Left Heart Cardiac Catheterization
Intisar Ahmed, Said Hajouli
Abstract
Cardiac catheterization is an invasive procedure that has evolved over the past four centuries. Although the description of circulation by William Harvey was the cornerstone of cardiac hemodynamics, Stephen Hales can be considered the pioneer of cardiac hemodynamics and cardiac catheterization as he measured the first arterial pressure in the early 17 century. Initial development in cardiac catheterization is based on experiments on animals. Werner Forssmann performed the first human right cardiac catheterization in 1929. Zimmermann HA performed the first left-sided cardiac catheterization in the 1950s. Cardiac catheterization evolved extensively in the 20th century due to Andre Cournard and Dickinson Williams and many other researchers' efforts. After the initial work and development of cardiac catheterization, William Sores described the first selective coronary angiogram when he incidentally injected contrast in the right coronary artery's ostium while doing an aortogram. Over the preceding few decades, the evolution of radiographic and catheter-based techniques has revolutionized left heart catheterization.Left heart catheterization has a diagnostic as well as therapeutic role. Although it is used for cardiac hemodynamics and assessment of valvular lesions, its main diagnostic role is the assessment of coronary artery disease. In the contemporary era, left heart catheterization, especially selective coronary angiogram, is considered the gold standard test for coronary artery disease diagnosis. The therapeutic role of left heart catheterization has evolved extensively over the last five decades. Apart from percutaneous coronary intervention, left heart catheterization plays an essential role in the closure of congenital defects, radiofrequency ablation of arrhythmias, and valve replacement in the contemporary era.In this article, we will summarize the anatomy, physiology, and indications of left heart catheterization. We will also discuss the basic technique, procedural complications, and clinical significance of left heart catheterization.