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| Catheterization laboratory | |
|---|---|
 German cardiac catheterization laboratory | |
| Purpose | visualize the arteries and chambers of the heart |
A catheterization laboratory, commonly referred to as a cath lab, is an examination room in a hospital or clinic with diagnostic imaging equipment used to visualize the arteries of the heart and the chambers of the heart and treat any stenosis or abnormality found.
Most catheterization laboratories are "single plane" facilities, those that have a single X-ray generator source and an X-ray image intensifier for fluoroscopic imaging. [1] Older cath labs used cine film to record the information obtained, but since 2000, most new facilities are digital. The latest digital cath labs are biplane (have two X-ray sources) and use flat panel detectors. [2]
Cardiac catheterization laboratories are usually staffed by a multidisciplinary team. This may include a medical practitioner (normally either a consultant cardiologist or radiologist), cardiac physiologist, radiographer and nurse. [3] [4]
The consultant cardiologist is responsible for gaining arterial access, inserting a sheath into either the radial or femoral artery, passing a wire and catheter into the coronary artery and selectively injecting contrast media into the coronary arteries. They then interpret the images taken to ascertain where the narrowed or blocked artery has the problem. They use a variety of techniques and imaging tools to measure the size of things such as balloons and stents.
Cardiac physiologists usually set up what is known as a transducer to monitor pressure in the arteries. They also have a live view of the patients ECG so they can tell whether or not there is a problem caused by the insertion of the catheter into the heart to the electrical pathways. [5] [6] The physiologist will also set up a temporary pacemaker if the procedure is an angioplasty or a percutaneous coronary intervention (PCI). Finally, they also set up defibrillators on to the patient for emergency use if needed. In some locations, some of these responsibilities may be carried out by other personnel, such as trained nurses or technologists. [7]
Cardiac catheterization is a general term for a group of procedures that are performed in the cath lab, such as coronary angiography. Once a catheter is in place, it can be used to perform a number of procedures including angioplasty, PCI (percutaneous coronary intervention) angiography, transcatheter aortic valve replacement, balloon septostomy, and an electrophysiology study or catheter ablation. Devices such as pacemakers may be fitted or rotablation to remove plaque can be performed. [8] [9]
Angioplasty, also known as balloon angioplasty and percutaneous transluminal angioplasty (PTA), is a minimally invasive endovascular procedure used to widen narrowed or obstructed arteries or veins, typically to treat arterial atherosclerosis. A deflated balloon attached to a catheter is passed over a guide-wire into the narrowed vessel and then inflated to a fixed size. The balloon forces expansion of the blood vessel and the surrounding muscular wall, allowing an improved blood flow. A stent may be inserted at the time of ballooning to ensure the vessel remains open, and the balloon is then deflated and withdrawn. Angioplasty has come to include all manner of vascular interventions that are typically performed percutaneously.
A coronary catheterization is a minimally invasive procedure to access the coronary circulation and blood filled chambers of the heart using a catheter. It is performed for both diagnostic and interventional (treatment) purposes.
Interventional cardiology is a branch of cardiology that deals specifically with the catheter based treatment of structural heart diseases. Andreas Gruentzig is considered the father of interventional cardiology after the development of angioplasty by interventional radiologist Charles Dotter.
Intravascular ultrasound (IVUS) or intravascular echocardiography is a medical imaging methodology using a specially designed catheter with a miniaturized ultrasound probe attached to the distal end of the catheter. The proximal end of the catheter is attached to computerized ultrasound equipment. It allows the application of ultrasound technology, such as piezoelectric transducer or CMUT, to see from inside blood vessels out through the surrounding blood column, visualizing the endothelium of blood vessels.
A balloon catheter is a type of "soft" catheter with an inflatable "balloon" at its tip which is used during a catheterization procedure to enlarge a narrow opening or passage within the body. The deflated balloon catheter is positioned, then inflated to perform the necessary procedure, and deflated again in order to be removed.
Cardiac catheterization is the insertion of a catheter into a chamber or vessel of the heart. This is done both for diagnostic and interventional purposes.
Percutaneous coronary intervention (PCI) is a non-surgical procedure used to treat narrowing of the coronary arteries of the heart found in coronary artery disease. The process involves combining coronary angioplasty with stenting, which is the insertion of a permanent wire-meshed tube that is either drug eluting (DES) or composed of bare metal (BMS). The stent delivery balloon from the angioplasty catheter is inflated with media to force contact between the struts of the stent and the vessel wall, thus widening the blood vessel diameter. After accessing the blood stream through the femoral or radial artery, the procedure uses coronary catheterization to visualise the blood vessels on X-ray imaging. After this, an interventional cardiologist can perform a coronary angioplasty, using a balloon catheter in which a deflated balloon is advanced into the obstructed artery and inflated to relieve the narrowing; certain devices such as stents can be deployed to keep the blood vessel open. Various other procedures can also be performed.
