Dear Editor:
I would like to ask if it is necessary to screen all patients who undergo a
cardiac catheter procedure for HBV & HCV. The physician should take all
precautions before, during, and after the catheterization procedure, no matter
whether the patient is HBV or HCV positive or not: am I right? Furthermore, if the patient was found to be
positive for any of the above viruses, is it the prerogative of the cardiac
surgeon to refuse to perform the coronary bypass?
M H
Dear MH:
As a routine, it is not necessary to screen all patients undergoing cardiac
catheterization for hepatitis B or hepatitis C virus infection. If a patient is
known to have chronic hepatitis B or C, and needs a cardiac study, then the
relative risks must be weighed. For the great majority of patients with mild to
moderate chronic hepatitis B or C with good synthetic function (bilirubin,
albumin and INR), catheterization should be safe. As a transplant physician, we
frequently arrange cardiac catheterization in patients with Child's class A and
B and occasionally Child's class C before determining the suitability of the
patient for liver transplantation. Although the risk is increased in Child's
class B and C, we usually proceed because the possibility of a liver transplant
outweighs the risk of bleeding or other complications from the cardiac study.
If a patient needs bypass surgery, this procedure is safe in patients with mild
to moderate chronic hepatitis B or C, has a small risk in Child's class A
cirrhosis, and more substantial risk in Child's class B or C cirrhosis.