Catheterization laboratory: Difference between revisions

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German cardiac catheterization laboratory (2004)

A catheterization laboratory or cath lab is an examination room in a hospital or clinic with diagnostic imaging equipment used to visualise the arteries of the heart and the chambers of the heart and treat any stenosis or abnormality found.

Equipment

Most catheterization laboratories are "single plane" facilities, those that have a single X-ray generator source and an image intensifier. 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 digital, flat panel labs. Biplane laboratories achieve two separate planes of view with the same injection and thus save time and limit contrast dye, limiting kidney damage in susceptible patients.

File:GE Cardiac Catheter Imaging Suite.jpg

A typical Cardiac Catheter Lab in the UK

A typical 'Cath Lab' will consist of:

Patient Couch
A floor or ceiling mounted Image intensifier C-Arm
Set of viewing monitors
Realtime ECG/Blood pressure/Oxygen Saturation measurements with softward to record and measure these when needed
Injector Pump used for imaging the Left Ventricle or Aorta
X-ray software for the recording and playback of the Flouroscopy runs acquired during the procedure

Staff

Catheterization laboratories in the UK are staffed by a multidisciplinary team including a Physician (normally either a cardiologist or radiologist), an Anaesthetist, a Cardiac Physiologist, a Nurse and a Radiographer.

Procedures

"Cardiac catheterization" is a general term for a group of procedures that are performed using this method, such as coronary angiography, as well as left ventricle angiography. Once the catheter is in place, it can be used to perform a number of procedures including angioplasty, PCI (percutaneous coronary intervention) angiography, balloon septostomy, and an Electrophysiology study or Catheter ablation.

A list of procedures carried out in a Cath Lab include:

Coronary Angiography or Coronary catheterization
Coronary Angioplasty or PCI
Closure of some congenital heart defect
Treatment of stenotic heart valves
Permanent and temporary pacemaker implantations
Electrophysiological studies such as AV node ablation
Rotablation of heavily Calcified vessles
Lt and Rt Sided pressure studies

Projections

Any combination of the following views are used in visualising the Coronary Arteries:

PA
RAO
RAO CRANIAL
PA CRANIAL
LAO CRANIAL
LAO
LAO CAUDAL (spider)
PA CAUDAL
RAO CAUDAL

As a general rule, cranial views are best used to demonstrate the Left Anterior Descending Artey or 'LAD', and caudal views are best used to demonstrate the Circumflex Artery.

@@ Line 25: / Line 25: @@
 ==Procedures==
+{{Main|Cardiac catheterization}}
+"Cardiac catheterization" is a general term for a group of procedures that are performed using this method, such as coronary angiography, as well as left ventricle angiography. Once the catheter is in place, it can be used to perform a number of procedures including angioplasty, PCI (percutaneous coronary intervention) angiography, balloon septostomy, and an Electrophysiology study or Catheter ablation.
-A number of procedures are carried out in a Cath Lab.  These include:
+A list of procedures carried out in a Cath Lab include:
-*[[Coronary Angiography]]
-*[[Coronary Angioplasty]]
+*Coronary Angiography or [[Coronary catheterization]]
-*closure of some [[congenital heart defect]]
+*Coronary [[Angioplasty]] or PCI
-*treatment of [[stenotic]] [[heart valve]]s
+*Closure of some [[congenital heart defect]]
+*Treatment of [[stenotic]] [[heart valve]]s
 *Permanent and temporary [[pacemaker]] implantations
-*electrophysiological studies such as AV node ablation
+*Electrophysiological studies such as AV node ablation
+*Rotablation of heavily Calcified vessles
+*Lt and Rt Sided pressure studies
-Although this procedure is relatively minimally invasive compared  to open surgery, local anaesthetic is given to numb the area around where the patients arterial system is to be accessed (usually the Radial or Femoral Artery). Once the artery in the wrist or groin has been successfully cannulated, its access is kept open with the use of a sheath. A sheath is a small hollow tube which has a valve on the end to prevent of blood flow back.  This valve also allows the passage of catheters and wires in and out of the artery whilst protecting the artery from damage. This is called the [[Seldinger Technique]]. In using this technique, thin and floppy wires are used ahead of any catheters to guide the way through the arterial system until the Coronary Arteries are reached, at which point the guide wire is removed, leaving only the catheter in place.
-Pre-shaped or steerable catheters are passed through the arterial access under [[fluoroscopic]] guidance and are used to [[cannulate]] the openings (ostia) of the coronary arteries. Small quantities of a radiographic [[contrast medium]] or 'dye' are injected into the coronary arteries through the catheters. The dye passes through the coronary arteries into the coronary venous circulation. During its passage, which typically takes a few cardiac cycles, the anatomy of the coronary [[arterial tree]] can be visualized under fluoroscopy due to the radio-opacity of the dye. The X-ray tube is rotated so as to provide specific views (projections) to enable complete visualization of the coronary arterial tree.
 ==Projections==