What is a right heart catheterization with heart tissue biopsy?
Right heart catheterization, or right heart cath, with heart tissue biopsy is a procedure in which your healthcare provider takes tissue samples directly from your heart muscle. In a right heart cath, your healthcare provider guides a small, thin tube (catheter) into the right side of your heart. The catheter is passed 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 healthcare provider measures pressures in your right atrium (right upper heart chamber) and right ventricle (right lower heart chamber). In some cases, your healthcare provider gives you IV (intravenous) heart medicines during the right heart cath to see how your heart responds. For example, if the pressure is high in your pulmonary artery, you may be given medicines 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 medicines.
Your healthcare provider 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 amount of blood your heart pumps per minute is also measured during a right heart catheterization.
Your healthcare provider usually does the biopsy at the end of the right heart cath. Another catheter is inserted into a vein, usually in your neck. At the end of the catheter is a tool to take a tissue sample. The tiny pieces of heart tissue are sent to the lab for exam under a microscope. Doctors called pathologists examine your tissue under a microscope for signs of infection, inflammation, or abnormal cells. Your healthcare provider does the biopsy to see if your heart tissue is normal.
What are the risks of a right heart catheterization with heart tissue biopsy?
Possible risks of a right heart catheterization with biopsy include:
-
Bruising of the skin at the site where the catheter is inserted
-
Excessive bleeding because of puncture of the vein during insertion of the catheter
-
Pneumothorax (partial collapse of the lung) if the catheter is inserted into your neck or chest veins
-
Perforation of the wall of your heart after pieces of tissue are removed from the ventricle (the lower pumping chamber of the heart)
Other rare complications may include:
-
Abnormal heart rhythms, such as ventricular tachycardia (fast heart rate in the lower heart chambers)
-
Pericardial effusion (fluid buildup around the heart)
-
Cardiac tamponade (fluid buildup around the heart that affects its ability to pump blood effectively), rarely resulting in death
-
Low blood pressure
-
Tricuspid valve damage (the valve on the right side of your heart)
-
Infection
-
Blood clots
-
Pulmonary artery rupture (damage to the main artery in your lung, which can result in serious bleeding and make it hard to breathe)
-
Nerve damage
-
Air embolism (air bubbles enter the bloodstream and block blood flow)
-
Deep vein thrombosis
For some people, 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 healthcare provider before the procedure.
What happens after a right heart catheterization with heart tissue biopsy?
Medical staff will put pressure over the insertion site for several minutes to make sure you are not bleeding. Or, they may use a closure device on the insertion site. 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 able 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 that 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 trouble breathing.
The biopsy samples will be sent to a lab for final evaluation; this may take a few days. Your healthcare provider 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, tell 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 told not to participate in any strenuous activities. Your healthcare provider will instruct you about when you can return to work and resume normal activities.
Call 911
Call 911 if you have any of the following:
-
Shortness of breath or trouble breathing
-
Chest pain or pressure
-
Fainting
-
Sudden numbness or weakness in arms, legs, or face, or trouble speaking
-
The puncture site swells up very fast
-
Bleeding from the puncture site that doesn't slow down with firm pressure
When to call your healthcare provider
Tell your healthcare provider if you have any of the following:
-
Chills or a fever of 100.4°F (38°C) or higher
-
Increased pain, redness, swelling, or bleeding or other drainage from the insertion site
-
Coolness, numbness or tingling, or other changes in the affected extremity
Your healthcare provider may give you other instructions after the procedure, depending on your situation.