The Cardiac Catheterization Lab

In the past, hospitals used cardiac catheterization labs for a very limited number of procedures, primarily studies of blood flow and pressure in the heart, visualization of the coronary arteries and balloon angioplasty. Today, the modern cardiac "cath" lab is home to a wide variety of diagnostic and treatment techniques that allow the doctor to tailor care for the very specific needs of individual patients. Saint Francis doctors have contributed to this rapid development in interventional cardiology. Patients at the Saint Francis Heart Center benefit from the complete range of state-of-the-art care. The procedures done in the cath lab are sometimes referred to as catheter-based modalities, because they all employ the basic techniques of cardiac catheterization.

Click on the text below to learn more about specific diagnostic and treatment procedures.

Cardiac Catheterization
Hemodynamics
Coronary Arteriography
Intracoronary Ultrasound
Angioscopy
Balloon Angioplasty
Rotational Atherectomy
Transluminal Extraction Angioplasty
Coronary Stents
Excimer-laser Angioplasty

Cardiac Catheterization

Cardiac catheterization is when a narrow tube, called a catheter, is inserted into an artery or vein of the leg or arm and passed through the blood vessel to the heart or the heart's circulation. Passage of the catheter is monitored by a special x-ray camera called a fluoroscope. The fluoroscope can also be used to record the flow of a radiopaque dye through the heart, coronary vessels and large vessels that supply blood to the heart and circulation.

Hemodynamics
Hemodynamics is the study of blood flow, pressure and cardiac output. During this evaluation, the catheter is positioned in a heart chamber or one of the "great" vessels of the body to record pressure changes during the cardiac cycle, resistance to flow through the valves or blood vessels and the amount of blood that is pumped out of the left ventricle during each cardiac cycle.

Coronary Arteriography

Coronary arteriography is the definitive diagnostic test for coronary artery disease. However, it is only used when the chances of heart disease are fairly high. Coronary arteriography is described as an "invasive" procedure, which carries certain risks. Also called angiography, it involves injection of a radiopaque dye into the aorta and the coronary circulation. X-ray pictures of the arteries show any obstruction to the flow of dye. The x-ray pictures also help determine how many vessels are affected, where the obstructing lesions are located and how severe the obstruction is.

Intracoronary Ultrasound
Using the same ultrasound technology as an echocardiogram, the intracoronary ultrasound technique produces direct images of each layer of the interior structure of the vessel walls. The catheter has a small transducer fitted into the tip, which is important for identifying calcium deposits beneath the inner layer of an artery. This information helps the cardiologist decide which angioplasty technique to use.

Angioscopy
Angioscopy involves use of a catheter with a fiber-optic tip to directly view vessel structures on a monitor. It is useful for identifying clots and fatty deposits that don't show up well with ultrasound imaging and in helping the doctor decide which method to use in removing obstructing lesions. Saint Francis is one of the few medical centers in the world to use this technique. The procedure is not used in routine diagnostic cases.

Balloon Angioplasty
The first of the "interventional" techniques, balloon angioplasty, is the most common method for reducing obstruction of a coronary artery. It involves inflation of a balloon-tipped catheter within an obstructed vessel. The balloon catheter is inserted over a catheter guide wire to the location of the obstruction. From here the balloon is inflated against the sides of the obstruction to re-open the channel for blood flow. About 1,400 angioplasties, stents and other interventional cardiology procedures are performed each year at the Saint Francis Heart Center. However, with the variety of new treatment procedures now available, several factors enter into the doctor's decision on the most appropriate treatment.

Rotational Atherectomy
In a rotational atherectomy, a special catheter shaft with a diamond-coated tip spins at 180,000 revolutions per minute through the obstruction without causing injury to the artery. The blockage is pulverized into tiny particles -- smaller than red blood cells -- which the body can eliminate naturally. This technique is preferred for treatment of obstructive segments that are long or located at various sites. It is also used for plaque that is hardened by calcium deposits, located at the entry to a vessel or with in a small vessel.

Transluminal Extraction Angioplasty
This technique utilizes a catheter that is tipped with razor sharp metal struts which are used to slice away debris as they spin. A collection chamber sucks the small particles into the catheter. It is particularly useful for treatment of soft sponge-like blockages such as blood clots and the fatty substance that sometimes builds up around bypass graft insertion sites.

Coronary Stents
These devices are placed within a vessel when it won't stay open after an angioplasty or extraction procedure has been completed. Coronary stents work as a type of scaffold that helps hold the vessel open and keep the channel secure. A balloon catheter is used to place the stent at the treated site.

Excimer-laser Angioplasty
Rather than burning plaque obstructions like the old "hot" lasers which can damage vessel walls, the excimer laser disintegrates the blockage by destroying the molecular bonds that hold the plaque together. The microscopic debris passes safely into the bloodstream and is removed through the body's normal blood filtering process.