Cardiac catheters: when an operation is necessary – and when not

A sick heart is not clearly noticeable. However, heart diseases can increasingly be identified and treated with a catheter intervention. Nevertheless, the procedure should be carefully considered and chosen – because a catheter is not always useful.

Wolfgang Koschel felt a feeling of tightness in his bronchi when he was cycling in Brandenburg in December 2015. The 68-year-old put the peculiar pain on the winter cold. But his doctor was concerned: “Not that there is anything on the heart,” she said and sent him to a clinic. When the cardiologist pushes the hair-thin catheter up to his heart, it becomes clear: Koschel’s coronary arteries are threateningly narrowed. The blood flows too sparingly. The risk of a heart attack is high.

Hair-thin cardiac catheters for diagnosis and therapy

Cardiologists perform 900,000 cardiac catheter interventions every year. “Germany is at the forefront internationally,” says Hugo A. Katus, Medical Director of the Clinic for Cardiology, Angiology and Pneumology at Heidelberg University Hospital. Infarcts can be recognized in this way, narrowed vessels can be expanded and cardiac arrhythmias can be treated. “Cardiac catheters used to be used for diagnostics. Today they are mostly used with the intention of providing therapy. This trend will only intensify, ”the cardiologist is convinced.

Nevertheless, experts also express criticism: People in this country get a lot of cardiac catheter interventions, but not less often die of cardiovascular diseases than in other countries, says health researcher Dawid Pieper from the University of Witten / Herdecke. That’s why you have to ask when a catheter examination really makes sense be.

During a catheter operation, the patient lies on an operating table with an X-ray device, the heart catheter laboratory. The cardiologist pushes a fine plastic cannula, the catheter, up to the heart via a blood vessel in the groin, the crook of the elbow or on the wrist. The patient does not feel it.

A contrast agent makes the vessels visible to the doctor in the X-ray image on a monitor. He can identify narrowed or blocked coronary arteries or recognize an irregularly beating heart muscle. Most patients go home with a companion four hours after the cardiac catheter operation.

One thing is beyond dispute, says expert Katus: “After a heart attack, an immediate catheter operation makes sense.” The narrowed or closed vessel must be opened again quickly so that the blood optimally reaches all parts of the heart muscle.

Catheter examination to find the exact cause

Most catheter examinations, however, involve patients in stable condition with suspected heart disease. “The dilemma is that a sick heart is not clearly noticeable,” says Christian Butter, head of cardiology at the Immanuel Klinikum Bernau Heart Center Brandenburg.

The typical symptoms how shortness of breath and chest pain occur up to the shoulders also with other diseases on. For many people who suspect their hearts, there is something else behind it.

“If a woman in her mid-fifties presents herself in a difficult private and professional situation, who is slim and lives healthy, you have to examine exactly where the complaints are coming from,” says Butter.

Psychological suffering too how anxiety disorders and depression express themselves like that. A respiratory disease can also be behind it. More often than not, the problems simply come from a tense back. “The most important thing is therefore to talk to the patient,” says Butter.

Before a catheter operation, doctors have to prove that there is a circulatory disorder.“This is often neglected,” regrets Butter, “and patients are catheterized too quickly.” The guidelines initially recommend an exercise ECG. While the person concerned is pedaling an ergometer, the doctor records the cardiac currents.

In addition, there are more modern procedures today: Patients can even ride bicycles in a lateral position while the cardiologist studies the heart in the ultrasound image. A special computed tomogram, the coronary CT, also makes the heart visible. “Coronary CT is a sensible alternative, especially for people with inconspicuous previous findings, but where we still suspect a heart disease,” explains Eberhard von Hodenberg, chief physician at the MediClin Heart Center Lahr / Baden.

Second opinion in case of uncertainty

When in doubt, the expert advises Second opinion before a catheter operation. Many health insurance companies offer a corresponding service. Von Hodenberg himself works as a second mine for the Medexo company.

“It does happen that I advise against the procedure that the first-time user recommended,” he says. “It mostly concerns catheter interventions for heart valve diseases or hasty interventions for atrial fibrillation.” The classic cardiac catheter examination, however, is this Dilation of vessels. To do this, the cardiologist pumps you into the bottleneck tiny balloon with a pressure of up to 20 bar, ten times the pressure of a bicycle tire. So that the stretched vessel does not collapse again, he usually uses a subsequent one Stent an tunnel-shaped support for the vessel walls.

Treatments can now also be carried out via catheters that were previously only possible in an open heart surgery or not at all. The cardiologist can ein hole in the heart septum with a Umbrella shut down. He uses the fine probes to replace or repair heart valves.

Catheter specialists are also treating cardiac arrhythmias more and more frequently. Often it is only a few cell associations in the organ that throw it out of step. Cardiologists obliterate this disruptive tissue. Atrial fibrillation can often be resolved entirely in younger patients. “We have a success rate of 70 to 80 percent. That’s enormous, ”says Katus. “Those affected then have to take no or less medication.”

Less tightness, more air

Uwe Bartsch benefited from the procedure. The 65-year-old used to work as a politician, entrepreneur and electrician. “As a young man, I feared ventricular fibrillation after being electrocuted,” he says. But the stress, too much work, cigarettes, no exercise, soon being overweight and diabetes put a completely different strain on his heart. Cardiac arrhythmias plagued him over the years. “Then you wake up from the heartbeat. From 70 to 130, ”he says. The doctors had warned him: “You are on your way really fast, they always said.” He has been to the Bernau Heart Center almost a dozen times. The doctors tried to treat his arrhythmia with various methods. Nothing worked for long.

In the spring of 2019, they for the first time obliterated tissue on the inside of the heart muscle in a catheter procedure. Since then, Bartsch has had an Apple Watch and has been monitoring his own rhythm. “Everything has been fine up to now,” he says. “But I also lost weight from 130 to 95 kilos.”

This article was written by Susanne Donner, medical journalist

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