Pediatric Cardiac Catheterization

Overview

Cardiac catheterization is a technique that includes puncturing an artery and/or vein, often in the groin, in order to guide a small, long, flexible tube (catheter) into the heart and main vessels around the heart.

Fluoroscopy is used to guide the catheter through the heart (X-ray machine). This is frequently done to aid in the identification of heart problems.

Interventional catheterization is a sort of cardiac catheterization in which real therapies are carried out using specialized catheters.

These specialist catheters include balloon catheters that can open constricted valves or arteries, as well as catheters that can deploy devices that can seal additional vessels or specific "holes" in the heart.

What is Pediatric Cardiac Catheterization?

A cardiac or heart catheterization, sometimes known as a "heart cath," is a minimally invasive procedure that employs thin, flexible tubes known as "catheters" to examine and get information about the heart from the inside. To enter the heart, catheters are introduced into the large blood arteries in the groin known as the femoral artery and vein, just like an intravenous (IV) line.

Other blood arteries in the neck or arm are sometimes employed as well. Fluoroscopy, a type of x-ray, is used to guide the placement of the catheters as they are carefully pushed into the blood veins and into the heart. Once within the heart, the catheters can be utilized to collect various sorts of information depending on what the clinician wants to know.

During a cardiac cath, numerous different types of catheters can be utilized, and each catheter serves a particular purpose. Some catheters allow the medical team to draw blood samples from various sections of the heart and lungs to determine oxygen saturation (the amount of oxygen in the blood), while others help assess blood pressure in the heart and lungs.

Others allow the doctor to examine the heart's electrical system. The doctor may examine the heart, as well as the arteries and veins in the heart and lungs, by introducing a special dye called "contrast" through the catheters and seeing it through fluoroscopy. The doctor can check how effectively the heart is pumping and take photographs of it to examine later.

Who Performs the Procedure?

Only a pediatric cardiologist can order this operation since it is conducted only after a thorough cardiac assessment by a pediatric cardiologist.

The request is then assessed by cardiologists who specialize in interventional procedures to determine the procedure's suitability. Only then will your child's interventional catheterization be planned.

The operation will be carried out by an interventional cardiologist with the assistance of a pediatric cardiology fellow, nurses, and radiology technicians.

When Pediatric Cardiac Catheterization is Required?

A cardiac catheterization may be required for a child to diagnose a heart disease (diagnostic cardiac catheterization) ,or your child may require catheterization to correct a condition (interventional cardiac catheterization). The issue is frequently one that they were born with (congenital heart defect).

Diagnostic catheterization is becoming less common. Instead, other tests like as echocardiography, MRI, and CT scans are employed. A diagnostic catheterization can be performed on:

• Improve your understanding of the heart or a heart defect.
• Examine the blood flow via the heart.
• Determine the pressures in various areas of the heart and lungs.
• Examine the heart valves to ensure they are in good functional order.
• Determine the oxygen levels in various areas of the heart, lungs, and blood vessels.
• Assess the electrical activity of the heart.
• Check for complications following surgery.
• Take tissue samples to a lab to be analysed (biopsy).
• Examine the heart before and after a heart transplant.

For some procedures, interventional catheterization has taken the role of surgery. An interventional catheterization can be used to:

• Close a gap between the two sides of the heart.
• Glue aberrant blood vessels together.
• Increase the size of a narrow blood channel or heart valve.
• Treat a heartbeat that is too rapid or too slow (abnormal heart rhythm).

Usefulness of Cardiac Catheterization

Pressure measurements and blood samples may be taken from the different cardiac chambers and blood vessels around the heart via cardiac catheterization, allowing extensive information about the heart's function to be calculated.

X-ray dye can also be administered through the catheters, allowing images of structures in and around the heart to be obtained.

Interventional catheterization encompasses a wide range of therapy for various cardiac conditions. It is useful in treating some cardiac issues in children, avoiding surgery.

Some treatments are considered first-line treatments and are chosen above surgery. Some procedures are deemed palliative, which means they will provide a temporary remedy until a more permanent surgical repair can be performed safely.

Treatments are varied and customized to each patient's specific needs. Interventions are most typically performed in circumstances where narrowed valves or arteries are obstructing blood flow.

Interventional catheterization is also used to close off communications in the heart when there are anomalies such as additional vessels or in a patient with an atrial septal defect (a hole between the upper two chambers of the heart).

How You Can Help Your Child to Undergo the Procedures Safely?

