|• Cardiac catheterization can be roughly
divided into diagnostic and therapeutic procedures although there
is often overlap between the two.|
• 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
• Single ventricle prior to their second and third stage repairs.
• 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
• 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).
• 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
• 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.
• 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
• 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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