Chapter 59
 • Cardiac catheterization can be roughly divided into diagnostic and therapeutic procedures although there is often overlap between the two.

### Diagnostic Catheterization

• • To obtain information about the physiology and anatomy of the circulatory system, frequently in the setting of structural congenital heart disease.

• To assess patients with the following:

• • Pulmonary atresia and tetralogy of Fallot who have complex collateral pulmonary blood supply.

• Pulmonary atresia with intact ventricular septum to evaluate coronary anatomy.

• Single ventricle prior to their second and third stage repairs.

### Therapeutic Catheterization

• • To treat heart disease, usually taking the place of a more invasive surgical procedure.

• To open stenotic valves or vessels.

• • Stenotic valves (in order of frequency, pulmonary, aortic, mitral, and tricuspid).

• Stenotic blood vessels (eg, pulmonary artery, coarctation of the aorta).

• To close such abnormalities as patent ductus arteriosus, atrial septal defect, and collateral blood vessels.

• • The trend is toward reserving diagnostic catheterization for cases in which noninvasive imaging is insufficient to provide the information necessary for management decisions.

• Examples of congenital heart disease where routine diagnostic catheterization is no longer performed prior to surgical repair include the following:

• • Uncomplicated ventricular septal defect.

• Atrioventricular canal.

• Transposition of the great arteries.

• Tetralogy of Fallot.

• Most types of single ventricle prior to their initial palliation.

• Some persons with the above conditions may be candidates for palliative therapeutic catheterizations (eg, balloon atrial septostomy for patients with transposition of the great arteries).

• • Estimate the length of the procedure to prepare the patients and family.

• • Accurate predictions are easier for simple diagnostic cases.

• Endomyocardial biopsy may take about 20 minutes.

• A multi-part therapeutic procedure may take half a day.

• • Cardiac catheterization is the invasive evaluation, and more recently, treatment of heart disease, using catheters that are threaded into the various chambers and vessels of the heart and circulatory system.

• Vascular access for most pediatric catheterizations is via the femoral vessels.

• For complex procedures or anatomy, multiple access sites may be required and include bilateral femoral vessels, jugular or subclavian veins; rarely, transhepatic puncture is required.

• Patients who have femoral access are generally required to remain supine with legs straight from 4 to 6 hours after the procedure to prevent rebleeding.

### Diagnostic Catheterization

• • Procedure does not require significant analgesia.

• However, anxiety and lack of understanding usually preclude young patients from cooperating sufficiently, so most procedures are performed with patients under deep sedation.

• Sometimes patient may perceive ectopic beats associated with catheter manipulation.

• Radiopaque contrast is instilled into area of interest while a fluoroscopic cine recording is made to obtain anatomic information.

• Instillation of contrast may be associated with a warm feeling and the need ...

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