Left cardiac catheterization

Left-sided cardiac catheterization is the most accurate method of coronary heart disease (CHD).
 * Most often under sciascopic control retrogradely through the aorta and it's branches
 * Under local anesthesia we puncture the femoral artery or radial artery → we insert the quidewire and the introducer (Seldinger's technique) → we insert our own diagnostic catheters though the introducer into the distance of the coronary artery extra et sinistra + into the left ventricle
 * Exceptionally left-sided transseptal catheterization: the cetheter is introduced through the femoral vein into the right atrium → we puncture the inter atrial septum and we penetrate the left atrium into the left atrium or left ventricle
 * Left heart catheterization includes:
 * 1) Selective coronarography + left ventriculography – coronary artery injection + left ventricle with X-ray contrast agent
 * 2) Tonometry – measurment of pressure in the left ventricle and in the aorta, determination of pressure gradients through the mitral and aortic valve
 * 3) Oxymetry – taking blood from individual sections of the heart (determination of blood oxygen saturation) to detect short circuits

Coronary angiography

 * Widely used method to askes coronary artery/ coronary artery bypass grafting
 * We determinace the degree of narrowing of the coronary kartery - in % (lumen of the kartery in the narrowed area/ in the nearest unaffected area)
 * A narrowing of >50% is significant
 * We also assess: type of stenoses, presence of collateral, calcifications, developmental abnormalities
 * Indications: suspicion of severe coronary artery disease, assessment + differential diagnostic reasons, after heart transplantation
 * Relative contraindications: Active infection, severe anemia, disruption of the internal environment, severe uncontrollable Hypertension, bleeding, severe blood clotting disorders, patient disapproval of revascularization

Left ventriculography

 * We determine the regional and global systolic function of the left ventricle
 * Currently it can be replaced by ECHO → we perform it only in connection with selective coronarography
 * Evaluation of momentum of individual parta of the left ventricle:
 * 1) Normokinesis (normal contractility),
 * 2) Hypokinesis,
 * 3) Akinesis (the monitored part of the left ventricle does not contract),
 * 4) Dyskinesis (abnormal arching of part of the left ventricular wall during systole),
 * Ejection fraction (EF) – it expresses the global systolic function of the left ventricle; standard: >55%
 * EF = (EDV – ESV) / EDV. 100%.

Complications of left heart catheterization

 * Local: haemorrhage, hematoma, pseudoaneurysm, arteriovenous fistula at the femoral artery
 * Cardiac and general: AIM, heart failure, arrhytmias, stroke, vagal reactions (hypotension+ bradykardia).

Related articles

 * Right cardiac catheterization