Q&A: Cardiac catheterization for cancer patients

A cardiac catheterization laboratory contains specialized technology that benefits cancer patients when they need more thorough cardiac evaluations and certain procedures. Cezar Iliescu, M.D., assistant professor in Cardiology, answers questions about this technology and why it's an important asset in a cancer center.

What is a cardiac catheterization?

Cardiac catheterization is a minimally invasive procedure that allows physicians to evaluate blood circulation and the condition of the heart's chambers. A thin, flexible tube, the catheter is inserted into an artery or vein in the patient's arm or groin, then gently moved farther into the arteries of the heart. Contrast agents are then injected and pictures (coronary angiograms) in various angulations are projected on a computer screen.

Is it strictly for diagnostic purposes?

No, it can be used for both diagnostic purposes and treatment. It helps recognize heart failure, pulmonary hypertension and valve disease, among other heart problems. It can also be used to implant pacemakers, defibrillators and intra-aortic balloon pumps, as well as perform pericardiocentesis (a procedure that uses a needle to remove fluid surrounding the heart) and endomyocardial biopsies (a procedure for patients with possible heart failure after chemotherapy, where a minimal piece of heart muscle is analyzed under the microscope).  

Why is it important to have a cath lab in a cancer center?

As a result of their disease and the treatments they receive, cancer patients are different from regular cardiovascular patients. With the cath lab at MD Anderson, we can care for our patients and tailor their treatments using state-of-the-art cardiovascular equipment. We can judge the appropriate time to do an intervention, which creates a lower risk of complications surrounding chemotherapy or surgery.

What is a specific example of the use of a cath lab?

With the equipment in a cath lab we can assess and treat cancer patients for heart failure (related to the chemotherapy). We can evaluate their volume status (right heart catheterization) and the coronary artery anatomy (left heart catheterization and selective coronary angiogram). If needed, in a nonischemic cardiomyopathy patient (one with a disease of the heart muscle) with decreased ejection fraction (not pumping enough blood), we can implant an automatic implantable cardioverter defibrillator (AICD). If a patient starts to have life-threatening arrhythmia or an abnormally high heart rate, the AICD gives the heart a shock that helps it start beating normally again.

For patient Mark Wood, who developed heart complications during surgery for melanoma, the cath lab proved to be life-saving technology. His results showed severe left main coronary artery disease. Given his condition, bypass surgery was too much of a risk. And because he was still in a coma, doctors decided to place a stent in his artery to keep it open. Today, he is free of melanoma and the tumor. He has fully recovered from his heart condition.

What types of research can you carry out?

Our first goal is to make sure that the research project is safe for our patients.

• In one research project, we're following patients with thrombocytopenia (low platelet count), and we evaluate the safety of procedures in this high-risk subgroup.
• In another research project, to decide the best time for valve surgery (tricuspid valve and sometimes pulmonic), we're looking at patients with carcinoid heart disease and measuring the pressure parameters in heart chambers and echocardiographic parameters (ultrasound waves to create an image of the heart muscle).
• Another research project being conducted with cath lab technology is using biopsies to identify toxicities from chemotherapy and create pathways to prevent heart damage.
• There are other tools available in the cath lab that help us gain knowledge about the simultaneous management of cancer and heart disease.