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Invasive imaging: Cardiac catheterization and angiography
Right heart catheterisation: indications and interpretation
  1. Paul Callan,
  2. Andrew L Clark
  1. Department of Cardiology, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
  1. Correspondence to Dr Paul Callan, Department of Cardiology, Hull and East Yorkshire Hospitals NHS Trust, Hull, HU16 5JQ UK; paulcallan843{at}btinternet.com

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Learning objectives

  • To gain an overview of the history and development of right heart catheterisation.

  • To learn how to perform a right heart study tailored to answer a specific clinical question.

  • To gain a better understanding of the role of right heart catheterisation as a diagnostic tool in specific conditions, including pulmonary hypertension, valvular heart disease and differentiating between constrictive pericarditis and restrictive cardiomyopathy.

Introduction

Significant improvements in the diagnostic power and availability of non-invasive cardiac imaging techniques, in addition to evidence of potential harm associated with pulmonary artery (PA) catheterisation in patients in critical care, have led to a decline in right heart catheterisation (RHC) over recent years.1 RHC, however, remains an important tool in a cardiologist's diagnostic armoury, providing direct haemodynamic data that can be used to determine cardiac output (CO), evaluate intracardiac shunts and valve dysfunction. It is the gold standard method for diagnosing pulmonary hypertension (PH) and an essential component in the evaluation of patients prior to heart and/or lung transplantation.2 ,3 RHC can be also used to assess the haemodynamic effects of treatments directly and provides an entry route for intracardiac biopsy. The European Society of Cardiology (ESC) core curriculum 2013 states that trainees should possess the skills to ‘carry out right heart catheterization in the catheterization laboratory and at the bedside, and measure cardiac output, intravascular pressure, and oxygen saturation’.4

This article covers the history of RHC, how to perform a complete right heart study and a review of its current place as a diagnostic tool in a range of cardiovascular disorders.

Background

The first reported RHC was performed on a horse by the physiologist Claude Bernard in 1844.5 Glass tubes were inserted via the jugular vein and carotid artery in order to measure the temperature in both ventricles. Bernard et al subsequently …

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