Right-heart catheterization (often abbreviated as ”right heart cath”) with heart tissue biopsy is a procedure in which your doctor takes tissue samples directly from your heart muscle. Your doctor does this procedure to see if your heart tissue is normal.
In a right-heart cath, your doctor guides a special catheter (a small, thin tube), called a pulmonary artery (PA) catheter, into the right side of your heart and passes it into your pulmonary artery. This is the main artery that carries blood to your lungs. As the catheter is advanced into your pulmonary artery, your doctor measures pressures in your right atrium (right upper heart chamber) and right ventricle (right lower heart chamber). In some cases, your doctor gives you intravenous (IV) heart medications during the right-heart cath to see how your heart responds. For example, if the pressure is high in your pulmonary artery, your doctor may give you medications to dilate, or relax, the blood vessels in your lungs and to help lower the pressure. Healthcare providers will take several pressure readings during the procedure to measure your body's response to the medications.
Your doctor can take indirect measurements of pressures in the left side of your heart, by inflating a small balloon at the tip of the catheter as well. The pressure detected in front of the balloon is known as the pulmonary capillary wedge pressure, or pulmonary artery occlusion pressure. Your cardiac output, or the amount of blood your heart pumps per minute, is also determined during a right-heart catheterization.
Your doctor usually performs the biopsy portion of the procedure at the end of the right-heart cath. Your doctor inserts a special catheter, with a small tool called a bioptome, into a vein, usually in your neck. He or she then passes the tool into your right ventricle. Under X-ray guidance, your doctor uses the biopsy catheter to take tissue samples, usually from your right ventricle. The tiny pieces of heart tissue are sent to the lab for examination under a microscope. Special doctors, known as pathologists, examine your tissue under a microscope for evidence of infection, inflammation, or abnormal cells.
A biopsy may be done to:
A right-heart cath with biopsy may also be necessary as part of our evaluation before a heart transplant. Pressures in your lungs need to be as low as possible in order for a donor heart to work as well as possible. Excessive pressures will make it difficult for the new (donor) heart to pump effectively. A right- heart cath will help to see if pulmonary pressures can be decreased with special medications (vasodilators) to ensure successful transplantation.
Your doctor may have other reasons to recommend a right-heart cath with biopsy.
Possible risks associated with a right-heart catheterization with biopsy include:
Other rare complications may include:
For some patients, having to lie still on the cardiac catheterization table for the length of the procedure may cause some discomfort or back pain.
There may be other risks, depending on your specific medical condition. Be sure to discuss any concerns with your doctor before the procedure.
Based on your medical condition, your doctor may request other specific preparation.
Your doctor will perform the right-heart cath with biopsy in the cardiac catheterization lab or in a special department. If you are critically ill, your doctor may give you the test in the intensive care unit (ICU). A right-heart cath may be performed on an outpatient basis or as part of your hospital stay. The procedure may vary depending on your condition and your doctor's practices.
Medical staff will put pressure over the insertion site for a minute or two, to make sure you are not bleeding. If the catheter was placed in your groin vein, pressure will be placed over the insertion site for a few minutes longer.
If your neck vein was used (most commonly), you will be allowed to sit up comfortably. If your groin was used for the procedure, you will have to lie flat in bed for a few hours, so the puncture site can heal properly.
You can eat and drink normally after the procedure. Your healthcare provider will monitor the insertion site for bleeding and check your blood pressure, heart rate, and breathing while you recover. Let your healthcare provider know if you have any chest pain or difficulty breathing.
The biopsy samples will be sent to a lab for final evaluation; this may take a few days. Your doctor will discuss the results of the right-heart cath and the plan for treatment if needed.
The length of time you’ll need to stay after the procedure will depend on the location of the insertion site. If your neck vein was used, you may be discharged very quickly, if bleeding from the site stops within a few minutes. If a groin site was used, you will be kept for a few hours to make sure bleeding from the site has stopped.
Once at home, you should monitor the insertion site for bleeding, unusual pain, swelling, and abnormal discoloration or temperature change, at or near the insertion site. A small bruise is normal. If you notice a constant or large amount of blood at the site that cannot be contained with a small bandage or dressing, notify your healthcare provider.
It will be important to keep the insertion site clean and dry. Your healthcare provider will give you specific bathing instructions.
You may be advised not to participate in any strenuous activities. Your healthcare provider will instruct you about when you can return to work and resume normal activities.
Notify your healthcare provider to report any of the following:
Your healthcare provider may give you additional or alternate instructions after the procedure, depending on your particular situation.
Before you agree to the test or the procedure, make sure you know:
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