A parent's or guardian's most important responsibility is to keep their child calm. Staying calm yourself is the greatest way to keep your child calm. Knowing what to expect and explaining it to your kid ahead of time is the greatest approach to prepare both you and your child for this procedure. Here are some tips to follow while talking about the cardiac cath with your kid.

• At any age:

Your kid may bring a "comfort" object to hold throughout the procedure, such as a favourite stuffed animal or "blankie." The Same Day Surgery Rooms have televisions, but you are allowed to bring a portable DVD player, laptop computer, or handheld video game if these devices may help your kid.

• From birth until 2 years:

Please bring a "comfort" object, such as a favorite blanket, stuffed animal, or toy, for your child.

• 2 to 7 years old:

Explain the process to your child in simple terms the day before the cardiac cath. You may say that the doctor "will take photographs of your heart as you sleep."

A medical play kit can help your kid become familiar with the stuff, he or she may meet. You might, for example, show your kid how to use a stethoscope on a teddy bear. Books about going to the hospital may also be beneficial.

• 7 to 11 years:

Discussing the cardiac cath with older children about a week before the scheduled date may be beneficial. At this time, children have a better understanding of the body, its organs, and how they function.

As a result, individuals may be more afraid of pain. You may tell your kid that he or she will be given medication to make him or her extremely drowsy during the cardiac cath and that this drug will protect him or her from feeling any discomfort throughout the operation. It will also make it difficult to remember much of the process later.

You might also mention that the heart is like a pump, and the heart cath will let the doctor determine how well your child's heart is working. Books about going to the hospital may also be beneficial.

• 12 years and up:

Preteens and teens can understand how the heart operates, what their heart issue is, and why they require this surgery. They may ask intelligent questions. Use these questions to lead your conversation.

How to Prepare Your Child For a Cardiac Catheterization?

The age of your child will determine how you prepare them. If your child is old enough, describe what will happen in terms they can understand. You might ask your child's healthcare professional, nurse, or child-life specialist to explain the operation to him or her. Before your kid's catheterization, you should: 

Before your kid's catheterization, you should: 

1. Keep your child healthy to avoid having to postpone the catheterization. 
2. Keep your child away from someone who has a fever, a cold, or another illness.
3. Inform the provider if your kid becomes ill prior to the surgery.
4. Before you agree to the test or the procedure for your child, make sure you know:

• The test or procedure's name.
• The reason for your child's test or procedure.
• What to assume from the findings and what they imply?
• The test's or procedure's risks and advantages.
• When and where will your kid receive the test or procedure?
• Who will do the surgery and what their credentials are?
• What if your child did not have the test or procedure?
• Any other tests or treatments to consider when and how you will receive the findings.
• Who to contact after the test or surgery if you have concerns or if your kid has the problem?
• How much the test or operation will cost you?

What Happens During Pediatric Cardiac Catheterization?

Your child's healthcare professional will go through the procedure's risks and advantages with you. You must also provide written permission (informed consent) to do the surgery.

The technique is carried out in a hospital's cardiac catheterization lab. During the process, your child's provider and a specially trained staff of nurses and technicians will be present.

Your child may be given sedative medication to help them relax (sedation). Alternatively, your kid will be sedated and unconscious for the treatment. They will lie on a tiny table with equipment nearby after they arrive at the cardiac catheterization lab. In general, the following will occur:

• The healthcare staff will inject numbing drugs (local anesthetic) into the region where the catheter will be implanted. This is generally the groin. However, alternative blood vessels, such as those in the neck or bellybutton, may be utilized instead.

• The healthcare expert will insert a special tube (sheath) into the blood vessel. The catheter is threaded through the sheath by the provider. Sometimes more than one catheter is utilized.

• The provider guides the catheter through the blood vessel to the heart. Moving X-rays (fluoroscopy) are used by the provider to aid locate the catheter. 

• For diagnostic catheterization, the provider may then:

1. Take blood samples and assess oxygen levels in each of the four cardiac chambers and each blood vessel.
2. Take blood pressure readings in each chamber and blood artery.
3. Inject contrast dye into the catheter and see the dye's journey through the heart (angiography).

• If interventions are needed, the provider may:

1. To open a heart valve or a constricted blood vessel, use a balloon.
2. To maintain the blood vessel open, insert small support (stent).
3. Special catheter tips are used to repair the walls between the upper and lower heart chambers (atria and ventricles), as well as aberrant blood arteries.
4. Heat a heart valve using a specific catheter tip.
5. Examine and treat irregular electrical activity in the heart using a specific catheter.

• When the catheterization is done, the provider will remove the catheter. They will apply pressure to prevent bleeding. The healthcare team will put a bandage on the site where the catheter was put in.

