Cardiac catheter-based interventions

Cardiac catheterization is a procedure that can be used to diagnose, and in some cases treat, heart conditions. A highly trained interventional pediatric cardiologist guides a long, flexible tube (catheter) through blood vessels and into the heart. The cardiologist uses this catheter to perform procedures that require less surgery and radiation than older methods.

A catheterization ("cath") lab is a dedicated space where a medical team performs these interventional procedures.

The newly expanded space at Children's Hospital is a hybrid lab. This means interventional cardiologists and pediatric cardiac surgeons operate together to correct heart problems. Our lab is equipped for both diagnosis and treatment. It features three catheterization rooms and a 10-bed holding and recovery area for our patients. We also have a video link to our cardiac intensive care unit and cardiac imaging teams, which allows for better communication and seamless care.

A child may need a cardiac catheterization to

• diagnose a heart problem
• diagnose or treat an abnormal heart rhythm

The problem is often one that he or she was born with (congenital heart defect) or one that has developed.

A diagnostic catheterization may be done to

• Get a more accurate image of the heart or a heart defect
• Check the flow of blood throughout the heart
• Find pressures in different parts of the heart and lungs
• Check the heart valves to see if they are working properly
• Measure oxygen levels in different areas of the heart, lungs, and blood vessels
• Measure electrical activity in the heart
• Check for problems after surgery
• Take tissue samples to be looked at in a lab (biopsy)
• Check the heart before or after heart transplant

Diagnostic catheterization is used less often now. Other tests such as echocardiography, MRI and CT scans are used instead.

Interventional catheterization has replaced surgery for many procedures. Such a procedure may be done to

• Close an abnormal opening between the two sides of the heart or abnormal blood vessels, such as with atrial septal defect, ventricular septal defect, and patent ductus arteriosus
• Widen a narrow blood vessel
• Widen a heart valve
• Implant a new heart valve, Melody valve, or Edwards Sapien valve
• Perform a hybrid procedure combining surgery and heart catheterization for certain procedures

You and your child will meet with the pediatric cardiologist who will complete the catheterization. You may meet with your doctor at an appointment before or the day of the procedure. This is your opportunity to learn about the procedure and ask questions.

Your doctor will ask questions about your child's general health, activity level and current medications. Feeding and medication instructions for the catheterization will be reviewed at the appointment. Other testing, such as EKG, echocardiogram and X-rays may be performed at that time. A small sample of blood may be necessary.

A Child Life specialist will be available at your request to meet with your child before the procedure to explain catheterization. Your child can see some of the medical equipment that may be used during the procedure. For young children, the Child Life specialist will explain that the test causes very little pain because doctors use medicine to help children relax or even sleep.

If your child develops some type of illness (fever, ear infection, cough/congestion, rash in the groin area, etc.) within the week before the catheterization, the procedure may be postponed until your child is well.

You will be instructed where and when to arrive on the day of the catheterization. Family and friends may come with you to the waiting area. Due to space limitations, only you and one other family member may be with your child in the holding area.

Your child will be taken from the holding area directly to the catheterization lab by a member of the staff. The nurses in the catheterization lab will call you about every 45 to 60 minutes to keep you updated about your child's progress.

Once the catheterization is finished, your child will be taken to the recovery room and will stay there until discharged or transferred to a hospital room. You and one other family member can stay with your child in the recovery area.

Your child's doctor will discuss the risks and benefits of the procedure with you. You will also need to give us written permission (informed consent) to do the procedure.

The procedure will take place in our cardiac catheterization lab. Your child's doctor, the anesthesia team and a specially trained staff of nurses and technicians will be there.

Your child is either given medicine to help him or her relax (sedation) or general anesthesia so he or she will remain asleep during the procedure. Once in the lab, he or she will lie on a small table with a lot of equipment nearby. In general, here is what will happen:

• Your doctor will put a special tube (sheath) into a blood vessel. Your doctor then places a catheter or catheters through the sheath.
• Your doctor guides the catheter through the blood vessel to the heart. Your doctor uses moving X-rays (fluoroscopy) to help see where the catheter is.

For diagnostic catheterization, your doctor may then

• Take blood samples and measure oxygen levels in each of the four heart chambers and each blood vessel
• Measure blood pressure in each chamber and each blood vessel
• Inject contrast dye into the catheter and watch the path the dye takes through the heart (angiography)

If repairs are needed, your doctor may:

• Use a balloon to open a heart valve or narrowed blood vessel
• Put a small support (stent) in the blood vessel to keep it open
• Use special devices to fix a hole between the upper or lower heart chambers (atria or ventricles) or close abnormal blood vessels

When the catheterization is done, the doctor will remove the catheter. Pressure will be applied to stop bleeding. The healthcare team will put a bandage on the site where the catheter was placed.

Your child will be taken to the recovery room. Our team will watch your child closely for several hours. Some children stay in the hospital for a day or more. How long it takes your child to wake up after the procedure will depend on the medicines used.

If blood vessels in the leg were used, your child will need to stay in bed and keep the leg straight for a few hours after the procedure. This makes the insertion site less likely to bleed. The site may be bruised and uncomfortable for a few days.

Your doctor will decide when your child is ready to go home. You will be given written instructions on

• How to care for the insertion site
• What signs of infection to watch for. These include fever, redness, swelling, pain, or drainage.
• Bathing
• What your child may and may not do
• Any new medicines
• Taking your child for follow-up appointments
• When you should call your doctor

Depending on the results of the cardiac catheterization, your child may need more tests or procedures.

Before you agree to the test or the procedure for your child make sure you know

• The name of the test or procedure
• The reason your child is having the test or procedure
• What results to expect and what they mean
• The risks and benefits of the test or procedure
• When and where your child is to have the test or procedure
• Who will do the procedure and what that person’s qualifications are
• What would happen if your child did not have the test or procedure
• Any alternative tests or procedures to think about
• When and how will you get the results
• Who to call after the test or procedure if you have questions or your child has problems
• How much will you have to pay for the test or procedure