Everything you need to know about cath lab equipment

Cath lab equipment is used in Cardiac Catheterization Labs, which are diagnostic rooms in nearly all the tertiary care hospitals. It is the place where minimally invasive procedures are performed to diagnose and treat problems within the heart and the vessels of the heart. These procedures use catheters instead of surgery. They also involve various imaging techniques to be able to see the vessels, any abnormalities in them, and see how well blood is moving through the heart and the vessels. Cath lab equipment can help the doctor locate sites of blockage or other pathology of the vessels and treat the condition.

Since 2000, cath labs have become digital and use 2 X-Ray sources and a flat panel detector, whereas, in the past, the single x-ray source and cine films were used. Cath lab equipment is not only used for diagnostic purposes, but it's also equally efficient in therapies.

Cath lab equipment brands

Various manufacturing companies produce cath lab equipment; some examples are as follows:

  1. GE Innova 3100 Cath/Angio System
  2. GE Innova 2100 Cath/Angio System
  3. Philips Allura Xper FD10 Cath/Angio System
  4. Siemens Axiom Artis Cath/Angio System
  5. GE Innova 3131 Cath/Angio System
  6. Siemens Artis One Cath/Angio System
  7. Toshiba Infinix Cath/Angio System
  8. Philips Allura Xper FD20 Cath/Angio System

These equipment are designed to perform diagnostic and therapeutic procedures of the catheterization lab. They also help with modifications in the designs and the operating systems.

Types of equipment:

In interventional cardiology, different cath lab equipment types are used to carry out the functions of the laboratory, and the interventional cardiologists are well trained to work with these types of equipment. Some of the most common instruments used in the cath lab are:

  • Catheters – Narrow, thin tubes that are inserted into the blood vessels. They are used to inject dyes in the specified blood vessels, which are then viewed by x-ray imaging, and this is how any blockage site is detected. Whereas, in angioplasty, blocked areas are opened via the catheters having balloons or stents on them.
  • Balloons– They are of two types: Angioplasty Balloon and Cutting Balloon. Angioplasty Balloon is located at the catheter's tip and inflated from the other side of the catheter. It eliminates the atherosclerotic plaques. Cutting Balloon is like a traditional balloon with blades in it, which gets activated on inflation. They eliminate the plaques that cannot be removed by conventional angioplasty balloons.
  • Guidewires – Long and thin wires to place stents and balloons.
  • Stents – A small mesh tube that keeps the vessels open. They are of three types: bare metal, drug-eluting, and bioabsorbable.
  • Atherectomy devices – Small cutting devices used to get rid of tough atherosclerotic plaques. The plaques are sometimes calcified and thus become difficult to deal with through simple angioplasty. Therefore, atherectomy devices are used to remove them. 
  • Optical Coherence Tomography Imaging – An imaging tool for getting detailed images of the arterial walls. It is beneficial for the cardiologists who intervene to improve the blood supply of the heart.
  • Fractional Flow Reserve (FFR) – With this tool, the extent of blockage of the artery is detected by inserting a pressure-sensing guidewire. It recognizes the pressure at the start and end of the vessel to know how much blood is obstructed.
  • Intravascular Ultrasound (IVUS) – This ultrasound technique is used to look at the structure of the plaque. An ultrasound probe attached to the catheter is inserted up to the plaque site, and imaging is done.
  • Near-Infrared Spectroscopy (NIRS) – This technique is relatively new and helps the doctor assess the situation and suggest what type of intervention will be the most effective.
  • Vascular Closure Devices – These devices are used to close the puncture site using either collagen plug, stitch, or unique bands.

History of Cath Lab equipment

Cardiac Catheterization is one of the most critical diagnostic as well as therapeutic procedures. Doctors carry out this procedure in a specialized room called the Cardiac Catheterization Laboratory. Cardiac medicine evolved slowly over four centuries, but cardiology's golden age began in the 19th century. Cardiac Catheterization was first performed on himself by Dr. Werner Forssman in 1929. He got himself punished due to his unconventional approach to such an essential and critical procedure. During World War II, Dr. André Frédéric Cournand developed the first cardiac catheterization lab, and then in the 1960s, Mason Sones defined Selective Coronary Angiography. In 1956, Dr. Forssman and Dr. Cournand won the Nobel Prize for the development of cardiac catheterization. Andreas Gruentzig, in the late 1970s, expanded this practice and made this procedure more and more refined.

