Cardiac Catheterization and Intervention

Cardiac catheterization involves the insertion of a catheter (hollow polymer-coated tubing) into a blood vessel of the heart or into one of its chambers. Cardiac catheterization procedures are one of the most commonly performed cardiac procedures today. This review outlines the basics of angiography and coronary anatomy, the technical details of cardiac catheterizations, preferred access sites, and hemodynamic measurements. The basic steps in coronary intervention are listed. Common indications and contraindications for cardiac catheterization and intervention are described, as are appropriate use criteria for diagnostic catheterization and coronary intervention, fractional flow reserve (FFR) and intravascular ultrasonography, and complications of cardiac catheterization and percutaneous coronary intervention. Future directions in the field are discussed. Tables describe normal hemodynamic measurements, derived measurements during right heart catheterization, coronary artery disease prognostic index for medically managed patients, American College of Cardiology (ACC)/American Heart Association (AHA) guidelines regarding indications for coronary angiography, ACC/AHA appropriate use criteria for diagnostic catheterization, common indications for FFR, and risk of cardiac catheterization and coronary angiography. Figures include an overview of coronary anatomy, angiograms of the coronary arteries, images of a normal cardiac cycle and hemodynamic waveforms, the design of a stent, FFR evaluation, basic intravascular ultrasonography measurements, and coronary imaging with an optical coherence tomography system. This review contains 7 highly rendered figures, 8 tables, and 62 references.