Door-to-balloon is a time measurement in emergency cardiac care (ECC), specifically in the treatment of ST segment elevation myocardial infarction. The interval starts with the patient's arrival in the emergency department, and ends when a catheter guidewire crosses the culprit lesion in the cardiac cath lab. Because of the adage that "time is muscle", meaning that delays in treating a myocardial infarction increase the likelihood and amount of cardiac muscle damage due to localised hypoxia, ACC/AHA guidelines recommend a door-to-balloon interval of no more than 90 minutes. As of 2006 in the United States, fewer than half of STEMI patients received reperfusion with primary percutaneous coronary intervention (PCI) within the guideline-recommended timeframe. It has become a core quality measure for the Joint Commission on Accreditation of Healthcare Organizations (TJC).
The history of invasive and interventional cardiology is complex, with multiple groups working independently on similar technologies. Invasive and interventional cardiology is currently closely associated with cardiologists, though the development and most of its early research and procedures were performed by diagnostic and interventional radiologists.
Lourdes Heart Institute and Neuro Centre (LHINC) is a new block set up in Lourdes Hospital, Cochin, Kerala, India, to cater to tertiary level care for the entire spectrum of cardiovascular and neurological disease. It was inaugurated on 16 March 2007, by Mr. A. K. Antony, the Defence Minister of India. This institute was started to meet a long-felt need to provide cardiac and neurological interventional facilities, and especially to provide interventional neurological facilities for the treatment of strokes, including selective thrombolysis and primary angioplasty for stroke which was hitherto unavailable in this part of India.
A coronary stent is a tube-shaped device placed in the coronary arteries that supply blood to the heart, to keep the arteries open in the treatment of coronary heart disease. It is used in a procedure called percutaneous coronary intervention (PCI). Coronary stents are now used in more than 90% of PCI procedures. Stents reduce angina and have been shown to improve survival and decrease adverse events in an acute myocardial infarction.
F. Mason Sones, Jr. was an American physician whose pioneering work in cardiac catheterization was instrumental in the development of both coronary artery bypass surgery and interventional cardiology.
Multan Institute of Cardiology (MIC), is a hospital located in Multan city in Pakistan. It was established by Nawaz Sharif, the former chief minister of Punjab province, in 2016.
Transradial catheterization is an endovascular procedure or catheterization procedure performed to diagnose and treat arterial disease. Endovascular procedure can be performed achieving access in to body’s arterial system from either femoral artery, brachial artery or radial artery in the wrist. The transfemoral approach to perform cardiac catheterization has typically been more prevalent in invasive cardiology. But radial access has gained popularity due to technical advances with catheters and lower complication rates than transfemoral access. The European Society of Cardiology and the American Heart Association both support a radial-first approach in acute coronary syndrome.
Cardiac imaging refers to minimally invasive imaging of the heart using ultrasound, magnetic resonance imaging (MRI), computed tomography (CT), or nuclear medicine (NM) imaging with PET or SPECT. These cardiac techniques are otherwise referred to as echocardiography, Cardiac MRI, Cardiac CT, Cardiac PET and Cardiac SPECT including myocardial perfusion imaging.
A hybrid cardiac surgical procedure in a narrow sense is defined as a procedure that combines a conventional, more invasive surgical part with an interventional part, using some sort of catheter-based procedure guided by fluoroscopy imaging in a hybrid operating room (OR) without interruption. The hybrid technique has a reduced risk of surgical complications and has shown decreased recovery time. It can be used to treat numerous heart diseases and conditions and with the increasing complexity of each case, the hybrid surgical technique is becoming more common.
Protected percutaneous coronary intervention, abbreviated as Protected PCI, is a heart procedure that involves a ventricular assist device that is used to treat patients with cardiovascular disease, including advanced heart failure.
Donald S. Baim was a researcher and clinician in the field of interventional cardiology. Baim's primary research focused on coronary blood flow, catheter intervention in heart disease, and congestive heart failure. His work helped to shift the use of catheters from a purely diagnostic tool to a therapeutic tool. After receiving a medical degree from Yale and initial medical training, residency and a fellowship at Stanford University Medical Center, Baim spent the bulk of his career at Beth Israel Hospital and at the Brigham and Women's Hospital in Boston. In 1993, Baim founded the Beth Israel Hospital's Cardiovascular Data Analysis Center (CDAC) -- later to be named Harvard Clinical Research Institute (HCRI). Baim died of cancer in November 2009. In October 2016, HCRI changed its name to the Baim Institute for Clinical Research.
National Institute of Cardiovascular Diseases (NICVD); (Urdu: نيشنل انسٹيٹيوٹ آف كارڈيو ويسكيولر ڈيزيزز) in collaboration with the Government of Sindh are a chain of health care centers located in Sindh, Pakistan.
Samin K. Sharma is an American philanthropist of Indian descent and an interventional cardiologist who co-founded the Eternal Heart Care Centre and Research Institute in Jaipur (EHCC). Sharma has served on New York State’s Cardiac Advisory Board since 2004. As of 2021, he is Senior Vice-President, Operations & Quality at The Mount Sinai Hospital in New York and runs the Dr. Samin K. Sharma Family Foundation Cardiac Catheterization Laboratory. As of 2018, he is Chairman Board of Trustees, Association of Indians in America (AIA). As of 2022, he has been an investigator on 86 grants and multi-center trials and authored 486 peer-reviewed articles that have been cited 21,734 times.
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