Hello, welcome everybody. This is Dr. Bolad, board certified physician in cardiology, interventional
cardiology and internal medicine. I am here to help you with all the information you need for
your heart health and general health and informing you about all the latest treatments in cardiology
and medicine. If you are new to this channel, then definitely consider hitting the subscribe button
below and switch on the notification bell so you don't miss any new video that I post. For my
international viewers outside the United States, you can get translated subtitles for this video
by pressing the closed caption CC button on the upper right part of your mobile device screen
and selecting your preferred language from the settings. Previously I made a video
called "Heart Catheterization Surgery" where I concentrated on the left heart catheterization and
at that time I promised to returnn later to Right Heart Catheterization. In this video, I will talk
to you about Right Heart Catheterization. This is the passage of a catheter to measure pressure and
oxygen saturations in the right heart chambers. When you hear the word cardiac catheterization,
this generally refers to left heart catheterization in which catheters are
passed to the left side of the heart, to evaluate the left left heart pressures and look into the
coronary arteries. Right heart catheterization is strictly evaluating the right side of the heart,
as shown in the image on the left side of the screen, evaluating the Right Atrium,
the Right Ventricle and the Pulmonary Arteries, all colored purple in this image.
To give an overview as shown in this image, venous blood returns from the legs and lower body
via the Inferior Vena Cava, and from the head via the Superior Vena Cava,
returns to the Right Atrium. Blood is then pumped through the Tricuspid valve to the Right
Ventricle. Blood is then pumped through the Pulmonary Valve to the Pulmonary arteries
which delivers blood to the lungs. In the lungs, blood get oxygenated and is then delivered to the
Left Atrium. Blood is then pumped to the Left Ventricle through the Mitral Valve.
From the Left Ventricle, Blood is pumped through the Aortic valve to the rest of
the body. A schematic representation of what happens is shown here on this image, which shows
the right and the left sided circulations are working in series. In this video,
I will concentrate on evaluating the right side of the heart by cardiac catheterization.
The right side of the heart receives deoxygenated blood from the head and lower body and the blood
is passed through the chambers of the heart and eventually delivered to the left side
of the heart, to the Left Atrium as shown on this diagram. We perform Right Heart Catheterization to
differentiate different causes of shock, which is the rapid drop in blood pressure, and whether the
shock is cardiogenic, meaning caused by the heart, or hypovolemic due to low fluid or blood volume,
or distributive due to infection, or obstructive due to a massive pulmonary
clot referred to as pulmonary embolism, obstructing flow of blood to the lungs.
Right heart catheterization is also done to differentiate between the causes of why
fluid accumulates in the lungs and whether the heart is a contributing factor.
We also perform right heart catheterization to evaluate
the cardiac output of how many liters of blood the heart is pumping per minute,
to measure the blood pressure in the pulmonary arteries,
to diagnose heart shunts and holes in the heart and to evaluate unexplained shortness of breath.
Here is how I perform the procedure. The patient is brought to the cardiac catheterization
laboratory and access to the right sided circulation is gained through the venous system
and a short access sheath is placed. Access can be obtained through the femoral veins
in the legs as can be seen here. Alternatively venous access can also be obtained through
the jugular vein in the neck and also through the arm veins or subclavian veins.
The catheter is then used to go all the way up to the Right Atrium. A commonly used catheter
for this purpose is the Swan-Ganz catheter. As shown here, this catheter is taken all
the way up to the Right Atrium and the pressure measured and if needed blood samples to measure
oxygen saturations is taken. This is what I see on the monitor when I perform the procedure
and here is a schematic representation of how it should look.
I then guide my catheter to the Right Ventricular and this is what I see on the monitor
and here is a schematic representation of how it should look.
I then pass my catheter up from the right ventricle to the pulmonary artery
as can be seen here in this video.
This is the pulmonary artery pressure that I see
in the monitor in front of me and here is a schematic representation of how it should look.
I then inflate the balloon at the tip of the Swan-Ganz catheter and push it further
to the pulmonary artery branches to wedge it and to get the "Pulmonary Artery Wedge
Pressure". This is the pulmonary artery pressure that I see in the monitor in front of me
and here is a schematic representation of how it should look. I then deflate the balloon and make
sure that I have documented all the pressures and taken all the blood samples to measure the oxygen
saturations in the different chambers of the right side of the heart. If this is complete, then I
remove my catheter and then remove the access sheath and apply gentle pressure to maintain
hemostasis in the access vein. This would conclude the right heart catheterization procedure.
If you have any question about what I presented to you today or any medical question in general, then
subscribe to my channel and share your question in the comments section below and I will reply
to you. If you have a question that you would not like to share in public, then subscribe to this
channel, follow me on Twitter at DoctorBolad and send me a private Twitter Direct Message
and I will reply to you. Please like and share this message with family and friends, this is
Doctor Bolad helping you with your heart health, thanks for watching and talk to you soon you.