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Cardiology
Pediatric and Congenital Cardiac Catheterization
Built from Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
What’s inside
19 sections · 148 slides
Overview
- Scope of this topic
Evolution and scope of the field
- Definition and current role
- Historical milestones
- Growth of interventional technique
- Overlap between paediatric and adult catheterization
- Adults with congenital heart disease
- Congenital versus acquired heart disease work
- Persisting role of diagnostic catheterization
Congenital anatomy and haemodynamics
- Distinctive features of paediatric cardiac anatomy
- Failure of transitional circulation
- Ventricular dominance after birth
- Neonatal myocardial compliance
- Resistance changes in the neonatal period
- Heart rate dependence of cardiac output
Congenital defects relevant to catheterization
- Atrial septal defect
- Ventricular septal defect
- Patent ductus arteriosus
- Pulmonary and aortic valve stenosis
- Coarctation of the aorta
- Pulmonary vein stenosis and single ventricle
Haemodynamic assessment
- Methods of cardiac output determination
- Fick principle and oxygen consumption
- Seckeler equation and its rationale
- Predictive equations for oxygen consumption
- Comparison of predictive equations for oxygen consumption
- Thermodilution and Doppler estimation
Imaging in the congenital catheter lab
- Angiography and two- versus three-dimensional imaging
- Coarctation morphology on rotational angiography
- Three-dimensional modelling before ductal stenting
- Imaging fusion and virtual reality planning
- Radiation safety and dose reduction
- MRI-guided catheterization
Indications for catheterization
- Diagnostic indications
Atrial septal defect closure
- Indications for transcatheter ASD closure
- Guideline recommendations for percutaneous closure
- Preprocedural imaging and vascular access
- Devices for atrial septal defect closure
- Device deployment sequence
- Atrial septal defect closure with two devices
- Upper pulmonary vein and balloon-assisted techniques
- Modified sheath and FAST techniques
- Device embolization and residual shunting
- Atrial arrhythmia and aortic erosion
- Outcomes of transcatheter ASD closure
Ventricular septal defect closure
- Indications for transcatheter VSD closure
- Devices for ventricular septal defect closure
- Procedural technique for VSD closure
- Complications after transcatheter VSD closure
- Complications of transcatheter ventricular septal defect closure
- Outcomes of VSD closure
Patent ductus arteriosus closure
- Indications for PDA closure
- Modified Krichenko classification of ductal morphology
- Technique for PDA closure
- Devices used for ductal closure
- Complications of PDA closure
- Device protrusion causing aortic or pulmonary artery obstruction
- Outcomes after ductal closure
Balloon valvoplasty and dilation
- Indications for balloon valvoplasty
- Balloon sizing and procedural steps
- Outcomes and complications of valvoplasty
Coarctation angioplasty and stenting
- Indications in neonates and children
- Indications in adolescents and adults
- Procedural approach for coarctation
- Stent selection in coarctation
- Outcomes and complications of coarctation intervention
Neonatal palliative interventions
- Indications for balloon atrial septostomy
- Rashkind balloon atrial septostomy
- Septostomy technique and outcomes
- Pulmonary valve perforation in PA-IVS
- Circular shunt after valve perforation
- Indications for PDA stenting
- Lesions treated by ductal stenting
- Technique for ductal stenting
- Complications of ductal stenting
Pulmonary valve replacement
- Indications for pulmonary valve replacement
- Transcatheter versus surgical valve replacement
- Melody valve
- Melody valve outcomes and limitations
- Edwards Sapien 3 valve
- Limitations of the Sapien 3 valve
- Venus P valve
- Limitations of the Venus P valve
- Alterra prestent and Harmony valve
- Matching valve to outflow tract anatomy
Pulmonary hypertension in congenital disease
- Right heart catheterization in pulmonary hypertension
- Procedural risk in pulmonary hypertension
Equipment and laboratory setup
- Intracardiac echocardiography
- Fusion imaging and intravascular imaging
- Radiation reduction in the laboratory
- Hybrid procedures
- Sheaths for neonates and infants
- Catheters for congenital intervention
- Adaptation of adult equipment for children
- Catheter interventions as a bridge to surgery
Preprocedural planning and vascular access
- Device and material selection
- Anatomical variations affecting access
- Sedation versus general anaesthesia
- Haemostasis in neonates and infants
- Vascular closure in older children and adults
- Early vascular access complications
- Late vascular access complications
Challenges and limitations
- Device size versus somatic growth
- BeGrow stent system
- Minima stent system
- Limitations in diagnostic accuracy
- Radiation and contrast exposure
- Challenges in low-resource settings
- Decision-making for high-risk neonates
The next decade
- Fetal cardiac intervention
- Fetal aortic valvuloplasty for critical aortic stenosis
- Biodegradable stents
- Growing stents
- Artificial intelligence and robotic navigation
- Will catheter intervention replace surgery
- Summary of key points
- References
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- Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
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