Chapter 59. Cardiac Catheterization

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 ...