Diagnostic Cardiac Catheterization

Nancy McDaniel M.D.

Procedure Explanation

Your child has been diagnosed with a heart problem. In order to learn more details about the heart problem, your child's cardiologist has recommended that your child have a test called a cardiac catheterization. This test or procedure will give the cardiologist information about the heart problem that cannot be learned from listening to the heart, looking at the electrocardiogram (EKG) or seen on the ultrasound (echocardiogram). Often the heart catheterization information is used to plan for the surgery to treat the heart defect.

Your child will need to have an empty stomach before the catheterization. The nurse or doctor will tell you when the child may eat or drink the night before or morning of the catheterization. Medications are usually not given the morning of the test.

A mild sedative is usually given before the procedure (newborn infants usually don't receive this). A numbing cream is often put on the upper thigh (groin area) one hour before the test. Some doctors will have you do this at home and then come to the hospital.

Numbing medicine is either put on the skin or under the skin at the top of the leg (one side or both may be used). After the area is numb, a needle is placed in to the artery and the vein at the top of the leg. The needle is then replaced with a plastic tube, like an IV and called a sheath. The sheath lets the doctor put the catheters in safely and prevents the child from bleeding from the needle puncture.

A catheter is a hollow plastic tube about the size of a piece of thin spaghetti. It shows up on the special x-ray camera that is used in the catheterization lab. The doctor then guides the catheter through the big blood vessels to the heart and uses the catheter to collect small samples of blood and measure the blood pressures. A special x-ray blocking dye is used to take the picture of the heart. The pictures will be recorded and saved.

Catheterization evaluates three major things: the amount of oxygen in the blood in each chamber of the heart, the blood pressure in each chamber of the heart and pictures are taken of the heart chambers. From these, the cardiologist can determine if heart surgery or other procedures need to be done.

You will be informed as to the reason for the procedure and be told of the risks to your child. Ask again if you are not sure why the test is being performed, and let the cardiologist know of any concerns or questions that you have.

What are the risks?

The risks of the catheterization depend on the type of heart problem your child has and the age of the child. In general, problems with the procedure are infrequent and minor. This might include bleeding, infection or injury to the blood vessel. More serious risks might be arrhythmia, injury to the heart, or allergic reaction to the dye used to make the picture. The most serious risk would be that your child could have a stroke or die as a result of the catheterization. You must discuss the procedure in detail with the cardiologist who will be doing the procedure, and you are required to give consent. This information does not replace informed consent for the actual procedure.

Common questions asked about heart catheterization

Q: Will my child be in pain during the test?

A: No, in general the children sleep though the test. If they are uncomfortable, medication can be given during the test. Mild soreness of the site may occur and usually needs nothing more than over the counter analgesics.

Q:What if my child is awake?

A: Often, the children are awake and talk with the nurses and doctors. Reassurance and comfort is always given and the child's needs are attended to.

Q:Can I watch the catheterization?

A: No, there is no place for the family to watch and care is taken to prevent infection much like an operating room, so only doctors, nurses and technicians are in the room with the child.

Q:How long will the test take?

A: Generally the test takes several hours and the child may be gone from the observation area (recovery area) for three to four hours. A member of the team will keep you informed of the progress.

Q:When will I know what the test showed?

A: The cardiologist who performed the test will tell you whatever information is available. Sometimes the doctor sends tests out, that take a few days to get back. Often final recommendations about the need for surgery or further testing will not be made until all the cardiologists and heart surgeons who care for your child have reviewed the test results. Sometimes that might take a week. Ask your child's doctor when to expect to hear from them with the final results.

Q:Will the x-rays harm my child?

A: No, the smallest amount possible is used and no harm should come to your child.

Q:Will my child need a blood transfusion after the blood samples are taken?

A: Most of the time the total blood loss is less than a tablespoon and does not need to be replaced.

Q:Are there stitches that need to be removed?

A: Only a small nick in the skin is left at the end of the cardiac cath, so stitches are not required. There will be a large bandage over the puncture site that will be removed the following day.