Selective Coronary Angiography in Pediatric Patients

Abstract

Selective coronary angiography (SCA) is an important diagnostic tool in pediatric cardiology; however, there are few reports on its feasibility and safety in young patients. We reviewed our experience with SCA from July 1, 1993 to December 31, 1997. There were 158 cardiac catheterizations that included SCA in patients whose ages ranged from 2 days to 46 years (median, 5.3 years). The most common indication was surveillance for coronary vasculopathy after heart transplantation. A retrograde approach was used in all patients through the femoral artery (n = 157) or umbilical artery (n = 1). Preformed coronary catheters were used and the Judkins left (JL) and Judkins right (JR) were the most common catheters, with the catheter curve size correlating with patient height (R(2) =.76 for JL, R(2) =. 673 for JR). Complications during SCA included brief ST-T wave changes (11%), bradycardia (2.5%), and ventricular fibrillation (0. 6%). Complications of vascular access were transient pulse loss (6%), hematoma (5%), and rebleeding (0.6%). Only one case of femoral artery occlusion was encountered on subsequent cath. In conclusion, complications of SCA were infrequent and serious complications were rare. SCA can be safely performed in pediatric patients at any age including neonates.

Long-term coronary artery outcome after arterial switch operation for transposition of the great arteries☆

“…However, most studies are on selected patient population without any clear strategy regarding the invasive follow-up of operated transposition patients. According to our experience, we believe that an early angiographic evaluation is mandatory in all patients, who underwent ASO, even those with usual coronary patterns and no reported symptoms, to predict coronary obstruction [14,16].…”

“…Despite being an invasive tool, coronary angiography, in our opinion, is best suited for routine evaluation of children after ASO, due to the low risk of complications (14) and the opportunity to perform simultaneous interventional treatment, if needed. Moreover, coronary spiral scans deliver a too-high radiation dosage, while optimal image acquisition requires cardiac rates, which are usually difficult to achieve in very young infants.…”

Radiation Dose from Contemporary Cardiothoracic Multidetector CT Protocols with an Anthropomorphic Female Phantom: Implications for Cancer Induction

“…An exposure age of 15 years was chosen to be representative of older children in a population of pediatric patients who undergo selective coronary angiography (16). An exposure age of 25 years was chosen to be representative of patients being evaluated for peripartum pulmonary embolism.…”

Surveillance for Transplant Coronary Artery Disease in Infant, Child and Adolescent Heart Transplant Recipients: An Intravascular Ultrasound Study

“…Right and left coronary arteries were imaged in two oblique views, which are standard at our center. 16 Angiograms were reviewed independently by two observers experienced in the interpretation of angiography and familiar with TCAD. Angiograms were graded on a 0 to 4 scale where: 0 ϭ normal angiogram; 1 ϭ presence of any luminal irregularity or loss of branching distal vessels; 2 ϭ mild (10% to 25%) stenosis in any large epicardial coronary artery; 3 ϭ moderate (25% to 50%) stenosis in any large epicardial coronary artery; and 4 ϭ severe (Ͼ50%) stenosis in any large epicardial coronary artery or diffuse narrowing with a lumen Ͻ2 mm.…”