10 Left and Right Heart Catheterization
Right Heart and Pulmonary Artery Catheterization
PA catheters are used primarily in three different settings: in the cardiac catheterization laboratory, in intensive care units (ICUs) and in the operating room. PA catheters are used in the cardiac catheterization laboratory in patients for whom detailed hemodynamic information is needed. Examples include patients with valvular heart disease, cardiomyopathy, and suspected intracardiac shunts. For patients with dyspnea and low CO syndromes in whom the relative contributions of systolic and diastolic function are unknown or in whom the differential diagnosis includes restrictive cardiomyopathy and pericardial constriction, right heart catheterization performed concurrently with left heart catheterization is invaluable because patients with pericardial constriction can improve dramatically with pericardiectomy (see Chapters 20, 42, and 43). There is no consensus on which patients need right heart catheterization, and even in a single catheterization laboratory there may be wide practice variation in which patients undergo right heart catheterization.
Indications for Right Heart Catheterization
Box 10-1 lists some common indications for PA catheter insertion. As with any invasive procedure, the risks and benefits should be weighed for the individual patient, and a PA catheter should be inserted only if there is a specific question that will be answered with respect to making a diagnosis and/or guiding treatment. For instance, a PA catheter may be used to determine the cause of shock in a hypotensive patient in whom the cause is not evident based on signs, symptoms, and noninvasive testing. Guidelines and consensus statements on indications for PA catheter placement and use have been formulated by numerous groups, including the American Society of Anesthesiologists, an expert panel of the European Society of Intensive Care Medicine, the American College of Chest Physicians, the American Thoracic Society, the American College of Cardiology, the Society of Critical Care Medicine, and a 1998 workshop convened by the U.S. Food and Drug Administration. The reader is referred to these documents for information on the use of PA catheters in specific indications.
Box 10-1 Common Indications for Right Heart Catheterization