Diagnostic Catheterization

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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.

Therapeutic Catheterization

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

  
  
  
  
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    • 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.

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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.