Cardiac Catheterization in Children:

What is a cardiac catheterization? 

Cardiac catheterization is a specialized procedure in which a long, flexible tube (catheter) is inserted into a vein and guided into the heart, allowing a close look at the structures inside. It may also be performed for the following reasons: 

• to obtain cardiac tissue samples for biopsy 
• to open the atrial septum in congenital (present at birth) heart problems that cause a child to become cyanotic (blue color of the skin, lips, and nailbeds due to an insufficient supply of oxygen in the blood) 
• to place mesh devices that close small holes inside the heart (such as with atrial septal defect or ventricular septal defect), or intentionally block blood flow in a blood vessel (such as with patent ductus arteriosus or pulmonary collateral vessels) 
• to place wire devices, called stents, in narrowed arteries to keep them open 

Cardiac catheterization can be performed on children of any age - even newborns immediately after birth. 

How  is a cardiac catheterization performed? 

The  procedure is performed in the hospital by a specially trained cardiologist. Your child's physician will discuss the risks and benefits of the procedure with you and will then obtain written permission (informed consent) from you in order  to perform the procedure. 

Your child is given a sedative to help him/her relax  and possibly even sleep during the procedure. Once in the "cath lab," he/she will lie on a small table with a c-shaped x-ray machine surrounding it. Heart monitors and other equipment are nearby.  A specially trained staff of nurses, technicians, and physicians will monitor your child and make sure he/she is comfortable during the procedure. 

An injection of local anesthetic will be given under the skin where the catheter is going to be inserted. 

An injection of local anesthetic will be given under the skin where the catheter is going to be inserted. Next, a  thin, flexible tube (catheter)  is inserted into a blood vessel, most often  in the  groin area (the crease of the leg where it bends when sitting). The catheter is guided up the vein towards the heart. The cardiologist uses x-rays, called fluoroscopy, to help visualize the movement of the catheter. The catheter enters the right atrium - the top right-hand chamber that receives oxygen-poor (blue) blood from the body. Eventually, the tube will be guided into the right ventricle, the pulmonary artery,  and perhaps the right and/or left pulmonary artery branches. 

While inside the heart, several things are done  to help evaluate  the heart structures, as well as the pattern of blood flow inside the heart, including the following: 

• Blood samples are drawn from each chamber  and each blood vessel, and the oxygen content is measured. 
• Blood pressure measurements are made inside each chamber and each blood vessel. 
• Contrast  dye is injected into the catheter and, as it flows inside  the heart, x-ray films are made  of the path the dye takes throughout the heart. 

X-ray films are made as the catheterization proceeds, enabling  your child's cardiologist to review the data after the procedure. If surgery is planned, the  heart surgeon may also review the data. 

What happens after the procedure? 

When the catheterization is complete, the catheter(s) will be withdrawn from the heart  and the blood vessels. Several gauze pads and a large piece of medical tape will be placed  on the site where the catheter was inserted to prevent bleeding. In some cases,  a small, flat weight  or sandbag may be used to help keep pressure on the catheterization site and decrease the chance  of bleeding. If blood vessels in the leg were used,  your child will be told to keep the leg straight for a few hours after the procedure to minimize the chance  of bleeding at the catheterization site.

Your child will be taken to a unit  in the hospital where he/she will be monitored by nursing staff for several hours after the test.  The length of time it takes for your child to wake up after  the procedure will depend on the type  of medicine given to your child for relaxation prior to  the test, and also on your child's reaction  to the medication.
After the test,  your child's nurse will monitor the pulses and skin temperature  in the leg or arm that was used for the procedure. 

Your child may be able  to go home after a specified period of time, providing he/she does not need further treatment or monitoring. You will receive written instructions regarding care  of the catheterization site, bathing, activity restrictions, and any new medications your child  may need to  take at home. 

Depending on the results  of the cardiac catheterization test, additional tests or procedures may be scheduled to gather further diagnostic information. 

Interventional  cardiac catheter procedures: 

Advances in interventional  cardiac catheterization have changed  the diagnostic work-up for babies  and children with newly suspected congenital heart disease greatly over the past 10 years. As a result of improved diagnostic imaging with echocardiography and magnetic resonance imaging (MRI), fewer cardiac catheterizations are performed just  to obtain information.

Congenital heart conditions that  may be treated  in the cath lab include: 

• patent ductus arteriosus (PDA) 
• aortic stenosis (AS) 
• pulmonary atresia (PA) with multiple collaterals 
• re-coarctation of  the aorta 
• atrial septal defect (ASD) 
• ventricular septal defect (VSD) 
• branch pulmonary stenosis 
• narrowing or re-stenosis of shunts 

Development of additional interventional cardiac cath procedures to treat other conditions is continuing. 

Notes: http://www.healthsystem.virginia.edu/uvahealth/peds_cardiac/cardcath.cfm

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EditText of this page (last edited August 8, 2009)