What Happens After Pediatric Cardiac Catheterization?

Your child will be transported to a recovery area. The medical personnel will keep a careful eye on your child for several hours. Some children are admitted to the hospital for a day or longer. The time it takes your child to wake up following the surgery is determined by the medications utilized. If blood vessels in the leg were utilized, your kid will need to stay in bed for a few hours following the treatment and maintain the leg straight. This reduces the likelihood of bleeding at the insertion site. For a few days, the site may be bruised and painful.

When your kid is ready to go home, the healthcare practitioner will make the decision. You will be provided with written instructions on:

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

Whatever type of cardiac cath your kid is having, you and your child should plan on an overnight stay. The cardiologist will determine whether your kid can go home following the catheterization or needs to stay overnight.

Your child will be sent to a recovery room as soon as the cardiac cath is completed. You will be summoned to the recovery room in order to be present when he or she awakens. You may assist by speaking softly and gently touching your child to let him or her know you are present.

• Pressure bandages will be placed to the areas where the catheters were implanted on your kid. To reduce bleeding, this tape must be left in place overnight following the cardiac cath. Even with pressure bandages, your kid may experience bruising at the insertion sites.
• If blood arteries in the leg were utilized, your kid will be instructed to keep the leg straight for 4 to 6 hours following the treatment to reduce bleeding.
• After the cardiac cath, your kid will need to rest flat on his or her back for at least 4 to 6 hours.
• Your kid will be monitored in the recovery room until he or she is aware and vital signs are stable. Because some children take longer than others to wake up following anesthesia, the length of time your kid will remain in the recovery room will vary.
• After the operation, the doctor will call you to let you know the results before you meet your kid in the recovery area.
• When your kid is completely awake, he or she will either be transferred to an inpatient room for an overnight stay or discharged once the "flat-time" is finished.
• If your kid is discharged, he or she may still be tired and should rest for the rest of the day.
• After being discharged from the hospital, your kid should be able to return to school within a few days, with some activity limits. Consult your kid's doctor about returning to school and activities, and let your child to resume activities at his or her own speed.
• As long as your child is feeling well, he or she can start eating and drinking little by little and then resume normal eating and drinking.
• To assist prevent infection of the catheter sites in the leg, your kid should avoid tub baths, hot tubs, and swimming for 3 to 4 days following the treatment.
• If you have any more questions, you should contact the cardiologist.

Pediatric Cardiac Catheterization Risks

Cardiac catheterization is generally considered safe for children. However, there are certain risks, such as:

• Radiation hazards.
• Risks of general anesthesia, if utilized.
• A significant decline in body temperature (hypothermia).
• Reduced oxygen levels (hypoxia).
• Heart rhythm irregularity (arrhythmia).
• Low blood pressure (Hypotension).
• Heart, heart valve, or blood vessel damage.
• Blood loss, which may necessitate transfusions.
• Allergy to contrast dye or medications, including anesthesia.
• Kidney injury caused by contrast dye.
• Stroke.

When and How Often is the Treatment Performed?

The timing of the treatment is determined by the sort of cardiac condition your child has. Most operations need just one visit, but some may necessitate a second visit later in the child's life.

Is Cardiac Catheterization Painful?

Before the surgery, a child is sedated. General anesthesia may be recommended for some procedures.

The injection of local anesthetic (similar to novocaine given by the dentist) used to numb the region in the groin where the catheters will be put is usually the only pain the child feels.

As needed, more sedation is administered periodically during the catheterization to keep the kid comfortable.

The child may experience bruises and pain in the groin area where the catheters were put for a few days. Acetaminophen is commonly used to treat this condition.

What is the Likelihood of Success?

The likelihood of success of the procedure depends on the type and severity of the heart problem.

Each procedure is individualized to the patient, and its effectiveness can be discussed with your child's cardiologist or one of the specialists in interventional cardiology.

Conclusion

Some heart issues in children may need a cardiac catheterization. A long, flexible tube (catheter) is inserted into a blood vessel by the healthcare professional. The catheter is then guided into the heart by the healthcare provider to detect and address any issues.

A pediatric cardiologist, who identifies and treats heart disorders in children, performs cardiac catheterization in children. 

A cardiac catheterization may be performed on your child to examine how the heart and blood vessels are formed and connected, to check the pressure and oxygen levels in the heart and blood vessels, to treat a congenital heart defect (a heart problem that a baby is born with), to treat an irregular heartbeat (arrhythmia), to open up narrowed blood vessels (called angioplasty), or to repair leaky or narrow heart valves.