The Cardiac Catheterization Laboratory, commonly called Cath Lab, is a specialized unit where X Ray imaging technology is used to visualize the heart and its vessels (coronary arteries) as well as other vessels or organs, such as the brain, kidneys, peripheral arteries and veins through the use of different catheters inserted through a small access into an artery or vein in the arm, groin or neck. The procedure involves injection of radiologic contrast directly through the catheters and takes only several minutes to perform.
Procedures are generally categorized as diagnostic or therapeutic. Diagnostic procedures include coronary angiography, hemodynamic studies, electrophysiologic studies, angiographies on the brain, kidneys and other organs. Therapeutic or treatment procedures include percutaneous coronary interventions commonly known as angioplasty, interventions on valvular diseases, closure of congenital shunt defects by transcatheter techniques, and treatment procedures for peripheral arteries.
Disease Conditions Detected by Cath. Laboratory
A number of disease conditions can be detected in a catheterization laboratory. These typically include:
- Coronary Artery Disease
- Congenital Heart Disease
- Valvular Heart Disease
- Peripheral Artery Disease
- Sick Sinus Rhythm
Most Frequent Procedures Performed in the Cath Lab
A. Coronary Angiography – this is a technique where the arteries of the heart are visualized to detect blockages of the coronary arteries and determine the best treatment options for such.
B. Percutaneous Coronary Intervention (PCI) – involves widening of the obstructed artery by using various devices such as balloon catheters, atherectomy devices or other tools and implanting metal mesh-like tubes called stents to prevent collapse and closure of the widened artery. Newer stents coated with drugs are employed to prevent early re-narrowing.
Preparation for the Procedure
A patient is asked not to have anything by mouth about six hours prior to time of procedure. Pre medications are given a few hours before he/she is called in to the Cath Lab. Intravenous fluids are a must. The procedure does not cause undue pain. A local anesthetic is applied over the access area such as the groin or the wrist, after which a fine needle is inserted into which is threaded a thin guidewire. The guidewire is used to guide the insertion of different types of catheters into the target area. During the procedure, the patient is awake though mildly sedated and can communicate with the operators. If only a diagnostic procedure is done, then the catheters are pulled out immediately upon completion of the test and bleeding is stopped by application of pressure over the access site or vascular closure device may be deployed depending on the indication.
The patient is then transferred back to his/her room. For interventional procedures, the same preparation is done. Additional medications may have to be given. An anesthesiologist may be called in during the procedure. Upon completion of the PCI, the patient will be observed for a few hours in the Cath Lab Holding area and later on transferred for further routine observation in the Intensive Care Unit for about 24 hours. With no complications or adverse reactions observed, the patient will then be transferred back to his room.