Cardiac catheterization, or interventional cardiology, is a procedure used for the diagnosis and management of patients with congenital (and acquired) heart disease. A small tube is inserted into the groin and a long catheter is advanced into the heart and blood vessels. X-ray equipment is used to monitor the course of the catheter, and to document specific images that are acquired during the procedure, such as angiograms (which is the injection of a contrast agent into the chambers of the heart and/or great vessels).
This technique facilitates not only diagnostic procedures, but also therapeutic interventions, such as the closure of holes within the heart, closure of abnormal blood vessels, opening of narrowed blood vessels, and implantation of vales into the heart. Procedures are performed in a dedicated state-of-the-art cardiac catheterization laboratory (including transcatheter valves and covered stents), and modern bi-plane imaging equipment. In many older patients, we perform the procedures as a team of pediatric and adult congenital interventional cardiologists. We offer the full spectrum of interventional cardiac catheterization procedures including (but not limited to) the following:
Closure of septal defects
Atrial septal defects (ASDs)
Ventricular septal defects (VSDs)
Surgically created fenestrations (e.g. after Fontan procedure)
Closure of abnormal vascular communications
Patent ductus arteriosus (PDA)
Pulmonary arterio-venous fistulas
Transcatheter valve implantation
Balloon angioplasty and/or stent implantation of stenotic blood vessels
Coarctation of the aorta
Simple and complex stenosis of branch pulmonary arteries
Stenotic superior and inferior caval vein
Stenotic intracardiac baffles and Fontan
Recanalization or opening of completely occluded blood vessels
Opening of atretic heart valves (valves that were not formed before birth)
Creating and maintaining of communications within the heart
Balloon atrial septostomy
Stenting of the atrial septum
What to Expect
Before the Procedure
Children and young adults who undergo cardiac catheterization in our cardiology practice will meet with the interventional cardiologist at a consultation prior to the day of the procedure. At that time, the procedure’s details, possible risks and adverse events specific to the procedure will be explained in detail. When possible, our team will use case examples and models to demonstrate the technical elements of the procedure.
In most cases, no blood tests are needed prior to the procedure with laboratory tests being taken once the child is under anesthesia, thereby avoiding unnecessary distress to patients and families. In addition to the interventional cardiologist performing the procedure, we have a dedicated cardiac interventional nurse practitioner who will be a primary point of contact for patients and families, and who will provide detailed pre-procedural instructions and guidelines.
Day of Procedure
Most patients will be asked to arrive at our center in the morning of the procedure, when they will again meet the interventional cardiologist and nurse practitioner for any additional questions or concerns, as well as the anesthetists who will provide anesthesia during the procedure.
The length of the procedure varies, depending on the individual patient, and can last anywhere between one to six hours, or sometimes longer. Most procedures are performed under general anesthesia.
During the procedure, parents and families will be provided with regular progress updates. When the procedure is done, patients are brought briefly to a recovery area. They are then prior to being admitted to the pediatric (or adult) floor, or in some cases, to the pediatric (or adult) intensive care unit. The interventional cardiologist will speak to parents and family immediately following the procedure and explain the details of what was performed. While some patients can be discharged home within 6 hours, most will be observed overnight.
The day after the procedure, some tests such as a chest X-Ray or echocardiogram may need to be performed. Prior to discharge, parents will meet with the interventional cardiologist one more time to discuss any additional questions or concerns. Families will be provided with detailed discharge instructions and a follow-up with the interventional nurse practitioner will be arranged for four weeks following the procedure.
At the follow-up visit, the vascular entry site (usually the groin) will be inspected and the patient evaluated for any problems or concerns relating to the cardiac catheterization procedure. After this visit, further follow-ups will be arranged with the patient’s original pediatric cardiologist.