New recommendations for pediatric cardiac caths

Emma Hitt

May 09, 2011

Dallas, TX - The American Heart Association (AHA) has issued a scientific statement containing recommendations for diagnostic and therapeutic cardiac catheterization in pediatric heart disease, which were last updated in 1998 [1].

Dr T imothy F Feltes (Nationwide Children's Hospital Heart Center, Columbus, OH) and colleagues published their scientific statement, endorsed by the Society for Cardiovascular Angiography and Interventions and the American Academy of Pediatrics, online May 2, 2011 in Circulation.

According to the study authors, cardiac catheterization is no longer recommended as a diagnostic tool for routine presurgical evaluation of most congenital defects. Such defects include ventricular septal and atrial septal defects, atrioventricular canal, tetralogy of Fallot, double-outlet right ventricle, coarctation of the aorta, hypoplastic left heart syndrome, and other complex congenital heart diseases.

"Advances in noninvasive imaging have allowed cardiac catheterization to become increasingly a catheter-based therapeutic option rather than a diagnostic tool," Dr. Feltes and colleagues write. "Two-dimensional echocardiography and three-dimensional imaging by echocardiography, magnetic resonance imaging (MRI), and computed tomography (CT) in many cases have replaced the need for cardiac catheterization," they add.

In the case where other techniques are inadequate or for centers without access to noninvasive imaging techniques, however, the study authors recommend diagnostic catheterization. Diagnostic catheterization may also be needed when the anatomy of a child with congenital heart disease cannot be fully defined by noninvasive methods, such as in very complex congenital heart disease requiring specific details on anatomy or hemodynamics, they note.

The scientific statement also explores a range of indications for which therapeutic cardiac catheterization can be considered.

According to the study authors, a literature review determined that common complications or risks of cardiac catheterization include the following: exposure to ionizing radiation; anesthesia; hypothermia, especially in small infants; aggravation of hypoxia; temporary or permanent arrhythmias; vascular injury, perforations, or tears; cardiac perforation; cardiac valve injury; blood loss requiring transfusion; allergic reactions to contrast agents, drugs, or anesthetics; renal insufficiency caused by contrast material; diffuse central nervous system injury; stroke; and death.

Studies evaluating the safety and efficacy of catheterization and transcatheter therapy in congenital heart disease are rare, with many important questions not suitable for clinical-trial investigation, the study authors note. However, they add that all recommendations will not be appropriate for all centers. "Individual centers must assess their own capabilities and limitations" and "dialogue between the interventionalist, surgeon, and managing cardiologist is paramount to the provision of quality care for the patient with [congenital heart disease]."

Feltes has no disclosures to report. Disclosures for the coauthors are listed in the paper. The development of the recommendations was not commercially supported.

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