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Swan-Ganz — Right Heart Catheterization

Definition

Swan-Ganz catheterization is the passing of a thin tube (catheter) into the right side of the heart. The procedure is done to see blood movement through the heart and to monitor the heart's function in people who are very ill.

Alternative Names

Right heart catheterization; Catheterization - right heart

How the test is performed

The test can be done while you are in bed in an intensive care unit (ICU) of a hospital or in special procedure areas such as a cardiac catheterization laboratory.

Before the test starts, you will be given a mild sedative to help you relax.

An area of your body, usually the neck or groin, is cleaned and numbed with a local anesthetic. The health care provider will make a small cut in a vein in your neck or groin. Sometimes, it is done in another area. A thin hollow tube called a catheter is inserted through the cut and up into a vein. It is carefully moved up into the right atrium (upper chamber) of the heart. X-ray images help the doctor see where the catheter should be placed.

The catheter is threaded through two heart valves (the tricuspid and pulmonary valve) and placed into the pulmonary (lung) artery. Once in place, the blood pressure in the pulmonary artery is measured.

During the procedure, your heart's rhythm will be constantly watched using an electrocardiogram (ECG).

How to prepare for the test

You should not eat or drink anything for 8 hours before the test starts. You may need to stay in the hospital the night before the test. Otherwise, you will check in to the hospital the morning of the test.

In critically ill patients, the test may be done in the intensive care unit.

You will wear a hospital gown. You must sign a consent form before the test. Your health care provider will explain the procedure and its risks.

How the test will feel

You are awake during the test. You may feel some discomfort when the IV is placed into your arm and some pressure at the site when the catheter is inserted. In critically ill patients, the catheter may stay in place for several days.

Why the test is performed

The procedure is done to look at how the blood circulates (moves) in people who have:

• Heart failure
• Shock
• Leaky heart valves (valvular regurgitation)
• Congenital heart disease
• Burns
• Kidney disease

It may also be done to monitor for complications of heart attack and see how well certain heart medications are working.

Swan-Ganz catheterization can also be used to see abnormal blood flow between two usually unconnected areas (shunt).

Conditions that can also be diagnosed or evaluated with Swan-Ganz catheterization include pulmonary hypertension, cardiac tamponade, and restrictive cardiomyopathy.

Normal Values

• Pulmonary artery systolic pressure is 15 to 30 mmHg
• Pulmonary artery mean pressure is 9 to 17 mmHg
• Pulmonary diastolic pressure is 0 to 8 mmHg
• Pulmonary capillary wedge pressure is 5 to 15 mmHg
• Cardiac index is 2.4 to 4.2 L/min/M2
• Right atrial pressure is 0 to 8 mmHg

mmHg = millimeters of mercury

L/min/M2 = liters per minute per square meter (of body surface area).

What abnormal results mean

Abnormal results may indicate heart valve disease, circulatory flow problems such as heart failure or shock, or lung disease.

What the risks are

Risks of the procedure include:

• Bruising around the area where the catheter was inserted
• Injury to the vein
• Puncture to the lung if the neck or chest veins are used

Very rare complications include cardiac arrhythmias, cardiac tamponade, low blood pressure, infection, or embolism caused by blood clots at the tip of the catheter.

References

Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 7th ed. St. Louis, Mo; WB Saunders; 2005:401-402.

Review Date: 7/17/2006

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