Indications
• Cardiac catheterization can be roughly divided into diagnostic and therapeutic procedures although there is often overlap between the two. |
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• 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:
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• 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.
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• To treat heart disease, usually taking the place of a more invasive surgical procedure.
• To open stenotic valves or vessels.
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• 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.
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Contraindications
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• 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:
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• 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).
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Patient Preparation
Procedure
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• 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.
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