Pediatric Cardiac Catheterization

Cardiac catheterization is a procedure in which a long, flexible tube (catheter) is put into a blood vessel. The doctor then guides the catheter into the heart to find and treat heart problems.

Your child may need a cardiac catheterization to diagnose a heart problem (diagnostic cardiac catheterization). Or he or she may need a catheterization to fix a problem (interventional cardiac catheterization). The problem is often one that a child is born with (congenital heart defect). A catheterization may also be done for both reasons.

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

Interventional catheterization has replaced surgery for some procedures. An interventional catheterization may be done to:

• Close an abnormal opening between the two sides of the heart
• Close abnormal blood vessels
• Widen a narrow blood vessel or heart valve
• Treat an abnormal heart rhythm (heart beating too fast or too slow)

Cardiac catheterizations in children are usually safe. But there are some risks, including:

• Risks from radiation
• Risks from general anesthesia, if it is used
• Serious drop in body temperature (hypothermia)
• Decreased oxygen levels (hypoxia)
• Irregular heart rhythm (arrhythmia)
• Injury to the heart, heart valves or blood vessels
• Blood loss, which could require transfusions
• Allergic reaction to contrast dye or medicines, including anesthesia
• Kidney damage from contrast dye
• Stroke
• Death

How you get your child ready depends on his or her age. If your child is old enough, explain what will happen in a way that he or she will understand. You might ask the doctor or nurse or a child-life specialist to explain the procedure to your child. Before your child's catheterization, you should:

• Make sure your child has stopped eating or drinking at a specified time before the procedure
• Try to keep your child healthy to avoid postponing the catheterization. Keep your child away from people with fevers, colds or other viruses
• Let the doctor know if your child gets sick before the procedure

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

The procedure is done in a cardiac catheterization (cath) lab in a hospital. Your child's doctor and a specially trained staff of nurses and technicians will be alongside your child throughout the process.

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

In general, here is what will happen:

• The healthcare team will give your child an injection of numbing medicine (local anesthetic) in the area where the catheter is going to be inserted. This is usually the groin. But other blood vessels may be used instead. These are the vessels in the neck or bellybutton
• The doctor will put a special tube (sheath) into the blood vessel. The doctor puts the catheter through the sheath. Sometimes more than one catheter is used
• The doctor guides the catheter through the blood vessel to the heart. The doctor uses moving X-rays (fluoroscopy) to help see where the catheter is

For diagnostic catheterization, the doctor may then:

• Take blood samples and measure oxygen levels in each of the 4 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, the 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 catheter tips to fix the walls between the upper or lower heart chambers (atria or ventricles) or abnormal blood vessels
• Use a special catheter tip to open a heart valve with heat
• Use a special catheter to examine and treat abnormal electrical activity in the heart

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

Your child will be taken to a room where he or she will be watched closely by the healthcare staff 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.

The 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, including fever, redness, swelling, pain or drainage
• Bathing
• What your child may and may not do while recovering
• Any new medicines
• Taking your child for follow-up appointments
• When you should call the doctor

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