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Cardiac Catheterization in Congenital Heart Disease: Pediatric and Adult

Cardiac catheterization is a procedure that involves inserting a thin, flexible tube (catheter) into a blood vessel and guiding it to the heart. Cardiac catheterization can be used for diagnostic or therapeutic purposes, such as measuring pressures and oxygen levels in the heart chambers and blood vessels, taking samples of blood or tissue, injecting contrast dye to visualize the heart structures, or performing interventions to treat certain heart defects.

Cardiac catheterization in congenital heart disease is a specialized field that requires expertise and experience in dealing with complex and diverse cardiac anomalies that affect both children and adults. Congenital heart disease (CHD) is a term that refers to any structural abnormality of the heart or its associated vessels that is present at birth. CHD can range from simple defects, such as a hole between two heart chambers, to more severe defects, such as a missing or malformed valve or chamber. CHD can cause symptoms such as cyanosis (bluish skin color), shortness of breath, fatigue, poor growth, or heart failure. Some CHD can be detected before birth by prenatal ultrasound, while others may not be diagnosed until later in life.

Cardiac catheterization in CHD can provide valuable information that complements other diagnostic tests, such as echocardiography, magnetic resonance imaging (MRI), or computed tomography (CT) scan. Cardiac catheterization can also offer therapeutic options for some types of CHD that are not amenable to surgical correction or that require palliation before surgery. Some of the common interventions performed by cardiac catheterization in CHD include:

Balloon atrial septostomy: This procedure involves creating or enlarging a hole between the right and left atria (upper chambers of the heart) to improve blood flow and oxygenation in certain conditions, such as transposition of the great arteries or pulmonary hypertension.

Balloon valvuloplasty: This procedure involves inflating a balloon inside a narrowed or stenotic valve (such as the pulmonary valve or the aortic valve) to widen its opening and improve blood flow.

Balloon angioplasty: This procedure involves inflating a balloon inside a narrowed or stenotic blood vessel (such as the pulmonary artery or the aorta) to widen its lumen and improve blood flow.

Stent implantation: This procedure involves placing a metal mesh tube (stent) inside a narrowed or stenotic blood vessel to keep it open and prevent restenosis.

Device closure: This procedure involves placing a device (such as an umbrella-shaped occluder or a coil) inside a hole or defect between two heart chambers or blood vessels to seal it and prevent shunting of blood.

Radiofrequency perforation: This procedure involves using radiofrequency energy to create a hole in an atretic (absent or closed) valve or chamber to establish blood flow.

Cardiac catheterization in CHD is performed by a team of specialists, including pediatric cardiologists, interventional cardiologists, cardiac anesthesiologists, cardiac nurses, and technicians. The procedure is usually done under general anesthesia or sedation in a dedicated cardiac catheterization laboratory equipped with advanced imaging and monitoring systems. The procedure may take from one to several hours depending on the complexity of the case. The risks and benefits of cardiac catheterization in CHD vary depending on the type and severity of the defect, the age and condition of the patient, and the expertise of the operator. Some of the potential complications include bleeding, infection, arrhythmia, stroke, embolism, perforation, valve damage, stent fracture, device malposition, or residual defect. However, most cardiac catheterizations in CHD are performed safely and effectively with minimal morbidity and mortality.

Cardiac catheterization in CHD has evolved significantly over the past decades with the development of new techniques, devices, and technologies that have expanded the indications and improved the outcomes of this procedure. Cardiac catheterization in CHD serves as an essential tool for diagnosis and treatment of pediatric and adult patients with congenital heart lesions worldwide.

References:

Mullins CE. Cardiac Catheterization in Congenital Heart Disease: 66dfd1ed39

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