The Right Heart Catheterization

| July 19, 2011 | 0 Comments

While on the waiting list and after the heart transplant, the patient will undergo a series of right heart catheterizations, left heart catheterizations and numerous heart biopsies. From the patient’s perspective, the right heart catheterization and the heart biopsy are strikingly similar.

The right heart catheterization and the biopsy can be performed using entry points in the neck or the groin. The left heart biopsy is always performed using the groin as the point of entry. In my case, I have another biopsy scheduled for July 29th.

After my heart transplant, the focus has been on uncovering any rejection symptoms as soon as possible. Originally, I had a biopsy done every week for six weeks. Then the process became every other week and finally once a month. I am now on a three month biopsy plan.

I have had these procedures done in Albany, New York, at Columbia Presbyterian in NYC and at Tampa General Hospital. I was surprised that my cardiologist, Dr. Debby Rynde-Hoffman actually performed the catheterizations and biopsies herself. At Columbia and in Albany, these tests were performed by other specialists.

I can say without equivocation that Tampa General Hospital has the best and smoothest catheterization and biopsy procedures. Dr. Hoffman wastes no time. She is careful at the point of entry and running the wire to the heart and taking away measurements or minute particles from the heart and gets the job done quickly and painlessly. Hoffman has set a high bar for anyone else who performs the test.

My most humorous catheterization was a right heart test at busy Columbia Presbyterian. The staff had sixty catheterizations planned that day. For some reason, they were short one operating room, which set the schedule way back.

As usual, I knew nobody in the room. These catheterizations were performed by physicians who were also taking students through the procedure.

The patient is first attached to an electrocardiogram. This particular incident was a right heart catheterization. As usual, the area in the neck was cleaned and numbed with a local anesthetic. The physician then made a small cut into the vein in the neck into which a small guide, called a swan, was inserted at the top of the vein.

The physician uses the swan to guide the catheter into the vein. Using real time X-rays, the catheter, a thin, hollow tube, is then guided through a path to the right atrium. The purpose of the right heart catheterization is to determine the cardiac output.

The procedure has other benefits such as revealing the pressure across the tricuspid and pulmonic valves as well as reading the pressures in the right atrium, right ventricle, pulmonary artery and the left atrium.

Meanwhile, the patient lies flat and can usually see the wire enter the heart. In the biopsy, the patient can see the minuscule clamp take small samples of the heart which are then tested for rejection.

On the day at Columbia Pres when 60 procedures were scheduled, the doctor had the catheter in the vein but not yet to the heart. Suddenly all the lights went out and the power for the computers went down.

The doctor calmly but forcefully said, “nobody move.” He did not want to remove the catheter. At this time, I felt okay except that when I had to lay flat, the position the patient is in during the procedure. Inevitably, I would have coughing fits as the fluids backed up. I told the doctor that I had to cough. He said to control it as much as possible. With the wire in, he could not change my positioning.

It seemed a long time before the lights came on but it was probably about ten minutes. However, nobody knew how to re-boot the computer and there was difficulty locating an IT specialist to get the computer up and running. By then, I was coughing vigorously. Once the computer images were working, the test was completed and the doctor was truly apologetic. That marked my last trip to Columbia Presbyterian.

I needed a less busy transplant center. Thanks to my insurance carrier, I found Tampa General Hospital. It did not take long for Dr. Hoffman to indoctrinate me. When she performed the first catheterization, I knew I was in safe hands.

My next articles will differentiate the right heart cath from the left heart cath and the biopsy.

 

 

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