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Preparation: To do the test, the right or left groin is shaved
in preparation for the study. The patient is then brought to the
catheterization laboratory and placed on a special x-ray table,
which is fairly well padded and reasonably comfortable. A special
soap is applied to sterilize the right and/or left groin area. The
groin area is covered with a large sterile drape that extends from
around the chin area down below the feet. A cutout in the drape
has been made so that there is access to the femoral artery, which
is just below the skin in the groin area.
Procedure:
Lidocaine or a similar anesthetic is injected around the femoral
artery through the skin. This stings or burns a little. Once the
area has been anesthetized, a hollow needle is inserted through
the skin into the femoral artery. A very slender and soft guide-wire
is inserted through the needle and is advanced up toward the heart.
You will not be aware of this movement, as there is no physical
sensation or discomfort during this phase.
The needle
is removed and the guide-wire remains in place in the artery. Next
a catheter (thin plastic tube) is threaded over the guide wire and
advanced up into the heart area. The guide wire is removed, leaving
the catheter in place. An x-ray dye material is injected into the
heart pumping chamber and rapid sequence x-ray pictures are taken
of the dye as it is pumped from the heart out to the body. This
determines whether or not the pumping chamber of the heart (left
ventricle) has any weakness. It also evaluates the function of the
various heart valves on the left side of the heart.
The first
catheter is removed and a second catheter is inserted into the artery
and advanced up into the heart. This second catheter, by its shape,
is able to identify and enter one of the main arteries of the heart,
the left main coronary artery. Dye is injected through the catheter
into the left coronary artery system (revealing three of the four
heart arteries). Rapid sequence x-ray pictures of the injection
of dye through the heart artery system are taken in multiple angle
views of the arteries so that all parts of the arteries can be clearly
seen.
The second
catheter is then removed and a third catheter is inserted. Third
catheter is able to identify the arteries of the heart that supply
the underside of the heart. Additional x-ray pictures are taken
with this third catheter.
That catheter
is then removed. If the patient has had prior bypass surgery, some
additional views of the bypass arteries are obtained in a similar
manner.
Post Procedure:
The patient is then moved to a recovery area where the sheath is
removed and a pressure device is placed on the involved groin area
for 15-20 minutes. After 20 minutes, the pressure device is removed
and a pressure dressing is applied. The patient goes back to his/her
room for 3-6 hours of bed rest. Then, ambulation (walking) occurs
for an hour or two so that insertion site can be evaluated for any
signs of bleeding.
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