Cardiac catheterization

For the diagnosis of congenital heart defects, the most important imaging examination after cardiac ultrasound (echocardiography) and alongside magnetic resonance imaging (MRI) is cardiac catheterization.

A thin catheter is inserted into the body from the groin via the artery or vein and advanced into the heart. This allows the pressure and oxygen content to be measured in different sections of the heart and the large vessels.

In order to visualize the exact anatomy, a contrast medium solution is injected into certain parts of the heart or vessels. This makes these sections of the heart visible in the X-ray fluoroscopy.

The combination of these two options (haemodynamic values and contrast imaging) provides information about the type and severity of the heart defect. Increasingly, however, therapeutic interventions on the heart are also being carried out as part of cardiac catheter examinations. This allows operations to be prepared or optimized.  

In many cases, catheter-interventional procedures can even replace operations. Our catheter laboratory offers the entire spectrum of interventional cardiac catheter procedures (tinvasive therapies). These include procedures to widen narrowed heart valves (balloon dilatation). This technique is also used to widen or recanalize blocked or narrowed vessels. To prevent a new narrowing, the vessels can be stabilized from the inside with wire prostheses (stent implantation). 


Another task is the closure of pathological vascular connections or connections within the heart. These procedures include coil embolization or umbrella closure of the ductus arteriosus. Malformations in the peripheral vessels (AV malformations) or additional pulmonary arteries (MAPCAS) can also be closed with the help of coil 
 

Defects in the cardiac septum between the atria (ASD II), the main chambers of the heart (VSD) and the ductus arteriosus are treated interventional with different closure systems and make surgical intervention unnecessary in many children. 


For the diagnosis and treatment of cardiac malformations, we have the most modern cardiac catheterization laboratory at our disposal, which enables us to reduce X-ray exposure for patients to a minimum. Around 250 examinations and interventions are carried out at the Children's Heart Center Vienna every year. The smallest child weighed just 900g. Therapeutic procedures (interventions) now account for 68% of all procedures.

Procedure of a cardiac catheterization

The examination takes place during an inpatient stay of 2 - 3 days.

On the day before the examination, a cardiac ultrasound is performed once again in order to fully plan the cardiac catheter examination and to be able to compare the measured values later. A blood test ensures that there is no acute infection. A small tube (Venflon) is inserted at the same time as the blood sample is taken, through which infusions and medication can be administered.

The educational talk

On the day of admission, the doctor will conduct a detailed consultation. All planned measures and possible complications will be discussed. If you would like to prepare for this, you can read through the form here and make a note of any questions you would like to ask.

On the day of the examination, you must fast about 4 hours beforehand if the examination is to be performed under anesthesia. If patients are very excited, a sedative will be administered on the ward. As a general rule: parents may accompany their children to the examination room (cardiac catheterization laboratory) and stay there until their child has fallen asleep, and may also collect them from there together with the nurse and the doctors.

However, most children only receive painkillers and sedatives, without the need for general anesthesia with ventilation. In addition, the groin is locally anesthetized so that there is almost no pain afterwards.

During the cardiac catheterization, you lie on your back with your arms bent upwards next to your head. The nurses attach ECG patches, an oxygen saturation monitor and a blood pressure cuff so that the circulatory function can be continuously monitored during the examination. The groin is then washed with a disinfectant solution so that no bacteria are washed into the bloodstream. For the examination, the patient is then covered with sterile drapes, leaving only the groin exposed. As the patient is completely naked, they lie on a warming mat and their body temperature is measured continuously. This is particularly important for very young children and longer examinations.

Access via the vein or artery is via a puncture, in which a tube is then inserted into the vessel via a very thin wire (sheath). This has a valve to prevent blood loss.

The rest of the procedure depends on the heart defect or the questions that you want to answer with the examination and is individually tailored to each child.

The duration of the examination is usually between one and three hours. At the end of the examination, the sheath is removed and only a small incision of 2-3 mm is visible in the groin, which is treated with a plaster and a bandage.

The patients are then taken back to the ward where they should lie quietly in bed for around 3-4 hours. Even with small children, this works so well with the help of their parents that complications are very rare. All patients are carefully monitored by the nursing staff. In the first few hours, an infusion solution is administered until the patients are allowed to eat again.

A blood-thinning medication is usually administered until the next day to ensure that the blood circulation in the punctured leg is functioning normally.

The course and results of the examination are discussed in detail on the same day.

The next day is usually the day of discharge. Before this, the results of the examination are checked again with a cardiac ultrasound and an ECG and X-ray may be taken. In the first few days after the cardiac catheterization, you should not do any sport, parents and patients will be informed about further rules of conduct and a final report will be handed out containing all important information for the family doctor or paediatrician providing follow-up care.