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Left heart catheterization describes the placement of a tube into the heart and coronary arteries . It is most commonly done to examine the arteries that supply the heart. It may also used to examine the structure and function of the left side of the heart.

Who is a candidate for the procedure?

Most people undergo this procedure because a blockage in the heart arteries, known as coronary artery disease, is suspected. These blockages may increase the risk of, or cause, heart attacks.

• examine defects of the heart, such as those found in congenital heart disease
• see how well the heart functions

How is the procedure performed?

The most common method of left heart catheterization is described below.

An intravenous or IV line is put in a vein in the person's arm and a sedative is usually given. The person is asked to lie on a flat table in the procedure room.

Skin on one side of the groin is cleaned. An small incision or nick in the skin is made in the thigh area near the groin. The needle is advanced into a major artery. A tube, or catheter, is inserted into the artery. The tube is then advanced into the artery and up toward the heart.

A special X-ray machine will follow the tube as it moves forward.

The tube eventually reaches the heart. Once the tube is in the right place, dye is injected through it. This dye shows up well on the X-rays giving clear pictures of the arteries of the heart and the heart itself.

Any blockage or defects in the heart or arteries can be seen, too.

If certain blockages or heart valve problems are seen, the doctor may try to correct them with tiny instruments that can be inserted through the tube.

For example, a balloon can be inserted through the tube into a blocked artery. A small balloon can be used to cross the narrowing and then inflated to open the blockage. This is known as angioplasty.

A rigid tube, or stent, may be placed into the artery to keep it from becoming blocked again.

Sometimes a blood clot is seen and a medication is given either in the vein or directly into the coronary artery to help dissolve or dissipate the clot.

After the pictures are taken and any corrections done, the tube is removed from the body. Pressure is applied over the incision to prevent bleeding.

Newer devices have been developed that can immediately seal or be sutured to the artery and the patient can be up in an hour or two.

What happens right after the procedure?

The person is taken to the surgery recovery room until the sedative wears off. Usually, the person is asked to lie flat on his or her back for a few hours. This prevents bleeding in the groin area. If everything is stable, the person may be able to go home later that day.

If a severe blockage was found, the person may need heart bypass surgery.

What happens later at home?

Usually a person can usually return to normal activities the next day unless surgery was indicated.

What are the potential complications after the procedure?

• bleeding
• infection
• death, though this is uncommon
• having to shock the heart due to an abnormal rhythm that occurs when the dye is injected into the coronary artery
• tear of the artery requiring surgery to repair the puncture site
• pseudoaneuysm, a small bulge in the outer layer of the arterial wall
• damage to the nerve in the leg
• transient ischemic attack or possibly stroke

When a balloon is used to open a blockage, the artery may be damaged or even rupture. This may require immediate surgery or inserting a needle into the heart sac (pericardium).

• flushing of the skin, in which the skin becomes hot and red
• itching of the skin
• rash
• kidney failure, known as acute renal failure
• anaphylactic shock, which is severe difficulty breathing and a drop in blood pressure. This may cause death.

All of the above risks are very low (less than 1%, and even in some instances less than 1 in a thousand) but could potentially occur.