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What is cardiac catheterisation?


Dr Khambadkone specialises in cardiac catheterization and interventional cardiology. Cardiac catheterisation is a very specialised procedure in which a long and flexible tube called a cardiac catheter is inserted into a vein or artery in the groin, limbs or the neck to achieve access to the heart chambers, large arteries and veins close to the heart. In addition to General Cardiology and Echocardiography, Dr Khambadkone can offer interventional treatment for a large variety of common and rare cardiac conditions that provides a one stop shop for children and their families. They generally involve putting small tubes in to different parts of the circulation and take measurements under different conditions such as with high oxygen inhalation or with drugs administered during the procedure to evaluate their effect. Cardiac catheterization performed to measure pressure and oxygen levels and assess structure and flow within the circulation are called diagnostic procedures.

Hybrid catheterization procedures are performed  with another imaging modality such as Cardiac Magnetic Resonance Imaging. Cardiac magnetic resonance imaging during hybrid procedures allow for measurement of flows and volumes most accurately during the pressure measurements with a catheter at the same time. These are most helpful for certain complex circulation (Univentricular heart) or severe pulmonary hypertension.


Where will the procedure be performed?


Dr Khambadkone performs these procedures in a Cardiac Catheterisation Laboratory. The team involved in catheterization include a cardiac anaesthetist, specialist nurses, a physiologist - expert in monitoring the child during the procedure and specialist radiographers helping with acquiring images. 




What does the procedure involve?


In the “cath lab”, the child lies on a specially designed table with two large cameras that take a video of X rays (Fluoroscopy) as Interventional cardiologists guide the catheters into the veins and arteries to the heart and its various chambers. The radiation exposure is meticulously controlled and monitored by the cardiologist and the radiologist. With the help of the physiologist, the pressure and oxygen saturations are measured in the chambers of the heart, and in the arteries and veins connected to them. This helps with the diagnosis and allows to make plans for management of a variety of heart conditions. As a standard protocol, all children having cardiac catheterization would be given Heparin, a blood thinning agent to prevent clot formation in the circulation when catheters are inserted. This is closely monitored both to maintain adequate blood thinning (anticoagulation) but also to avoid excessive anticoagulation which may increase the risk of bleeding.



What is cardiac angiography?


Angiography involves injection of a dye (radio-opaque contrast) at a rapid rate into the circulation.  This mixes with the blood and highlights its flow through the heart chambers, arteries and veins. The dye can highlight holes in the heart, narrowing or leaking of heart valves, narrowing of arteries and veins or missing parts of the heart chambers, arteries or veins. After the procedure, firm pressure is applied to the site of entry through the artery or vein to stop bleeding. Rarely, this may re-start after children wake up distressed after the anaesthetic or if they cough or cry incessantly. Bruising or haematoma formation (a collection of blood or clot in tissue space) is seen occasionally but they resolve completely over time.

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