Overview of services offered in the Cardiac Catheterization Laboratory
A diagnostic cardiac catheter is inserted into the femoral artery (in the upper leg) or the radial artery (in the wrist) to inject a contrast agent into the right and left coronary artery. This makes it possible to easily identify constrictions or blockages. In addition, a technique called fractional flow reserve (FFR) can be used to measure the blood pressure directly in the coronary artery. This is done mainly to plan further procedures.
Levocardiography (to determine the ejection fraction)
Administering a contrast medium into the left ventricle of the heart makes it possible to directly measure the heart’s pumping capacity. This procedure investigates what is called ejection fraction, which should normally be between 55 and 65%. An abnormally low ejection fraction is often referred to as heart failure or cardiac insufficiency. Levocardiography is also used to investigate functional disorders of the mitral valve (especially leakage).
Coronary interventions with/without drug-eluting stents (drug-coated stents)
If coronary arteries are found to be constricted or blocked, they can be widened using a balloon catheter (balloon angioplasty, PTCA). A small metal tube (stent) is usually implanted during this procedure in order to hold the vessel open. Patients need to take blood-thinning aspirin and clopidogrel for several weeks or months after the surgery to prevent clots from forming within the stent.
In some patients, excessive wound healing in the area of the stent may cause the vessel to narrow again (restenosis). Modern stents are therefore coated with specific drugs that slow the healing process slightly in order to prevent this narrowing. However, patients with such stents need to take aspirin and clopidogrel for a longer period of time.
Today, state-of-the-art materials have also made it possible to reopen blockages in the coronary arteries by inserting a special microcatheter into the blockage. This catheter is then used to pass a special guide wire through the blockage. A very small balloon can then be positioned at the affected site to open up the blockage, almost always finishing with the placement of a stent.
Right heart catheterization to investigate valvular defects or shunts
Comparable to left heart catheterization, a thin plastic catheter is inserted from the groin, – the difference being that it is passed through a vein instead of an artery. This way, the right ventricle can be comfortably probed and examined, including measurement of blood pressure in the right ventricle, right atrium, pulmonary artery and superior and inferior caval vein. Determining the blood oxygen levels in the various cavities additionally allows an assessment of the heart’s pumping capacity. Less common heart conditions (e.g. malformation of the cardiac septum) can also be diagnosed this way. Right heart catheterization is also commonly performed prior to surgical procedures on the cardiac valves in cases such as narrowing of the aortic valve (aortic valve stenosis) or leakage of the mitral valve (mitral valve regurgitation).
Testing drug therapy for pulmonary arterial hypertension
If high blood pressure in the pulmonary artery (pulmonary arterial hypertension) is suspected, possible drug therapy can be tested as part of right heart catheterization. The blood pressure in the pulmonary artery is measured via the catheter before, during and after the administration of specific drugs. If there is a significant decrease in pulmonary blood pressure, long-term drug therapy may be beneficial.
An accumulation of fluid in the pericardium (e.g. due to inflammation) can considerably affect the heart’s function. In some cases, it may be necessary to remove this fluid by employing a special puncture needle as well as a drainage catheter. This is also done in the Cardiac Catheterization Laboratory with the help of fluoroscopy, allowing for the puncture to be performed safely and quickly.
Electrophysiological examinations (in cooperation with the medical practice of Dr. K. Adler)
Specific cardiac catheterization techniques have made it possible to cure or significantly alleviate a wide range of cardiac arrhythmias. Usually, several catheters are inserted through the femoral vein into the heart to stimulate the ventricles or atria using electric currents. This often makes it possible to accurately classify a cardiac arrhythmia and remedy it with ablation therapy. For some cardiac arrhythmias, such as atrial fibrillation, the rate of treatment success is higher than 95%.
On-call emergency service for acute myocardial infarctions
Since the beginning of 2013, the Cardiac Catheterization Laboratory at Klinikum Landkreis Erding has been offering around-the-clock medical care. This is the only way to guarantee that a clogged coronary artery can be swiftly reopened in the event of an acute myocardial infarction. An ECG is obtained and transmitted to the hospital by radio while the patient is still in the ambulance. Based on the ECG results, the team of the Cardiac Catheterization Laboratory can be alerted even before the patient arrives at the hospital. By the time the patient reaches the hospital, the emergency team is already on site to immediately initiate treatment.
Cooperation with cardiosurgery
Not all patients can be helped with balloon catheter dilatation and stent implantation. In some cases, venous or arterial bypass surgery is the better option. This is why we work closely with the German Heart Center Munich, as we have done in the past. As a new addition, a telemedical connection with its Cardiosurgery Department will soon be established. A special monitor camera system will enable the hospital’s cardiologists to directly contact the cardiosurgeons at the German Heart Center Munich and discuss clinical findings. This project is unique in Bavaria and provides a significant improvement in the care of patients suffering from coronary heart disease as well as valvular heart diseases.