Interventional diagnostics
Interventional diagnostics refers to a group of medical procedures that are performed in a minimally invasive manner to diagnose diseases. Instruments such as catheters or special probes are inserted into the body, often under imaging control (e.g. X-ray, ultrasound,optical coherence tomography (OCT)).
At the Deutsches Herzzentrum der Charité (DHZC), this method is used to detect heart disease, for example, by directly examining vessels, heart valves or heart chambers and checking the function of the cardiovascular system. The procedures are more precise and less stressful than open surgical interventions.
Left heart catheter / coronary intervention
A basic distinction is made between coronary angiography (imaging of the coronary arteries) and LV angiography (imaging of the heart's pumping capacity). Treatment with catheters can often be carried out directly after the examination. The aim is to widen the constriction (coronary angioplasty, PTCA), possibly stabilize the vessel with a stent and thus restore sufficient blood flow to the coronary vessels.
To examine the heart and coronary arteries, individual cardiac catheters - thin, flexible plastic tubes - are inserted via a punctured artery from the wrist (radial artery) or groin (femoral artery) into the left ventricle or coronary arteries under X-ray control. By injecting contrast medium into the left ventricle, the pumping and valve function of the heart can be visualized (LV angiography).
For coronary angiography, a contrast agent is injected into the coronary vessels via the inserted catheter. This allows these vessels to be visualized in the X-ray image and constrictions and occlusions to be detected. If a constriction or blockage is found in the vessel, a balloon catheter is advanced to the constriction using a thin wire. This balloon is usually dilated several times over a few seconds with diluted contrast medium (balloon dilatation, PTCA) and then a stent is inserted.
Right heart catheter with and without load
The blood used by the organs is collected in the veins of the body, transported to the right atrium of the heart and pumped via the right ventricle into the pulmonary artery. The lungs enrich the blood with oxygen and transfer it to the left ventricle. From there, the blood is pumped into the aorta (main artery) and distributed to the organs.
Certain diseases of the lungs and heart (e.g. congenital or acquired heart valve defects, diseases of the pericardium) lead to changes (usually increases) in the pressures in the pulmonary artery, which can be determined by means of a right heart catheter examination at rest and during exercise. Such functional diagnostics in the so-called small circulation determine pressure values, resistances and cardiac output.
Procedure of the examination
- Die Untersuchung unter sterilen Bedingungen erfolgt über die Vene im Bereich der Ellenbeuge, der Leistenvene oder der Halsvene (auf der Intensivstation).
- Nach Punktion und Einlegen einer Schleuse (Einführhilfe für den Katheter) wird unter Röntgenkontrolle ein spezieller Katheter (Swan-Ganz-Katheter) über den rechten Vorhof (rechte Vorkammer) und die rechte Herzkammer in die Pulmonalarterie (Lungenschlagader) geführt.
- Während der Patient in entspannter Position den Atemkommandos des Untersuchers folgt, werden Druckmessungen durchgeführt und aus verschiedenen Regionen Blutproben zur Bestimmung des Sauerstoffgehalts entnommen. Weitere Druckmessungen erfolgen beim langsamen Rückzug des Katheters.
- Bei einer Untersuchung unter Belastung muß der Patient in liegender Position auf einem Fahrradergometer treten. Während steigender Belastungsstufen werden die Drücke in der Lungenstrombahn und die Herzauswurfleistung gemessen, die wertvolle Informationen über eine eventuell eingeschränkte Leistungsfähigkeit der linken Herzkammer liefern.
- Nach der Untersuchung werden die Kunststoffkatheter aus der Leiste oder der Ellenbeuge entfernt, eine kurzzeitigen Kompression zur Blutstillung vorgenommen und ein leichter Druckverband für 4 Stunden angelegt. Bei Untersuchung über die Leistenvene ist dann ein Aufstehen möglich, bei der Untersuchung über die Ellenbeuge ist keine Bettruhe vorgesehen.
In patients with 2 to 3 narrowed coronary arteries, a bypass in the form of the internal mammary artery (IMA) is first applied to the anterior interventricular artery (RIVA) via a small “mini-incision”. This arterial bypass has very good long-term results and the longest durability of all bypass vessels, as the arterial tissue is better suited to higher pressures than tissue from other localizations or venous bypasses. All remaining constrictions (outside the bypassed anterior wall artery) are then treated with modern drug-eluting stents, which also have very good long-term results.
This means that cardiac surgery and cardiology approaches are combined in HCR, so that patients with multi-vessel disease and pronounced narrowing of the anterior wall artery in particular can be optimally treated as gently as possible without opening the sternum and without using a heart-lung machine, with very good results. This is a very good treatment option, especially for patients with concomitant diseases outside of the heart.
Extraction of left and right ventricular myocardial biopsies
A myocardial biopsy (removal of samples from the inner wall of the heart) is performed on the basis of preliminary examinations such as ECG, ultrasound, MRI, X-ray examination and left heart catheterization in cases of suspected heart muscle disease, in particular acute or chronic inflammation (myocarditis), or storage diseases.
If left untreated, myocarditis can develop into chronic heart failure (cardiac insufficiency), in which the pumping capacity is no longer guaranteed.
Method and procedure of the examination
- In the catheterization laboratory, the groin area is disinfected and covered with sterile drapes. A fine needle is used to puncture the inguinal vein (femoral vein) under local anesthesia. A thin plastic tube (the sheath) is then inserted into the inguinal vein via a wire that has been inserted. This plastic tube has a “non-return valve” at its outer end, which is designed to prevent unnecessary blood loss during catheter replacement.
- The biopsy forceps are inserted into the right atrium and then into the right ventricle under X-ray control. About 6-8 pinhead-sized samples are taken from various points on the cardiac septum and delivered to the various laboratories on site. Before and after the sample is taken, the pressures in the right atrium and right ventricle are measured using a special catheter. Finally, the right ventricle is visualized with contrast agent to assess its function.
- The introducer and venous sheath are removed and compressed for a maximum of 5 minutes. After about 3-4 hours, bed rest is lifted and the patient can leave the hospital the following day.
- The samples taken are examined histologically and immunohistologically by a specially trained team in various specialized laboratories within our organization for inflammatory cells, various viruses and proteins. Due to the sometimes very elaborate examination methods, it takes about four weeks before the findings can be discussed.
Interventional Diagnostics at the DHZC
Our three DHZC clinics for cardiology, angiology and intensive care medicine in Berlin-Steglitz (Campus Benjamin Franklin), Berlin-Mitte (Campus Charité Mitte) and Berlin-Wedding (Campus Virchow-Klinikum) are modern and highly specialized centers that are available to you around the clock to ensure optimal care. We are also one of the leading international centers for scientific research in the fields of cardiovascular examination, intervention (stent) and heart failure. Our interventional cardiologists have many years of experience and expertise.
Contact and further information
Interventional diagnostics at Campus Benjamin Franklin
- Contact and further information about our services in interventional diagnostics at CBF
- To the website of the Department of Cardiology at CBF
- Further information for referrers and colleagues
Interventional diagnostics at Campus Charité Mitte
- Contact and further information about our services Interventional diagnostics at CCM
- To the page of the Clinic for Cardiology at CCM
- Further information for referrers and colleagues
Interventional diagnostics at Campus Virchow-Klinikum
- Contact and further information about our services at CVK
- To the website of the Clinic for Cardiology at CVK
- Further information for referrers and colleagues
Interventional diagnostics at the Clinic for Congenital Heart Defects – Pediatric Cardiology
- Interventional cardiology for congenital heart defects in all age groups
- To the services of the Clinic for Congenital Heart Defects – Pediatric Cardiolog
