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
• Unusually 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 – test to measure the pressure inside your eyes. The test is used to screen for glaucoma. It is also used to measure how well glaucoma treatment is working.
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 asses 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 collaterals, 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).

References

Related articles

• Right cardiac catheterization

References

• DÍTĚ, P.. Internal medicine. 2. edition. Praha : Galén, 2007. ISBN 978-80-7262-496-6.