Left heart catheterization is a medical procedure in which a cardiologist passes a thin flexible tube known as a catheter into the left ventricle of the heart. Also known as a cardiac catheterization or a heart cath, it can be used to diagnose or evaluate a variety of heart problems, including blockages and aneurysms. Usually an iodine solution is injected so that an X-ray video is made of the whole procedure.
The cardiac catheter is typically inserted in the femoral artery, near the groin, because the artery is close to the surface at that point. Occasionally it is inserted in the brachial artery in the left arm or the radial artery in the wrist. Then the cardiologist uses X-rays to visually guide the catheter into the aorta, the coronary arteries and, finally, the left ventricle
Left heart catheterization can be used to evaluate cardiac valve disease, heart defects or heart function or even to repair some of these problems. When the catheter is inserted, an iodine solution is injected through the catheter. Although the solution is colorless, it provides contrast on the X-rays. This contrast enables doctors to watch the heart and arteries in action and immediately diagnose any blockages.
Before undergoing a left heart catheterization, a patient must be carefully prepared. Typically, patients must fast for eight hours before the procedure. Nurses will take the patient’s blood pressure and insert an intravenous (IV) line. Then the insertion site, whether it is the groin or arm, will be shaved and sterilized just prior to the procedure.
General anesthesia is not used for this procedure; instead, doctors give a mild sedative so that the patient will remain awake. This is known as conscious sedation. A local anesthetic, such as lidocaine, is injected at the insertion site. The patient should not feel any pain during the procedure, although he or she might be conscious of a tugging sensation when the catheter is inserted.
After the catheter is removed, pressure must be applied to the insertion site in order to stop the bleeding, unless a closure device is used. Patients are required to lie flat for three to four hours to make sure the injection site does not reopen. Nurses will monitor blood pressure and pulse during this time. If no problems are discovered during the left heart catheterization, most patients are able to go home about six hours later. Although a patient cannot drive home, he or she usually has no problems other than a feeling of soreness.
Sometimes doctors discover blockages within the arteries during catheterization. In this case, most patients require a balloon angioplasty, stent procedure or bypass surgery. If the blockages are relatively small, the surgery can be scheduled later. If not, the doctor will discuss his or her findings with the patient and family members and might perform emergency surgery immediately.