Interventional Cardiac Catheterization
Interventional catheterizations allow cardiologists to perform procedures that once required open surgery to be performed in the catheterization lab. This includes procedures such as closing holes in the heart, widening narrowed blood vessels or closing abnormal blood vessels. Children's interventional cardiologist Jeff Delaney, MD, is nationally recognized for his work in this area and is involved in multiple research studies and multi-center clinical trials to further advance the use of interventional procedures to replace open heart surgery. He performed the first "surgery-free" valve replacement procedures in Nebraska at Children's using the Melody Transcatheter Pulmonary Valve (TPV).
Interventional catheterization procedures, which are increasingly becoming the preferred treatment option, offer several advantages to open heart surgery. This includes less pain, shorter recovery times than surgical treatments for the same conditions and fewer risks. Children are often able to go home the same day or the next morning. In some cases, interventional procedures can provide temporary solutions until a more permanent surgery option is possible.
How is a catheterization performed?
A cardiac catheterization is used to diagnose and sometimes treat many different heart conditions. It is a test that can help your cardiologist learn more about how your child's heart is working and to help determine the best treatment plan. Dramatic advances in cardiac catheterization techniques allow cardiologists to treat more conditions in the catheterization laboratory than ever before.
Cardiac catheterization involves inserting a catheter -- a thin, flexible, hollow tube into a vein or artery, usually in the groin. A local anesthetic numbs the skin and muscle around the entry area where the catheter is inserted. Neither an incision nor stitches is necessary. Once the catheter has been inserted into the blood vessel, the cardiologist uses a fluoroscope, which allows the doctor to see into the arteries to guide the catheter into the different areas of the heart. The movement of the catheter within the heart is not painful because the inner parts of the heart do not have nerve endings.
While the tube is in the heart, several procedures are done. These include recording blood pressures in the different heart chambers and blood vessels; evaluating oxygen content of the blood in each chamber of the heart; injecting a liquid dye through the catheter and filming X-ray "movies" called angiograms. These pictures enable the cardiologist to see most abnormalities inside the heart. The procedure can last between one and three hours depending on the patient.
Our cardiac catheterizations are always performed by a pediatric cardiologist and a team of qualified and trained professionals. To prevent infection, the catheterization is treated like a surgical procedure. This means that the staff wears sterile gowns and the patient is covered with sterile sheets.
After your child's catheterization, the cardiologist will review the findings with you. At a weekly cardiology conference, the catheterization results are reviewed by all the pediatric cardiologists and by the cardiac surgery team. This group of specialists carefully studies each child's heart problem and discusses the best treatment.
Who is a candidate?
A cardiac catheterization is performed after X-rays, electrocardiograms (referred to as EKGs or ECGs), echocardiograms (sound wave tests) and listening to the heart have indicated that a definite heart problem exists. Several catheterizations may be necessary during your child's lifetime to evaluate changes in the heart or the results of an operation or a catheter intervention. Our patients range in age from one day to adulthood. No child is too small or too sick to have this test, but risks are higher in small and very ill children.
A cardiac catheterization may be performed on your child to:
- Diagnose his or her heart problem.
- Learn more about a heart problem.
- Obtain cardiac tissue samples for biopsy.
- If there is an abnormal heart beat, conduct an invasive electrophysiology study (EPS) in conjunction with a catheterization to locate the origin of the arrhythmia and determine how best to treat it.
- Treat the heart problem through interventional catheterization.
What are the risks?
While every cardiac catheterization involves a small risk, the important knowledge gained by this test far outweighs the small risk involved. Possible complications include loss of circulation to a leg, blood clots (which could result in a stroke), bleeding, infection, perforation through a blood vessel or heart wall and even death. The pediatric cardiology team at Children's Hospital & Medical Center is highly skilled and experienced at performing this procedure and average five to six catheterizations in children every week.
What is done to prepare for the procedure?
About one hour before the test, your child will be given a sedative. General anesthesia usually is not needed. Once your child is in the cardiac catheterization room, a shot of local anesthesia (or numbing medication) is used where the catheter enters the skin. This shot may or may not be felt by the sedated child. Most children sleep soundly through the catheterization. If your child awakens during the procedure, more sedation usually is given through the catheter in the blood vessel.
If your child has had a fever, cold, flu, diaper rash or any contagious disease (or exposure to one) during the week prior to admission, check with your child's cardiologist or cardiology nurse before coming to the hospital.
Discharge from the Hospital
We recommend showers and sponge baths instead of tub baths for three days following the catheterization or until the catheterization site in the groin is healed completely. Try to keep this area clean and dry.
Your child may resume normal activities the day after the catheterization. However, running, skating, jumping or vigorous sports are not recommended for one or two days. No swimming is allowed for approximately one week or until the catheterization site is totally healed. Your child may return to school the day after catheterization, unless otherwise directed by the cardiologist.
By the time your child goes home from the hospital, he or she will probably not need medicine for pain. However, if pain medication is needed, we recommend Tylenol.
Your child may resume a normal diet, unless otherwise directed.
When to call the Doctor
- Fever more than 100.6 F, lasting for 8 hours, during the week after catheterization.
- Increasing redness or swelling around the catheterization site or any drainage from the catheterization site. A small amount of blood on the bandage is normal.
- Bleeding at the catheterization site soaking through the bandage. (Apply pressure until bleeding stops, then notify the cardiologist.)
If your child is discharged from the hospital the same day as the heart catheterization, bedrest is recommended for the rest of that day.