Annual Studies
Cardiac Biopsy, Angiography and Catheterization, Bronchoscopy
The purpose of the cardiac biopsy and bronchoscopy has been explained in separate sections of the Web site. You are probably familiar with cardiac catheterization and coronary
angiograms
or bronchoscopies as procedures done before your transplant to assess your level of cardiac or pulmonary function and anatomy.During annual studies the cardiac biopsy is performed at the same time as the catheterization and coronary angiography.
Cardiac catheterization allows precise assessment of the function of your new heart. To perform the procedure, a small area of skin over a vessel (usually the right femoral artery in your groin area) is numbed with a local anesthetic and a catheter (long narrow plastic tube) is advanced through a small skin puncture, with fluoroscopic assistance, through the body to the base of the heart.
The catheter tip is inserted into the mouths of the right and left coronary arteries (one at a time) and the dye is injected. As the dye flows down the arteries and opacifies them, films or angiograms are made and, when developed, demonstrate any areas of narrowing or arteriosclerosis in the walls of these vessels.
The catheter is also advanced through the aortic valve into the main pumping chamber or left ventricle where an injection of dye allows filming of the contours of this chamber as it beats.
Baseline coronary arteriograms may be performed at the time of discharge (except in pediatric patients) and will be compared on a yearly basis with subsequent studies to detect the possible development of coronary artery narrowings.
Occasionally, your doctor may choose to substitute a "DSE" (dobutamine stress echo) for the coronary arteriogram. During this study an intravenous dose of dobutamine is given to increase your heart rate.
An echo is then performed to determine if any change in ventricular function is present that may be due to coronary disease. If the DSE is abnormal, you may then be scheduled for a coronary arteriogram.
Instruction for Angiographic Studies
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Before Hospital Admission
If you take coumadin, consult your physician about timing for discontinuing it prior to catheterization. This decreases the possibility of bleeding following the procedures. Otherwise you should continue taking all medications as you usually do.
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Pre-Procedure
Before the angiograms, your right neck and groin will be shaved, and an IV will be started to administer fluids to assure adequate hydration and urine flow to minimize the toxicity of the angiographic dye on the kidneys.
You should try to drink more fluids the evening before the angiogram to further insure adequate hydration and circulating blood volume.
Do not take diuretics the morning of the procedures. It is desirable to have adequate circulating fluid volume for performing the angiogram and for diluting the dye. Diuretics, which increase urination, might also pose some inconvenience during the procedures.
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Post-Procedure
Following the angiogram, you will return to a hospital room or holding area. Your vital signs are taken frequently for several hours. This includes checking your blood pressure, heart rate, neck and groin entry sites, and the pulses of both feet.
You will be flat in bed for approximately six hours without bending your right leg or lifting your head. This reduces the risk of bleeding at the catheter insertion sites. The head of the bed may be elevated slightly (up to 30 degrees) if no bleeding occurs.
You may be advised to drink extra fluids over the first six hours following the angiography (or as specified by your physician). The dye is excreted from the body through the kidneys and is less irritating to the kidney tissue when diluted by increased fluid volume. Intravenous hydration will also be continued.
Diuretics may be taken following the procedures unless otherwise instructed. You should not shower for 24 hours and should avoid strenuous activity or lifting heavy objects for 24 to 48 hours.
General Instructions
After discharge from the Stanford area, you will be asked to return to Stanford for studies every year around the anniversary of your transplant. These studies may include routine cardiac biopsy, coronary angiography or DSE, cardiac catheterization, ECG, urinalysis, blood work and chest x-ray.
The studies are usually completed within two days, and will not require an overnight in hospital stay. Additional studies will be scheduled for the pulmonary transplant patients to evaluate their pulmonary status. The tests will evaluate lung capacity and blood oxygenation in the resting state and following exercise.
In order to optimize the ongoing care of the transplant population and to help advance aspects of transplant medicine, you may be asked to participate in various research studies at the time of your annual checkup. You are, of course, free to accept or decline such requests without any change in your basic medical care.
Bring a supply of your routine medications to the hospital. You will be responsible for continuing your own medication regimen during your visit. Do not bring tranquilizers, sleeping pills or pain pills. Hospital policy requires that a nurse administer these types of medications.
At any time between hospital visits, if you notice a change in your health or have questions regarding any aspects of your care, please contact your physician or the transplant nurse coordinators at the Department of Cardiothoracic Surgery. Phone (650) 723-5771.