Iodinated Contrast Media in Pediatric Cardiac Angiography Nephrotoxic risk evaluation

Abstract

Contrast agents are among the most frequently used drugs in medical practice. The aim of our study was to evaluate the incidence of complications associated with the use of different contrast agents in an angiography lab dedicated to pediatric patients with congenital heart disease. Between June 2015 and December 2017, 166 patients with congenital heart disease were diagnosed and/or treated in the angiography lab. Of these patients, 38 were excluded because they did not require contrast substance administration. As interventional procedures we performed pulmonary valvular dilatation in 17 cases (10.2%), stent implantation in coarctation of the aorta in 9 cases (5.4%), PDA closure in 62 cases (37.3%), atrial septal defect (ASD) closure in 36 patients (including patients without contrast agent�s administration) (21.7%). In the group of 129 patients who received contrast agents, the median age was 5.8 years (range 0.1-19 years) and median weight 22.8 kg (range 2.8-72 kg). Average consumption of contrast media per procedure was 79 ml/procedure (range 5 - 400 mL) and 4.3 mL/kg (range 0.4 - 22.7). We used iomeprol (24%), iohexol (8.5%), iopromide (67.4%). No contrast related complications are reported in this group. In conclusion, the contrast agents we used seem to be safe and are not associated with renal complications.

Isolated hypoplastic right ventricle – a challenge in medical practice

“…Sizing balloon occlusion test is important to evaluate the response of the ventricle after increasing the preload. The risk of contrast agents is not negligible, especially in patients with significant RVH who will undergo cardiac surgery with cardiopulmonary bypass [16]. Pressure evaluation in cardiac chambers may reveal, elevated "a" wave at RA level, due to resistance to flow in the presence of a small RV.…”

Interventional Treatment of Cardiac Emergencies in Children with Congenital Heart Diseases

“…1 Contrast media administration may also increase procedural risk, especially when associated with other previously discovered risk factors such as acute kidney injury, pre-existing hypotension, infection or sepsis, requiring the administration of potentially nephrotoxic substances (e.g., gentamicin). [2][3][4] In newborns, cardiac emergencies that can be managed with interventional therapies include transposition of the great arteries (TGA), simple valvular obstructive diseases such as critical pulmonary stenosis (PS), critical aortic stenosis (AS), aortic coarctation (AC) with contraindica-tions for surgical treatment; complex obstructive disorders such as tetralogy of Fallot (TOF) or pulmonary atresia with intact ventricular septum (APSI); and left-to-right shunt diseases such as large ventricular septal defects (VSD) or patent ductus arteriosus (PDA) associated with HF and pulmonary hypertension (PH).…”

Correlation of Intravenous Administration of Iodinated Nonionic Contrast Agents with Contrast-Induced Nephrotoxicity in Sedated Dogs

“…The rapid development of sciences made the radiography a routine procedure in the diagnostics of a various pathology and introduce also the Computed Tomography (CT) as a diagnostic tool for the veterinarian. Iodinated contrast agents are use in special radiological procedures because of their high-contrast density, this property makes these substances useful in visualization of a certain soft structures, making the contrast agents the most frequently used drugs in veterinary radiology [1,2]. The downside of using those substances is the supposed renal toxicity.…”

“…It derives their structure from iodine or barium sulfate and do not emit radiation. According to their structure, the contrast agents, are ionic or non-ionic [2]. Those are organic compound, monomeric or dimeric with low or high osmolarity, with benzene structures and variable content of iodinated compound.…”