The role of diagnostic cardiac catheterization for children with congenital heart diseases: local experience

Abstract

IntroductionDespite the development of non-invasive tools of investigations for congenital heart diseases (CHDs), still the role of diagnostic cardiac catheterization (DCC) cannot be undermined. The study aimed to analyze the clinical profile of indicated CHDs cases at our center for DCC to evaluate the contribution of DCC in patients’ management plans.Material and methodsThe study checked files of cases performed DCC between 2011 and 2012 at the pediatric catheterization unit of Alexandria University Children’s Hospital by the same operator. Demographic, laboratory and hemodynamic data were collected and analyzed.ResultsFiles of 61 children were included in the study. They were grouped into: group I (GI) (n = 25) with pulmonary hypertension (PH), and group II (GII) (n = 36) cases with obstructive pulmonary artery diseases. For the PH group, ventricular septal defect (VSD) was the most common (55%), and patients’ outcome plans were based on angiography – operable subgroup GI-A: (84%) (n = 21) and non-operable (16%) GI-B: (4% inoperable, 12% recommended for sildenafil). GI-B cases were significantly older, with higher PVRI and PVRI/SVRI (3.62, 0.68, p = 0.002) compared to GI-A (0.89, 0.23, p = 0.002, respectively). For group II, tetralogy of Fallot (TOF) was predominant (60%) among the disease spectrum, and the McGoon ratio ranged from 0.7 to 3.2 (median: 1.8). Outcome for GII: 63% operable, 25% shunt, 12% stent. Only pulmonary atresia cases showed a significant difference in the unmatched plans between echocardiography and catheterization reports (χ2 = 7.438, p = 0.023).ConclusionsDiagnostic cardiac catheterization had a positive contribution for determination of the management plans for more than 84% of cases. The utility of pediatric cardiac catheterization in diagnosis should be adjusted according to the local needs of every cardiac center.

Cardiorespiratory Parameters in Intermittent Positive Pressure Ventilation Versus Spontaneous Ventilation in Under One-Year-Old Pediatrics: A Randomized Trial

“…Anesthesia management for pediatric cardiac catheterization is a matter of debate (5)(6)(7). The shunts may be seen at different levels, and patients may be cyanotic (6).…”

“…Anesthesia management for pediatric cardiac catheterization is a matter of debate (5)(6)(7). The shunts may be seen at different levels, and patients may be cyanotic (6). Further, young patients may not have the required cooperation, and the parents may not be able to offer assistance due to severe stress (6,7).…”

“…The shunts may be seen at different levels, and patients may be cyanotic (6). Further, young patients may not have the required cooperation, and the parents may not be able to offer assistance due to severe stress (6,7). The diagnosis of cardiac anomalies is usually made by echocardiography, but the determination of therapeutic course and approaches is done through cardiac catheterization (8)(9)(10).…”

“…The use of general anesthesia in children may affect the hemodynamic parameters and diagnostic angiography results, thus necessitating the knowledge of such effects (4). Decreased apnea threshold and some degrees of respiratory depression during general anesthesia would lead to increased carbon dioxide pressure, as well as lung vascular resistance and pulmonary hypertension (4)(5)(6). Hence, the use of anesthesia methods with minimal hemodynamic and respiratory effects can increase diagnostic accuracy (14)(15)(16).…”

An investigation of the optimal inter-pregnancy interval following pregnancy with a fetus with congenital heart disease

“…The estimate of 8 per 1000 live births is generally accepted as the best approximation [4]. As the management of neonates with CHD is constantly improving [5][6][7][8], there is still little effort put into the optimization of planning the subsequent pregnancies. The lack of development of strategies regarding the timing of the next conception to minimize the risk of recurrence of CHD is concerning.…”