child
- Your child develops fever, severe cold symptoms or other major health problems affecting the catheterization; please notify the cardiologist if your child becomes ill before the day of admission
Canceled catheterizations are rescheduled as soon as possible.
What are the risks?
For most children, catheterization is a safe procedure. It carries additional risks for very sick newborns and children. The cardiologist will explain any special risks for your child. Parents are asked to sign a consent form before the catheterization.
What happens before the catheterization?
The day before admission, you will receive a call from a nurse. She will set the time and place of arrival, tell you when to feed your child, give his medicines and answer any other questions.
In most instances, your child will be admitted to the hospital the day of the catheterization. He will be examined by several doctors and nurses. Some children may need blood and urine tests, an EKG, chest X-ray or echocardiogram. Before the catheterization, a member of the Heart Institute team will speak with you to make certain you understand the procedure.
For several hours before going to the cath lab, your child will not be allowed to eat or drink. Before the start of the procedure, he will receive either a sedative, which will make him relaxed and sleepy, or general anesthesia.
Where is it done?
The catheterization is performed in a large room with special equipment called the catheterization laboratory or cath lab. A nurse or technologist will remain with your child to care for him and assist the doctor. Parents accompany their child to the cath lab and wait in the nearby lounge while the catheterization is being performed.
What happens during the catheterization?
In the cath lab, your child is moved onto a special bed and connected to a monitor. The monitor allows the team to carefully observe his blood pressure and heart rate. An intravenous (IV) will be placed in a vein in the arm or hand to give fluid and medicine as needed. The IV is inserted in an area that has been numbed with anesthetic cream. Special precautions are taken to prevent infections. The cardiologist wears a gown and gloves. An area of skin near large blood vessels, usually the groin, is washed with special soap and covered with sterile (very clean) towels. Then, this area is made numb with an injection of local anesthetic like the dentist uses. Next, the cardiologist inserts the catheter (a long thin plastic tube that is soft and hollow) into a blood vessel in the sterile area. The catheter is passed gently up the vessel into the heart. In the heart, blood pressure is measured in each chamber and the surrounding blood vessels. Oxygen content of the blood also is measured in all these areas. If additional studies or treatments are needed, they are done at this time.
Finally, a special fluid called dye or contrast is injected through the catheter. The fluid enables the structures of the heart to be photographed by X-ray cameras. These pictures are recorded and become part of your child’s permanent record. When all the information has been obtained, the catheter is removed from the blood vessel. It slides out easily. Pressure is applied over the vessel for several minutes so bleeding will not occur. Then, a large bandage is placed on the area to provide additional pressure.
How long does it last?
Most catheterizations last two to four hours. Several factors influence how long your child will be in the cath lab:
- The ease in finding blood vessels to be used for catheterization
- The time needed to enter each chamber of the heart and the surrounding blood vessels
- The number of other studies or treatments required
Each catheterization your child has presents a new set of circumstances that change the amount of time needed to complete the procedure. The cardiologist will let you know how long he expects the procedure to last. In addition, a member of the staff will tell you periodically how the catheterization is progressing.
What are the results?
The cardiologist who performs the catheterization talks with you about what he found immediately after the procedure. However, before giving you his final decision, he needs time to study the results and talk with the other cardiologists and/or surgeons. The results of the catheterization may show that your child needs to continue being followed by the cardiologists or referred to the cardiac surgeons for an operation.
What happens after the cath?
Immediately after the catheterization, you will rejoin your child and go to his hospital room. Children who have received general anesthesia go to the Recovery Room for a short time. Your child will need to stay in bed for several hours. A nurse will check frequently for several hours to make certain his recovery is satisfactory. An upset stomach or slight fever is common after the procedure, but these symptoms usually disappear in a few hours. Gradually, your child is allowed to eat and drink. After several hours, the large bandage is removed and a small band-aid is applied.
If the doctor has written special orders for your child, the nurse will explain them to you.
Typically, your child will be discharged from the hospital either the same or the next day and usually can resume normal activities. For infants, the band-aid can be changed as needed when diapers are soiled.
We realize the information obtained from the catheterization is often difficult to understand. If you have questions or concerns after you return home, please let us know. Members of our staff will be glad to talk with you by phone or make an appointment to see you.
March 25, 2013
March 25, 2013