ľ¹ÏÖ±²¥

What is therapeutic cardiac catheterization?

A therapeutic cardiac catheterization is a procedure to repair a heart defect.  The doctor uses a thin, flexible tube (called a catheter) that goes to the heart through a blood vessel in the leg or neck. This allows the doctor to fix the problem without surgically opening the chest or heart. This method can close holes in the heart, open narrow blood vessels or valves and close abnormal blood vessels using small devices.

What happens before the cardiac catheterization procedure?

Before going into the cardiac catheterization laboratory (cath lab), your child will get an IV. The IV allows the care team to give medications and fluids during the procedure. Medication may be given to help your child relax or sleep. The care team will check your child’s vital signs before and during the procedure.

Your child may receive sedation to help them relax and sleep, or they may need general anesthesia. If general anesthesia is used, a breathing tube will help your child breathe. They may also receive extra medication and fluids during the procedure to keep them comfortable.

What happens during the cardiac catheterization?

After your child is sedated or asleep, the area where the catheter will go is cleaned to help prevent infection.

During the procedure, the doctor places small tubes into a blood vessel in the groin or neck to guide catheters to the heart. In newborns, doctors may use umbilical blood vessels instead. Medication is used to numb the area before the tubes are placed.

Doctors carefully watch the movement of the catheters using X-ray images on a screen in the cath lab. They measure the pressure inside the heart and take small blood samples through the catheters. This helps the doctor understand how your child’s heart is working and how blood flows through the heart and lungs. A special contrast dye is also used to create X-ray pictures of the heart, which helps show where the defect is and how serious it is. This information helps your child’s doctor decide the best treatment.

As the catheter moves, it can sometimes cause an irregular heartbeat. Doctors can usually fix this by adjusting or removing the catheter. Rarely, the catheter may temporarily affect the heart’s electrical system. This is called heart block. It is usually temporary, but in some cases, a temporary pacemaker may be needed until the heart rhythm returns to normal.

When the procedure is complete, all catheters are removed, similar to taking out an IV. Pressure is applied to the area where the catheter was inserted for a few minutes to help prevent bleeding, and a bandage may be placed.

Your child will then be taken to the recovery area. 

What happens after the cardiac catheterization?

When your child goes to the recovery area, the care team will watch them closely. If your child had general anesthesia, the breathing tube will be removed once they can breathe on their own. Your child may need medication to prevent nausea or vomiting.

Going home after the cardiac catheterization

Your child may go home the same day, but sometimes staying overnight is needed. Your child’s doctor will decide when it’s safe for them to go home.

Before you leave the hospital, a doctor or nurse will explain how to care for the bandage and site where the catheter was placed.

After you take your child home, call your healthcare team if your child has:

• Bleeding that won’t stop
• Chest pain
• Fever
• Increased pain or swelling
• Anything else that concerns you

If you have questions or concerns about your child’s health, contact their cardiologist.

Types of therapeutic cardiac catheterization

In recent decades, doctors have been able to treat some heart problems in the cath lab without surgery. These procedures include:

Valvuloplasty or balloon valvotomy

This procedure opens a heart valve that is too narrow. It is most often used to open the valves that let blood flow to the lungs (pulmonary valve) or to the body (aortic valve).

Sometimes the valve is too narrow or did not develop correctly. This makes it harder for the heart to pump blood.

To open the valve, the doctor uses a catheter with a small balloon on the end. The catheter is moved through a blood vessel in the groin or neck to the narrowed valve. The balloon is then inflated to widen the valve opening.

Angioplasty

This procedure opens a blood vessel that is too narrow. Narrowed blood vessels are common in children with congenital heart disease. They can happen at birth or after surgery. When a vessel is narrow, blood flow is reduced and the heart has to work harder.

The doctor uses a catheter with a small balloon on the end. The balloon is placed inside the narrowed vessel and gently inflated to stretch the vessel open.

Stent implantation

Sometimes, using a balloon alone doesn’t open a narrowed blood vessel enough. In these cases, a stent is used to help keep the vessel open. A stent is a small metal mesh tube that supports the vessel from the inside.

Many stents used in children are expanded using a balloon. The stent is attached to a balloon and guided to the narrowed area. The balloon is then inflated, which opens the stent to the right size. The balloon is removed, but the stent stays in place to keep the vessel open.

After the stent is placed, your child will usually take medication, such as aspirin, to prevent blood clots.

Most everyday household appliances and electronics do not affect the stent. Your child’s care team will tell you about any precautions, including when MRI scans are safe.

Balloon and blade septostomy

In some cases, doctors need to make a larger opening between the heart’s two upper chambers (the right and left atrium). This can help improve blood mixing and circulation in babies with certain serious heart defects. They use special balloons and blade catheters to create this opening. 

Valve perforation

Some babies are born with a pulmonary valve that is blocked. This valve controls blood flow from the heart to the lungs. This condition is called pulmonary atresia. Treatment depends on how severe the blockage is.

• In some cases, blood flow can be improved with cardiac catheterization. During this procedure, doctors may use a balloon to open the valve or place a stent to keep the blood flowing. The stent may be placed in a blood vessel called the ductus arteriosus, which usually closes shortly after birth. In babies with pulmonary atresia, keeping this blood vessel open can help blood reach the lungs and improve oxygen levels until further treatment is possible.
• In many cases, babies with pulmonary atresia may need surgery soon after birth to open or replace the valve.

Most babies will need regular follow-up care as they grow.