Procedures performed in cath labs.

A variety of procedures can be performed in this lab; here is a list of some examples of the procedures:

  • Right Heart Catheterization
  • Left Heart Catheterization
  • Valve Assessment
  • Pacemakers and Defibrillators
  • Pulmonary Angiography
  • Shunt Evaluation
  • Ventriculography
  • Septal Ablation
  • Balloon Septostomy
  • Valve Replacement

The cardiac catheterization procedure

When performing cardiac catheterization, a vein or artery is used to gain access to the heart. After entry, guidewires and catheters are inserted to diagnose or intervene in various conditions of the heart. The most used vessels are Radial Artery, Femoral Artery, Internal Jugular Vein, and Femoral Vein. All the mentioned vessels have their pros and cons.

The catheterization events puncture the vessel via a needle, enter the guidewire through the needle, and then replace the needle with a large sheath of plastic. This procedure is called the Seldinger Technique. 

Indications to use 

Cardiac catheterization can be indicated in a variety of conditions, be it therapeutic or diagnostic. Some of these indications are as follows:

  • Coronary artery disease. This is where the coronary vessels get narrowed or blocked due to the deposition of fats in the vessels. Because of this blockage, the blood supply distal to it gets compromised, and the myocardium starves for oxygen, causing pain in the chest. When less severe, this pain is called Angina Pectoris, but when more severe, it is called Myocardial Infarction or Heart Attack.
  • Cardiac arrhythmias. These are a group of conditions in which the heart starts beating abnormally; it can beat slowly (Bradycardia), rapidly (Tachycardia), irregularly (Fibrillation), or prematurely (Premature Beats). In cath labs, these patients can receive internal pacemakers or defibrillators to deal with various kinds of Arrhythmias. Cardiac Ablation can also be performed using catheterization.
  • Valvular heart disease. The condition when the heart valves of a person are damaged or get stiff and stop normal functioning is called Valvular Heart Disease. The disease may be a result of aging, birth abnormality, or illnesses like Rheumatic Heart Disease. Echocardiography is performed to diagnose the valvular disease and assess valve status.
  • Congenital heart disease. Cath Labs perform cardiac catheterization on patients with hereditary heart diseases. The purpose of this is to diagnose as well as treat the illness. Some of the treatment options that can be performed via catheterization include: 
    • septostomy (to create or enlarge an opening in the heart's upper chambers to allow mixing of the blood); 
    • defect closure;
    • balloon valvuloplasty (to widen the valve opening), 
    • stent placement;
    • balloon angioplasty.
  • Heart failure. This is the condition when the heart is unable to pump blood effectively, and the body requirements of oxygen do not get fulfilled. A patient with heart failure may face difficulty in breathing, exhaustion, and leg edema. Cardiac catheterization is done to implant assisting devices in the heart.

Complications

Cardiac Catheterization is an invasive procedure and has complications as well. The difficulties of this procedure depend upon the patient's condition, the expertise of the doctor performing the procedure, coagulation status of the patient, etc. Some of its complications are:

  1. Heart Attack
  2. Stroke
  3. Pericardial Effusion
  4. Ventricular Arrhythmias
  5. Ventricular Ectopy
  6. Bleeding
  7. Infection
  8. Radiation Exposure
  9. Kidney Injury due to the injected dye
  10. Death

Conclusion

Cath lab equipment is widely present in various hospitals to detect and treat illnesses of the heart. Sometimes, those equipment are used to perform treatment procedures of the heart and vessels. Any good hospital, particularly a cardiology hospital, should have this equipment. When completed efficiently, this procedure can save a lot of lives. 

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