Dr Jyoti Prakash
Consultant Interventional Cardiologist
Paras Global Hospital

Cath Labs Heading for ExpoNential Rise

Most modern angiography systems offer rotational 3D angiography, which uses a quick spin around the patient to create a 3D image of the structure. Some systems allow these 3D images to be overlaid or fused with the live 2D fluoroscopic images.

Cardiovascular diseases are the leading cause of mortality in India, with 30 percent of deaths attributed to the disease. It is estimated that 10 percent of the urban adult population and 5 percent of the rural adult population suffer from some form of heart diseases and 20–30 percent of them require specialized investigation and treatment. Cardiac catheterization laboratory is the place where majority of cardiovascular diseases are diagnosed and treated.

Major components of the cath lab include the C-arm which is either floor-mounted or ceiling-suspended and carries the X-ray tube and the detector, encircles the patient table and are movable; the X-ray tube which generates the X-ray pulses; and the X-ray detecting device or detector. In older cath lab systems an image intensifier is used, but in newer models, a flat panel detector replaces the image intensifier. For cardiac angiography and valvular procedures a single-plane machine with a small or medium detector is sufficient. In cardiac electrophysiology and neurological procedures, a bi-plane system with a large detector is a better choice.

Cath lab equipment requires optimal temperature and humidity control for proper functioning. In addition, one has to take AMC (annual maintenance contract) or CMC (comprehensive maintenance contract) from the company for any malfunctioning. Philips, GE Healthcare, Siemens Healthineers, and Allengers Medical Systems Limited are major vendors in the Indian cath lab market.

There are many advances occurring in cath labs. Next-generation cath labs will improve operator performance, enable more complex procedures, improve patient and operator safety, and expand the use of minimally invasive cardiovascular procedures into new areas. Most modern angiography systems offer rotational 3D angiography, which uses a quick spin around the patient to create a 3D image of the structure. Some systems allow these 3D images to be overlaid or fused with the live 2D fluoroscopic images. This fusion technology is used with planning and navigation software to better guide the procedures. There will be also introduction of free-floating holographic imaging, which will allow image projections in the cath lab above the patient where the image can be rotated or sliced through any axis.

The last 5 years have seen a major growth in the number of cath labs and cardiac interventions in India. According to the NIC database there were 539 cardiac cath labs in 2012 which increased to 1200 labs in 2016. With increasing population and growing cardiovascular diseases, we expect exponential increase in the number of cath labs in the country. Cardiovascular procedures are mainly emergency procedures so time is the key. It is therefore necessary to do the procedure as early as possible. This can be done only if cath labs are present in smaller places. With increasing government support like Ayushman Bharat, National Health Protection Mission, and decreasing cost of procedures we can see cath labs in smaller places and hospitals.

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