Coronary catheterization - a minimally invasive procedure designed to study the coronary arteries and heart chambers. It is performed as a diagnostic and therapeutic purposes.
Coronary catheterization is one of the procedures in cardiac surgery. This method allows you to visualize changes in coronary vessels such as clogging, narrowing, re-narrowing, thrombosis or aneurysmal enlargement of the lumen of these vessels, the size of the heart chambers, contractility of cardiac muscle, as well as some aspects of the functioning of the heart valves. In addition, this method allows to determine such important parameters of the heart as the blood pressure in the cavities of the heart and pulmonary arteries, which can not be done non-invasive methods.
Narrowing of the coronary artery blood flow to the violation of heart tissue that forms the basis for the symptoms of angina. Blockage of an artery leads to myocardial infarction. However, coronary catheterization can not recognize whether the walls of blood vessels affected by atherosclerosis or not, but a significant narrowing of their lumen, which occurs in the final stages of atherosclerosis.
Historical information on coronary catheterization
The method of coronary catheterization was introduced in the late 1950s and first applied in practice in 1960 and Sounsom Shire. The opening of the coronary catheterization method was discovered by chance Sounsom child cardiologist at the Cleveland Clinic from when he accidentally entered radiopaque substance into the coronary artery instead of the left ventricle. Although the patient appeared reversible cardiac arrest, Souns and Shire have funding for further research of this method. In 1966 they published a report on coronary catheterizations performed in 1000.
Beginning in the late 1970s based on research by Charles Dottera in 1964 and especially Andreas Gryuntsiga in 1977, coronary catheterization was more widely used in less invasive treatment of angina pectoris, and certain complications of atherosclerosis, as well as in the prevention of myocardial infarction and in research in terms of better understanding of the pathogenesis of coronary heart disease and atherosclerosis.
Patient's participation in the procedure
Typically, coronary catheterization method requires only local anesthesia at the site of the catheter and the lowest total sedation (ie use of sedative drugs), we have a patient during a procedure in mind. This method is more secure because in case of any problems or discomfort, the patient can immediately tell it, that contributes to the rapid elimination of unwanted effects. Even the most modern devices that monitor the condition of the patient, do not give complete information, being patient is often the most reliable indicator of ongoing security procedures.
At the dawn of the method in the early 1960s, coronary catheterization lasted several hours and was accompanied by complications in 2-3% of patients. Over time, the method has been improved and is now a simple procedure of coronary catheterization, takes no more than 5-8 minutes at the rate of complications of 0.1%. However, compliance with patient safety during training method requires about 20-45 minutes.
Coronary catheterization procedure
See also the article by angioplasty
The method of coronary catheterization is the introduction into the lumen of the coronary arteries, thin tube - a catheter, a thickness of typically about 2 mm. A catheter is inserted through the femoral artery access, a place inguinal folds (that is, where you can easily test the pulsation of the arteries). Catheter is inserted so that its tip is located at the entrance of the coronary artery. At the same time is continuously measured intra-arterial pressure to make sure that the catheter did not close the vessel lumen.
Usually the catheter is made of radiopaque material so that you can control its position in the vessel. Through the catheter into the blood is introduced special radiopaque substance. Typically, this substance is applied in an amount of 3.8 ml to visualize blood flow within 3-5 seconds, as radiopaque quickly dissolves in the blood.
If the lumen of a coronary artery narrowed by plaque or thrombus, when angiography shows narrowing of the site or vessel blurring, uneven contours of the X-ray shadow. If the vessel lumen is completely obstructed, there was a so-called "cliff effect" that is, staining of the vessel suddenly stopped, as if dub.
If the calcified atherosclerotic plaque (ie, "soaked" with lime), then it can be visualized by conventional radiography and without contrast material.
Coronary catheterization is also used to perform transluminal coronary angioplasty. In this method, into the narrowed coronary artery catheter balloon inflated with a special at the end. In the place of constriction balloon is inflated and the artery expands. However, often in place of the restricted area marked expansion of the formation of endothelial tissue (normal tissue lining of the arteries). This is the re-narrowing of the lumen of the artery. Therefore, at present, angioplasty is often supplemented in such a highly effective method, as stenting. It lies in the fact that during the execution of angioplasty with balloon inflated it is a stent - a cylindrical wire frame, which does not allow the artery to narrow.
Complications of coronary catheterization
One serious complication of coronary catheterization is the occurrence of an allergic reaction to the introduction of blood radiopaque substance. Typically, these drugs are made on the basis of iodine. Therefore, iodine intolerance is a contraindication for the this method. Other complications of the method, as with any surgery are bleeding from the puncture site, infection. Other complications are more correlated to clinical status and the anatomic features of the patient than the procedure itself.
