Right Heart Catheterisation in India
Right heart catheterisation in India from $1,500. Diagnostic cardiac catheterisation for CHD and pulmonary hypertension. Apollo, AIIMS, Medanta.
Estimated cost: $1,500 – $3,500 · Average stay: 1–2 days
Right heart catheterisation (RHC) is an invasive diagnostic procedure that directly measures pressures and oxygen saturations in the right atrium, right ventricle, pulmonary artery, and pulmonary capillary wedge position. It is the gold standard for quantifying haemodynamics in children with congenital heart disease (CHD) and pulmonary arterial hypertension (PAH).
RHC provides data essential for: surgical candidacy assessment before cardiac operations, monitoring disease progression in pulmonary hypertension, assessing the response to pulmonary vasodilator therapy (vasoreactivity testing), and planning Fontan palliation.
India's paediatric catheterisation laboratories at Apollo, AIIMS, Sri Jayadeva, and Medanta perform RHC as a routine service. Combined with interventional procedures (balloon dilation, stenting, device closure), India's catheterisation units provide comprehensive paediatric cardiac catheter services.
What Does Right Heart Catheterisation Measure?
RHC directly measures: right atrial pressure (RAP), right ventricular pressure (RVP), pulmonary artery pressure (PAP — systolic, diastolic, mean), pulmonary capillary wedge pressure (PCWP, an estimate of left atrial pressure), and cardiac output (by thermodilution or Fick method). From these measurements, pulmonary vascular resistance (PVR) and systemic vascular resistance (SVR) are calculated.
Oximetry run (oxygen saturation sampling from all chambers and vessels) quantifies shunt magnitude (Qp:Qs) and precisely locates the level of shunting. This is critical for surgical planning in CHD.
Vasoreactivity testing uses inhaled nitric oxide (iNO), oxygen, or intravenous adenosine to test whether elevated PAP falls in response to vasodilators — determining whether PAH is reversible (surgical treatment is appropriate) or fixed (surgery is contraindicated).
When is RHC Required?
RHC is indicated for: pre-operative assessment of CHD when pulmonary hypertension is suspected (to assess operability), diagnosis and severity assessment of pulmonary arterial hypertension, monitoring response to PAH therapy, Fontan candidacy assessment, and evaluation of unexplained heart failure. RHC is the mandatory prerequisite before advanced PAH therapy (sildenafil, bosentan, epoprostenol) and before lung transplantation assessment.
How is RHC Performed?
Under general anaesthesia (for children) or sedation, a 4–7 French catheter sheath is placed in the femoral vein (or jugular vein in small infants). A balloon-tipped catheter is advanced through the right atrium and right ventricle into the pulmonary artery by flow direction. Pressure measurements and blood oxygen saturations are obtained from each location. If vasoreactivity testing is required, iNO is administered and measurements repeated.
For diagnostic cardiac catheterisation in CHD, additional catheters may be placed from the femoral artery to measure aortic and left heart pressures. Selective angiograms of the pulmonary arteries, aorta, and ventricles are performed.
Procedure Steps
- Pre-procedure: echocardiogram; full blood count; coagulation; fasting.
- Anaesthesia: general anaesthesia for children <12 years; sedation for adolescents.
- Femoral vein (and artery if required) access under ultrasound guidance.
- Catheter advanced to right atrium, RV, PA, PCWP position.
- Pressure measurements: baseline haemodynamics in room air and on oxygen.
- Oximetry run: blood sampling from all chambers for Qp:Qs calculation.
- Vasoreactivity testing: iNO administered if pulmonary hypertension present.
- Angiography: selective injections of contrast for anatomical imaging.
- Sheath removal; groin compression; 4–6 hours observation.
- Results reviewed with cardiology and surgical team; management plan formulated.
Cost Comparison Worldwide
Country — Range — Savings
--- — --- — ---
India — $1,500 – $3,500 — Save 80%
UAE — $3,500 – $7,000 — Save 65%
United States — $8,000 – $20,000 — —
United Kingdom — $5,000 – $12,000 — —
RHC in India costs $1,500–$3,500 for diagnostic catheterisation with oximetry run and vasoreactivity testing. Combined diagnostic and interventional catheterisation costs $3,000–$6,500. These are 75–80% cheaper than equivalent Western procedures.
Recovery & Follow-up
RHC recovery: observation for 4–6 hours; discharge same day or next morning. Femoral puncture site must be compressed for 15–20 minutes; bed rest for 4 hours. Return to normal activity the next day. Mild groin bruising resolves within 1–2 weeks.
Recovery Tips
- Maintain pressure dressing on the femoral puncture site for 4 hours.
- Bed rest for 4 hours after the procedure to prevent groin haematoma.
- Stay well hydrated to flush the contrast dye.
- Return to full activity the next day.
- Report any increasing swelling, pain, or pulsatile mass at the groin puncture site.
Risks & Complications
RHC risks are low at experienced centres: femoral artery or vein injury (<1%), cardiac perforation (rare), arrhythmia during catheter manipulation (usually transient), contrast allergy, and radiation exposure. General anaesthesia carries standard paediatric risks.
Why GAF Healthcare
Gaf Healthcare coordinates diagnostic cardiac catheterisation packages for international patients needing haemodynamic assessment before cardiac surgery or PAH therapy initiation. We arrange catheterisation, report interpretation, multidisciplinary team discussion, and written management plan within a 3–4 day visit to India.
Frequently Asked Questions
What is the difference between right heart catheterisation and cardiac catheterisation?
Right heart catheterisation is a specific diagnostic study measuring right heart and pulmonary artery pressures. Diagnostic cardiac catheterisation is a broader term that includes both right and left heart catheterisation plus angiography. In practice, paediatric diagnostic catheterisation usually includes both components.
Is general anaesthesia always required for RHC in children?
General anaesthesia is standard for children under 12 years. Adolescents and adults may have RHC under conscious sedation. General anaesthesia keeps the child still and prevents anxiety-driven haemodynamic changes that would alter pressure measurements.
What is vasoreactivity testing?
Vasoreactivity testing assesses whether elevated pulmonary artery pressure responds to short-acting vasodilators (inhaled nitric oxide, IV adenosine, oxygen). A positive response (PAP fall ≥10 mmHg to <40 mmHg) indicates reversible PAH and predicts response to calcium channel blockers and other PAH therapies.
Can RHC be done on the same day as cardiac surgery planning?
Yes. At India's centres, same-day catheterisation and surgical team discussion is routinely arranged. The catheterisation data is reviewed the same afternoon; a definitive surgical plan is communicated by evening.
Is RHC painful?
The procedure is performed under general anaesthesia or sedation; the child feels nothing. Post-procedure, there is mild discomfort at the groin puncture site managed with paracetamol. Most children are alert and eating within 2 hours of recovery.