Cardiac Catheterization Laboratory

The Cardiac Catheterization Laboratory at the Walter Reed National Military Medical Center Bethesda performs state-of-the-art invasive diagnostic and therapeutic procedures to address a wide range of cardiac conditions. Our lab is staffed by a team of professionals on call 24 hours a day to quickly respond to any emergencies that may occur. As part of the Cardiovascular Health and Interventional Radiology service, we work closely with Cardiothoracic Surgery, Vascular Surgery and Interventional Radiology. Here are just some of the therapies that we offer and perform here at the WRNMMC cath lab:

• Cardiac Catheterization: During a cardiac catheterization, a small catheter (or tube) is threaded through your blood vessels to the heart or vital organs. Using X-rays and injecting a contrast agent, we can diagnose conditions such as blockages in your coronary arteries from cholesterol plaques or life-threatening blood clots. Pressures in the different chambers of the heart can be measured and analyzed.
• Angioplasty and Stenting: Should cardiac catheterization reveal that there are blockages in the coronary arteries that require treatment, Angioplasty and Stenting can be performed. During Angioplasty, a small balloon is inflated inside the blockage, opening up the vessel and restoring blood flow to the heart muscle. Stenting involves the insertion of a metal mesh tube (called a stent) to re-establish normal blood flow and to keep the vessels open. Sometimes, the interventional cardiologist may choose a stent coated with special medication which can help prevent excessive scar tissue from building up inside the stent, thereby improving long-term results.
• Fractional Flow Reserve (FFR): If a person has a blockage in one of their coronary arteries that does not obviously limit blood flow (such as a 50-70% narrowing), FFR can help determine if further treatment with stenting is necessary. A sensitive wire is carefully threaded across the blockage. If a major change in pressure is detected, then a stenting procedure may be necessary. If the pressure is the same, then a stent may be avoided.
• Intravascular Ultrasound: A tiny ultrasound probe is maneuvered down the blood vessel and pictures of the vessel are taken from the inside. This can help better diagnose certain conditions, such as tears in the vessel wall, and the amount of blockage within an artery. It can also help the interventional cardiologist place stents and evaluate the result in real time.
• Thrombectomy: Some blockages in the coronary arteries are soft and due to blood clots. These can be aspirated (literally sucked out) via a tiny vacuum tube that is advanced down the vessel. This is known as “aspiration thrombectomy.” Other blockages are very hard due to calcium buildup, and cannot be opened with a balloon. We can use a Rotablator device, which is a tiny diamond-tipped drill, to cut through the plaque and restore blood flow.
• Cardiac Assist Devices: In the critically ill patient, medications alone may not be enough to support adequate blood flow. We offer two therapies which may, in some cases, be life-saving. The Impella support device is the smallest heart pump used today. It is inserted into the heart via a catheter, and can provide extra cardiac support in special circumstances. Another device, the Intraaortic Balloon Pump, may also be inserted into the main blood vessel just outside the heart, and can provide support in critical situations as well.
• Atrial Septal Defect / Patent Foramen Ovale (ASD/PFO) closure: Some patients are born with a defect, or hole, in the atrial septum. This is a thin wall which separates the right upper chamber of the heart from the left upper chamber. Sometimes, this can result in an abnormal pressure buildup in the right side of the heart. It can also result in abnormal heart rhythms, permanent changes in the heart’s size, heart failure and stroke. In some cases, these defects can be closed without open heart surgery, via an IV placed in the leg. We use the Amplatzer Septal Occluder system to manage patients with ASD/PFO who are at risk for these complications.
• Electrophysiology and Pacemakers: Our Electrophysiology service provides a wide variety of services, such as pacemaker and implantable cardiac defibrillator insertion, and arrhythmia ablation procedures. Please take a look at their web page for more information.
• Peripheral Vascular Disease (PVD): The buildup in plaque inside blood vessels which supply the arms, legs, brain and other organs can result in a variety of conditions, such as pain in the legs with walking (claudication), ulcers of the legs and feet (critical limb ischemia), and decreased oxygen to the brain (stroke). We offer a variety of services for patients with suspected PVD, including angiography, angioplasty, and stenting.