什么是右心导管伴心脏组织活检?

Right-heart catheterization (often abbreviated as ”right heart cath”) with heart tissue biopsy is a procedure in which your doctor takes tissue samples directly from your heart muscle.

In a right-heart cath, 你的医生引导一个特殊的导管(一个小的, 细管)进入心脏的右侧. 导管插入你的肺动脉. 这是将血液输送到肺部的主要动脉. 当导管进入你的肺动脉时, your doctor measures pressures in your right atrium (right upper heart chamber) and right ventricle (right lower heart chamber). In some cases, your doctor gives you intravenous (IV) heart medicines during the right-heart cath to see how your heart responds. For example, 如果你的肺动脉压力很高, 医生可能会给你开一些扩张剂, or relax, 血管在你的肺部和帮助降低压力. Healthcare providers will take several pressure readings  during the procedure to measure your body's response to the medicines.

Your doctor can take indirect measurements of pressures in the left side of your heart, 通过在导管的尖端充气一个小气球. The amount of blood your heart pumps per minute is also measured during a right-heart catheterization.  

你的医生通常在右心导管末端做活检. 另一个导管插入静脉，通常在你的脖子上. 导管的末端是采集组织样本的工具. The tiny pieces of heart tissue are sent to the lab for examination under a microscope. Doctors, known as pathologists, 在显微镜下检查你的组织是否有感染的迹象, inflammation, or abnormal cells. 你的医生会做活检，看看你的心脏组织是否正常.

为什么我可能需要右心导管穿刺和心脏组织活检?

活检可用于:  

• Diagnose the cause of heart failure or heart disease, such as dilated cardiomyopathy. 这是由细菌或病毒感染引起的. 该方法还可以诊断限制性心肌病, 由许多不同的情况引起，如淀粉样变. Amyloidosis is caused by irregular deposits of proteins in the heart that affect the contraction and relaxation of the heart muscle. 了解心力衰竭的原因可以帮助确定治疗计划. 
• 确定你的心脏对心力衰竭治疗的反应是好是坏. Your healthcare team may need the information to adjust medicines used to treat heart failure.
• 评估心脏移植后的心脏组织, 确保你的身体不会排斥移植的(供体)心脏.

A right-heart cath with biopsy may also be needed as part of your evaluation before a heart transplant. Pressures in your lungs need to be as low as possible for a donor heart to work as well as possible. 压力过大会使新的(供体)心脏难以有效地跳动. A right- heart cath will help to see if pulmonary pressures can be decreased with medicines (vasodilators) to ensure successful transplantation. 

Your healthcare provider may have other reasons to recommend a right-heart cath with biopsy.

右心导管穿刺合并心脏组织活检的风险是什么?

右心导管穿刺活检可能存在的风险包括:

• 导管插入处的皮肤擦伤
• 因插入导管时刺穿静脉而出血过多
• Pneumothorax (partial collapse of the lung) if the catheter is inserted into your neck or chest veins.
• Perforation of the wall of your heart after pieces of tissue are removed from the ventricle (the lower pumping chamber of the heart)

其他罕见的并发症包括:

• Abnormal heart rhythms, 如室性心动过速(下心室心率过快)
• Cardiac tamponade (fluid buildup around the heart that affects its ability to pump blood effectively), 很少导致死亡
• Low blood pressure
• 三尖瓣损伤(心脏右侧的瓣膜)
• Infection
• 空气栓塞(空气泄漏到心脏或胸部)，很少导致死亡
• 导管末端的血凝块会阻碍血液流动
• 肺动脉破裂(肺部大动脉损伤), 这会导致严重出血并使人呼吸困难)。
• Nerve damage

For some people, having to lie still on the cardiac catheterization table for the length of the procedure may cause some discomfort or back pain.

根据您的具体医疗状况，可能会有其他风险.  请务必在手术前与您的医疗保健提供者讨论任何问题. 

我该如何为右心导管穿刺和心脏组织活检做准备?

• Your healthcare provider will explain the procedure to you and you can ask questions.
• 您将被要求签署一份同意书，允许您进行测试. 仔细阅读表格，如果有不清楚的地方就问问题.
• Tell your healthcare provider if you are sensitive to or are allergic to any medicines, latex, tape, 或麻醉剂(局部和全身).
• 如果你怀孕了或认为你可能怀孕了，你应该告诉你的医疗保健提供者.
• Tell your healthcare provider of all medicines (prescription and over-the-counter) and herbal supplements that you are taking.
• 如果你有出血性疾病的病史，告诉你的医生, 或者如果你正在服用任何抗凝血剂(血液稀释)药物，如华法林, aspirin, 或者其他影响血液凝固的药物. 你可能需要在手术前停药.
• 如果你有心脏起搏器，告诉你的医生, 植入式除颤器, 或者其他植入设备.
• 如果你有一个人工心脏瓣膜, your healthcare provider will decide if you should stop taking warfarin before the procedure. 
• You may be asked not to eat or drink anything after midnight or within 8 hours before the procedure.

