Cardiac Catheterization for Congenital Heart Disease

Abstract

Interventional pediatric cardiology is a specialty of pediatric cardiology that deals specifically with the catheter-based treatment of congenital heart diseases. Cardiac catheterization involves the evaluation and manipulation of the heart and surrounding vessels through catheters place in peripheral vessels. In this chapter we begin by discussing the significant difference between adult and pediatric interventional cardiology. We will discuss basic hemodynamic measurements performed in cardiac catheterization and its application to congenital heart disease. Stent and balloon catheters are briefly discussed. Finally, specific catheter based interventional techniques, indications, and complications for various pediatric congenital heart disease is described.

Echocardiographic changes and quality of life after surgical unroofing of myocardial bridges

“…The catheterization procedures were performed from either a radial or femoral arterial access depending on the patients' age and vascular access availability. All patients received 5000 IU (for adults) or 100 IU/kg (for adolescents) of unfractionated heparin 19 and 200 lg (for adults) or 3 lg/kg (for adolescents) of nitrates 20 before insertion of the guidewire to control the vasomotor tone. 21 Basal angiography was obtained in different angiographic views for optimal visualization and characterization of the MBs.…”

Off-label use limitation of the Super Arrow-Flex® sheath introducer in congenital heart disease interventions

“…High flexibility and the ability to pass through tortuous vessels without collapsing are the main assets of long braided sheaths. 1 They have been widely used by interventionists all around the world for more than three decades. Many interventionists are infatuated by the recent resurgence of the coilwire design with the Super Arrow-Flex® sheath (Teleflex, Inc., NC, United States of America).…”

“…Yet, technical difficulties in transjugular closure of atrial septal defects are well known and frequently encountered. 1,3,4 Several techniques were described to ease the procedure including the "off-label" use of heat-shaped, pre-shaped, or steerable sheath introducers. 1,[3][4][5][6] In transjugular closures, it is certain that a shorter operation path with a shorter delivery system makes device implantation better controlled and less cumbersome.…”

“…1,3,4 Several techniques were described to ease the procedure including the "off-label" use of heat-shaped, pre-shaped, or steerable sheath introducers. 1,[3][4][5][6] In transjugular closures, it is certain that a shorter operation path with a shorter delivery system makes device implantation better controlled and less cumbersome. Therefore, the off-label use of intermediate-length sheaths is an ideal alternative.…”

“…Therefore, the off-label use of intermediate-length sheaths is an ideal alternative. 1,3,5 If unapproved sheaths are used instead of the manufacturer's recommended equipment, encountered limitations may not necessarily be related to sheath design, but rather to the problem with off-label use. Indeed, the technical specifications of the sheath's off-label use need to be fully understood and it is the operators' responsibility to "adapt" the equipment.…”