Society for Cardiac Angiography Officers and Trustees
Cardiac catheterization and angiography should be planned carefully, as should all diagnostic procedures, in order to answer the questions raised by preliminary clinical evaluation, to best define the therapeutic alternatives available, and to minimize patient risk, discomfort, and cost. No procedure should be strictly routine; each must be carried out according to the special problems presented by the individual clinical situation. Each component of the procedure should be expected to provide useful information.
The Society for Cardiac Angiography is concerned with establishing and maintaining standards of high quality for the performance of procedures in cardiac catheterization laboratories. In this regard, the Laboratory Performance Standards Committee has drawn attention to the potential abuse of right heart catheterization and/or temporary pacemaker insertion in conjunction with routine coronary arteriography when these procedures do not have a specific indication and generate an additional fee.
Right heart catheterization is properly employed to evaluate the functional or hemodynamic consequences of known or suspected cardiac conditions. These may include but are not limited to congenital heart disease, valvular heart disease, left heart failure or decompensation, previous myocardial infarction, cardiomyopathy, or other clinical conditions in which a substantial cardiac abnormality may exist.
Right heart catheterization is not ordinarily indicated in the evaluation of patients with known or suspected coronary heart disease unless there are complicating features such as a history of congestive heart failure, suspicion of postinfarction mitral insufficiency, ventricular septa1 defect, etc. In some teaching institutions, right heart catheterization serves as an important research and teaching function, but right heart catheterization performed routinely as a part of every selective coronary arteriographic procedure is unwarrranted because of the added unnecessary risk and increased costs engendered. Even if there is no additional professional fee generated, radiation exposure and laboratory and personnel time are increased and more catheters and supplies are required.