根据您的医疗状况，您的医生可能会要求您进行其他特定的准备.

右心导管穿刺和心脏组织活检会发生什么?

Your doctor will do the right-heart cath with biopsy in the cardiac cath lab or in a special department.  If you are critically ill, your doctor may give you the test in the intensive care unit (ICU). A right-heart cath may be done on an outpatient basis or as part of your hospital stay. 手术过程可能会根据你的情况和医生的做法而有所不同.

• You will need to remove any jewelry or other objects that may interfere with the procedure. 如果你使用假牙或助听器，你可以戴假牙或助听器.
• 你需要脱下衣服，换上一件长袍.
• 手术前你需要排空膀胱.
• An IV line will be started in your hand or arm before the procedure to inject medicine, and give fluids, if needed.
• 你要仰面躺在手术台上.
• 你将被连接到一个心电图监视器上. 心电图记录了手术过程中心脏的电活动, through small, adhesive electrodes. 你的医生会密切监测你的生命体征(心率), blood pressure, breathing rate, 和氧合水平).
• 该手术一般不需要镇静, 但是医生可能会给你开一些药来帮助你放松.
• 如果要用你的颈静脉, you will be asked to turn your head away from the insertion site to help the doctor locate the proper location to insert the catheter.
• 如果使用颈部静脉，将在胸部和颈部放置无菌毛巾. 
• 如果你的腹股沟被使用，无菌毛巾将被放置在腹股沟区域. 
• 将清洗插入部位的皮肤，并用局部麻醉剂麻醉. 将使用一根小针来寻找静脉. 接下来，一根被称为导管的细管将被插入静脉. You may feel some burning or stinging when the numbing medicine is given and some pressure when the needle punctures your vein.
• Your doctor will place an introducer sheath (a slightly larger, hollow tube) into your vein first. 接下来，他或她将把活检导管插入导入器. 当介绍人被放置时，你可能会感到一些压力. You may hear sounds as tissue samples are taken from the heart, but you should not feel any pain. 活检只取非常少量的组织. 
• 当取组织样本时，你可能会有一种拉扯的感觉.
• 如果同时做右心导管, 另一个导管将穿过你的右心房, right ventricle, 进入肺动脉. 测量心脏和肺的压力. 特殊的药物可以通过静脉注射来评估我们心脏的反应. 监测心脏对药物的反应可能需要大约30分钟.
• 一旦你的医生从你的组织样本和心脏压力中得到信息, 导管和引入器将被移除, unless your doctors decide you need additional monitoring in the ICU or post procedure recovery area.

右心导管穿刺和心脏组织活检后会发生什么?

医务人员会在插入部位按压一到两分钟, 确保你没有流血. 如果导管插入了你的腹股沟静脉, 将压力放置在插入部位上几分钟.

如果你的颈部静脉被使用(最常见的)，你将能够舒适地坐起来. 如果手术用到了你的腹股沟, 你必须平躺在床上几个小时, 这样穿刺部位就能正常愈合.

手术后你可以正常饮食. Your healthcare provider will monitor the insertion site for bleeding and check your blood pressure, heart rate, 在你恢复的时候呼吸. 如果你有任何胸痛或呼吸困难，让你的医疗保健提供者知道.

The biopsy samples will be sent to a lab for final evaluation; this may take a few days. Your doctor will discuss the results of the right-heart cath and the plan for treatment if needed.

The length of time you’ll need to stay after the procedure will depend on the location of the insertion site. 如果你的颈静脉被使用, 你很快就可以出院了, 如果出血部位在几分钟内停止. 如果使用了腹股沟部位, 你将被留院观察几个小时，以确保伤口止血.

Once at home, 你应该监测插入部位是否出血, unusual pain, swelling, 以及异常变色或温度变化, 在插入部位或附近. 有一点擦伤是正常的. If you notice a constant or large amount of blood at the site that cannot be contained with a small bandage or dressing, 告诉你的医疗保健提供者.

保持插入部位的清洁和干燥是很重要的. 你的医疗保健提供者会给你具体的洗澡指导.

你可能会被告知不要参加任何剧烈的活动. Your healthcare provider will instruct you about when you can return to work and resume normal activities.

告诉您的医疗保健提供者报告以下任何情况:

• 呼吸短促或呼吸困难
• 体温大于或等于100度的发烧.4°F (38°C) or chills
• Increased pain, redness, swelling, or bleeding or other drainage from the insertion site
• 受累肢体出现冰凉、麻木或刺痛或其他变化
• 胸痛或压痛、恶心或呕吐、大量出汗、头晕或昏厥

您的医疗保健提供者可能会在手术后给您其他指示, 取决于你的情况.

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