Understanding Cardiac Catheterization

How is a cardiac catheterization performed?

Cardiac catheterization procedures are performed in one of two state-of-the-art catheterization labs in the Tidwell Procedure Center at CHOC. The child’s doctor will discuss the risks and benefits of the procedure with the child’s family and require written permission (informed consent) from the child’s legal guardians to do the procedure.

Upon arriving at the procedure center, the child will be taken to a “pre-op” room where he or she is prepared for the procedure. This includes taking vital signs, having the child change into a hospital gown and starting any necessary IVs. The child is also given a sedative to help him or her relax before the procedure. Once in the “cath lab,” he or she will usually receive general anesthesia. The child will lie on a small table with a c-shaped X-ray machine surrounding it. Heart monitors and other equipment are nearby. A specially trained staff of nurses, technicians and doctors will monitor the child and make sure he or she is comfortable during the procedure.

An injection of local anesthetic is given under the skin where the catheter is going to be inserted. Next, a thin, flexible tube (catheter) is inserted into a blood vessel, most often in the groin area (the crease of the leg where it bends when sitting). The catheter is guided up the vessel (artery or vein depending on the purpose of the procedure) towards the heart. The cardiologist uses X-rays, called fluoroscopy, to help see the movement of the catheter. From the vein, the catheter enters the right atrium–the top right-hand chamber that receives oxygen-poor (blue) blood from the body. Eventually, the tube will be guided into the right ventricle, the pulmonary artery, and perhaps the right and/or left pulmonary artery branches. In addition, another catheter may be placed into the artery in the groin, which can be advanced to the aorta.

While inside the heart, several things may be done to help evaluate the heart structures, as well as the pattern of blood flow inside the heart, including the following:

• Blood samples may be drawn from each chamber and each blood vessel and the oxygen content measured.
• Blood pressure measurements may be made inside each chamber and each blood vessel.
• Contrast dye may be injected into the catheter and, as it flows inside the heart, X-rays may be used to show the path the dye takes throughout the heart.
• X-ray movies (angiograms) are made as the catheterization proceeds. This lets the child’s cardiologist review the data after the procedure. If surgery is planned, the heart surgeon will also review the data.
• In some cases, certain procedures may be performed in lieu of open-heart surgery or in conjunction with a heart surgeon. One such procedure is the insertion of a revolutionary Melody® Transcatheter Pulmonary Valve.

Learn more about what to expect at the Tidwell Procedure Center.

What is a Melody® Transcatheter Pulmonary Valve?

Among the variety of treatment options available through the Interventional Cardiology Program at CHOC Children’s is the Melody® Transcatheter Pulmonary Valve that offers children with failing pulmonary valve conduits a new option for their condition without open-heart surgery. CHOC is proud to be one of less than 100 centers in the United States to offer this FDA-approved alternative to open heart surgery. CHOC boasts a program that rates above average in the number of these procedures performed in the nation as well as some of the best patient outcomes. Learn more about the Melody valve at CHOC.

What happens after a cardiac catheterization procedure?

After the procedure, the child will need to lie still for four to six hours to decrease the risk of bleeding, and pressure must be applied to the site where the catheter was inserted. Special machines are used to monitor the child’s heart as he or she recovers. Most patients go home on the same day, but some will stay in the hospital for one night for observation.

In the days following the procedure, patients may experience mild symptoms like an achy chest and discomfort or bruising in the area where the catheter was inserted. Some children might also notice skipped heartbeats or irregular heart rhythms. Most children can return to their normal activities within a few days.

Caregivers should contact the child’s doctor immediately if they notice unusual pain or swelling, excessive bleeding or if the child complains of consistent irregularities in their heartbeat.

It is important to follow all of the doctor’s instructions, especially regarding follow-up visits, medication schedules and safe levels of physical activity.