What is Right Heart Catheterization?

Right heart catheterization, also known as Swan-Ganz catheterization or pulmonary artery catheterization, is a medical procedure used to monitor blood pressure and flow within the heart. It is less common than left heart catheterization and is used primarily in patients who have a critical illness or heart abnormality. During the procedure, a cardiologist guides a catheter into the right side of the patient's heart and the pulmonary artery, where it gathers information such as blood pressure.

Patients who have any of a variety of conditions can benefit from right heart catheterization. Sometimes this procedure is done in order to evaluate kidney abnormalities that don’t respond to medicine or to monitor patients who have pulmonary edema. Another example is patients who have extremely low blood pressure. If this low blood pressure, or shock, continues in spite of receiving fluids and medicine, this type of cardiac catheterization might be necessary to diagnose the problem.

In addition, heart disease or heart abnormalities are often evaluated and even treated by using right heart catheterization. For instance, valvular regurgitation, in which the heart valves do not close properly, can be easily diagnosed with this type of procedure. Right heart catheterization can also help doctors evaluate patients who have fluid around the heart.

Unlike left heart catheterization, right heart catheterization is performed primarily on critically ill patients. During the procedure, the patient’s heart is constantly monitored by an electrocardiogram. Patients receive a mild sedative and a local anesthetic but not general anesthesia.

To get the catheter to the pulmonary artery, it must first be inserted in a vein in the neck or groin area. Eventually, the catheter goes into the heart’s right atrium, passes through the tricuspid valve and the pulmonary valves and enters the pulmonary artery. After it is there, the catheter is used to measure both blood pressure and lung pressure.

One major complication of a right heart catheterization is a punctured lung, also called pneumothorax. The catheter is guided through veins very near the lungs, so the catheter might poke through the wall of the vein and puncture a lung. The risk is greater when the cardiologist inserts the catheter through a vein in the neck.

Other risks of right heart catheterization include pain during placement, infection and bleeding. Occasionally, a blood clot forms inside the vein during catheterization, but it usually dissolves when the catheter is removed. In extremely rare occasions, air enters the veins through the catheter, causing a dangerous air embolism. Less than 5 percent of patients experience any serious complications.