Cardiac Catheterization

Cardiac catheterization is a test which is performed to obtain certain diagnostic information about the heart. Patients may require this medical therapy rather than undergo angioplasty or bypass surgery when they suffer from rare or easily controlled episodes of angina. Alternatively, cardiac catheterization is not performed in patients who have infrequent episodes of angina and in whom angina can be easily controlled. When a patient has heart failure due to suspected coronary artery disease or there is suspected coronary artery disease, cardiac catheterization is conducted. Cardiac catheterization can help:

• Measure blood pressure within heart.
  
• Know the amount of oxygen in the blood.
  
• Check the pumping ability of the heart muscle.
  
• Check blood flow through the heart after surgery.
  
• Collect blood samples from the heart.
  
• Inject dye into the coronary arteries.
  
• To provide treatment in certain types of heart conditions like congenital heart defects and how severe it is.
  
• To find out a coronary artery disease and if found to pinpoint the size and location of fat and calcium deposits that have built up in coronary artery from atherosclerosis.
  
• To determine whether the patient needs bypass surgery or angioplasty.
  
• Examine the arteries of the heart with an x-ray technique called fluoroscopy.

The patient is asked not to drink or eat anything, except a small amount of water, for at least 6 to 12 hours before the test. The patient is tested for allergy to iodine or other medications. Patients suffering from kidney disease or diabetes or bleeding disorders must keep the cardiologist informed. The cardiac catheterization test is performed in a cath lab by a cardiologist. The actual catheterization procedure takes about 15 - 30 minutes. The patient's electrocardiogram that continuously records the electrical activity of the heart is taken.

A pulse oximeter device that measures the oxygen levels of the patients' blood is monitored. An intravenous needle is inserted into the patients' vein to give fluids or medicine during the catheterization procedure. A sedative is also given through this IV line which helps the patient to relax.

Cardiac catheterization procedure involves passing a catheter, a thin flexible tube, into the right or left side of the heart. The doctor inserts this thin plastic tube into the groin - femoral artery. Other places where in the catheter may be inserted are the elbow- brachial artery or the wrist - radial artery. From there it is slowly advanced into the chambers of the heart or into the coronary arteries. The doctor watches the progress of the catheter into the heart's vessels and chambers on the imaging screen. Pressures within the heart chambers are measured and the blood and tissue samples are also removed through the catheter. A small amount of dye is also injected through the catheter into the heart chamber or into one of the coronary arteries.

Therapeutic catheterization: Certain types of heart defects can be repaired using catheterization. For instance, if the coronary arteries are blocked, the cardiologist can use a catheter, guide wire and balloon to open and improve blood flow to the heart. This is termed as percutaneous coronary intervention (PCI).

Normal result indicate that there is no significant narrowing or blockage in the coronary arteries. Abnormal results may suggest that the heart does not pump blood normally or the valves in the heart may be weak. There may be leakage between heart chambers. There is a possibility of aortic aneurysm. Some complications with cardiac catheterization include heart attack or stroke, hematoma, puncture of the heart or arrhythmia.

Falloposcopy

Falloposcopy is a diagnostic method that allows visual inspection of the fallopian pipes from inside. Falloposcopy is performed to assess the abnormalities present in the fallopian tubes right from the uterotubal ostium to the fimbrial end. Hysterosalpingogram and laparoscopy are the conventional methods followed to assess the tubal function; however falloposcopy has been the preferred choice in recent times as it provides accurate visual status of the Fallopian tubes. Falloposcopy is highly useful in diagnosing the conditions such as scar tissue formation, adhesions, blockage in the tubes and damage in the inner lining of the tubes. Falloposcopy is not only used as diagnostic tool, but can also repair and help restore the health of the Fallopian tubes. Fallopian tube blockage is a common cause of female infertility and the procedure helps in recanalizing the obstruction.

Falloposcopy procedure

The procedure involves inserting a thin catheter into the fallopian tubes. The Fallopian pipes are approached through the cervix and uterus. Once the catheter is placed, a tiny fiber optic endoscope is inserted through it. A small digital camera is attached at the end of the scope which allows the visualization of the fallopian tubes on the external monitor. Falloposcopy is generally carried out under local anesthesia or mild intravenous sedation. The ideal time to perform falloposcopy is mid-follicular phase of menstrual cycle as ostium can be evaluated better in the absence of blood and thick endometrial lining. Falloposcopy requires 30-45 minutes to perform. If followed by tubal reconstructive surgery, the time may extend up to 2 hours.

The catheter can be inserted by following two methods namely coaxial system or LEC (linear everting catheter). The coaxial system needs hysteroscope for its uterine passage and also makes use of the thin guide wire over which catheter is inserted. The guide wire is slowly withdrawn and falloposcopy along with camera will be introduced to take the inside images of the Fallopian tubes. LEC method is performed by unrolling the balloon catheter with internal endoscope and there by doing away with hysteroscopy. LEC method is the latest and preferred choice as inserting the falloposcope with LEC technique is easier and allows visual guidance throughout the process. Hence there is less chances of trauma.

There are no major known risks associated with the falloposcopy. However in rare cases, falloposcopy may cause tubal trauma and may also puncture the tubes. Like any other internal investigation, falloposcopy too carries the risk of infection and bleeding. The patient is normally advised to take antibiotics before the procedure to minimize the risk of infection.

Arthrectomy

Arthrectomy is a procedure administered to remove plaque from blood with the help of a modified catheter. This particular catheter consists of a sharp end which enables it to scrape the plaque of the blood vessel. The design of the catheter facilitates the collection of removed plaque into a small pit-like aperture.

Arthrectomy is suggested in conditions where the administration of a stent is not advisable to clear the blood vessel. This procedure is done under local anesthesia and prior to the procedure physicians advise the patients to discontinue certain type of medications as they may interfere with the procedure. Arthrectomy is usually a short procedure, however the duration of the procedure sometimes may depend upon the amount of atherosclerosis a person has in the blood vessel. The post procedural recovery time is usually a few hours and patients are usually advised to stay in the hospital for two to three days to avoid any kind of complications. The adverse effects pertaining to Arthrectomy are similar to that of any surgical procedure, such as perforations, embolism or even Restenosis if the patient's lifestyle is not healthy.