Heart Catheterization

TYPES OF DIAGNOSTIC AND THERAPEUTIC PROCEDURES PERFORMED WITH CARDIAC CATHETERIZATION AT MAYO CLINIC

Angiography or angiogram

In this test contrast dye is used to view blood vessels or structures in the heart.

Coronary angiography is commonly used to visualize blocked coronary arteries. The terms coronary angiography and cardiac catheterization are sometimes used synonymously.

Diagnostic coronary angiography may also be performed prior to open-heart surgery to treat defective valves or congenital heart disease. If coronary artery blockages are found, then those can be bypassed during the same open-heart procedure.

Angiography is also used to visualize:

• Other arteries, such as the pulmonary artery, the aorta, or the carotid artery
• Structures within the heart, such as the ventricles or valves
• Fistulas, or abnormal pathways between the heart's chambers, often due to congenital defects
• Blood vessels in parts of the body farther away from the heart (peripheral), sometimes referred to as arteriography when viewing arteries, or venography when viewing veins

Angiography may be used just for diagnosis or may be used to guide treatment.

Ultrasound

Intravascular ultrasound may be used with angiography to assess the severity of coronary blockages or to verify that stent placement is adequate. Intracardiac ultrasound is used to guide the placement of devices to close congenital heart defects, and ultrasound is used with angiography to guide valvuloplasty, a surgical procedure to separate or pleat a valve leaflet that has prolapsed, and other procedures.

Hemodynamic assessment

This test measures both quantity and pressure of blood flow. By allowing the sensors to be placed directed where the measurement is desired, cardiac catheterization helps physicians obtain the most accurate information possible. Catheter-based hemodynamic assessment is often used in diagnosing pulmonary hypertension, valve problems or congenital heart defects. Oxygen levels may be measured in various blood vessels and the heart chambers during this procedure.

Endothelial and microcirculation assessment (coronary spasm study)

This testing is performed to evaluate patients with a long history of chest pain but coronary arteries that appear normal during angiography. Medications are given to measure blood flow in the heart vessels that are too small to be seen during an angiogram. The medications are also used to test the frequency of spasm in the heart arteries.

Endomyocardial biopsy

Cardiac catheterization is sometimes used as a way to collect blood or tissue samples within the heart. This is often used in evaluation of cardiomyopathies (weak heart muscle), and for the follow-up of heart transplant patients to check for early signs of organ rejection (a surveillance biopsy).

Angioplasty and stenting

Angioplasty is performed to open an obstructed artery by inflating and deflating a small balloon. Stenting involves placing a small wire mesh tube in the area for continued support of the blood vessel. Angioplasty with stenting is most commonly performed on the coronary arteries, referred to as coronary angioplasty (and stenting), but may also be performed on the aorta, the carotid artery, or in other locations farther from the heart (peripheral vascular), such as in the leg or kidney.

Atherectomy

Atherectomy is a procedure in which the physician cuts or shaves away plaque to open an artery. The plaque is then flushed out of the body through the catheter.

Thrombectomy

Thrombectomy, when performed as a catheter-based procedure, mechanically removes a blood clot.

Cell and gene therapy

Genes and growth factor proteins may sometimes be injected via catheter to stimulate new vessels to grow (angiogenesis) and help restore blood flow to the heart. Mayo Clinic has been an international leader in researching novel therapies to treat heart disease. These therapies are still under investigation and are available for select patients.

Cardiac assist devices (also called ventricular assist device or heart pump)

Ventricular assist devices may be used in patients awaiting heart transplant, in some patients with potentially reversible forms of heart failure as a "bridge to recovery," and in some patients as treatment. Different types of cardiac assist devices are available for different uses. Read more.

Temporary support systems, such as intra-aortic balloon bump (IABP) or a new percutaneous left ventricular assist device (LVAD), may be used during cardiac catheterization when the procedure to be performed is very complex. They may also be appropriate when the patient's left ventricular function is poor.

Septal occluder placement

To close an abnormal opening between chambers of the heart, a coil or a patch (usually resembling a small umbrella) may be inserted. This is usually performed to treat congenital defects such as ostium secundum atrial septal defects (ASD) or patent foramen ovale (PFO) or patent ductus arteriosus (PDA).

Septal ablation

Sometimes a catheter may be used to inject a very small amount of alcohol into an artery supplying blood to a thickened septal muscle when the muscle obstructs blood flow. This results in a localized scarring and thinning of the muscle, thereby leading to improved blood flow. This procedure is still new and is used for hypertrophic cardiomyopathy. Read more.

Balloon valvuloplasty

Sometimes stenotic (tight) heart valves may be treated by balloon, in a technique similar to angioplasty. Because the valves still need to close, stents are not used.

Closure of periprosthetic valve leaks

Leaks that have developed next to replacement heart valves can sometimes be sealed via a catheter-based procedure. This technique involves the use of devices similar to a vascular plug.

Valve replacement
Procedures to replace heart valves via catheter are under investigation and may soon be available. Mayo Clinic physicians work with patients to determine when these procedures may be appropriate.

Enhanced external counterpulsation (EEC)

This procedure, used to treat refractory angina (chronic chest pain), does not involve actual cardiac catheterization. It is available for patients who have severe blockages that are not amenable to further revascularization. Read more.