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Varrica A, Lo Rito M, Generali T, Satriano A, D'Oria V, Conforti E, Pluchinotta F, Chessa M, Butera G, Frigiola A, Carminati M, Giamberti A. Surgical rescue after transcatheter interventional procedures in congenital heart disease patients: an existing problem. EUROINTERVENTION 2017; 12:1724-1729. [PMID: 27773863 DOI: 10.4244/eij-d-16-00031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Nowadays, transcatheter approaches are the treatment of choice for several congenital heart defects. However, adverse events may occur during interventional procedures. Even if the complication rate has been reduced remarkably because of learning curve and technological improvements, catastrophic events are still possible. The aim of this study was to review cardiac catheter complications that required surgical treatment during or after a percutaneous procedure. METHODS AND RESULTS We evaluated retrospectively a thirteen-year experience at our centre. We examined all transcatheter procedures involving device release or implantation needing surgical rescue. We performed 3,205 interventional catheterisation procedures with device release or implantation: ASD device closure (n=2,205), PDA device occlusion (n=355), VSD device closure (n=218), aortic coarctation or recoarctation stenting (n=199), pulmonary artery stenting (n=154) and pulmonary valve implantation (n=74). Complications that required surgical treatment occurred in 1.2% of cases. Early surgery was performed in 22 cases, while in 18 patients a surgical treatment related to late complications was performed in a mean follow-up of 17 months. There were no deaths in either group. CONCLUSIONS A spectrum of CHD can be treated today by transcatheter interventional procedures with good results and a low, but not negligible, risk of complications that require a surgical operation. The risk of developing late complications makes a long-term follow-up mandatory in such patients.
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Affiliation(s)
- Alessandro Varrica
- Department of Pediatric Cardiac Surgery, IRCCS San Donato Milanese Hospital, San Donato Milanese, Italy
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Hascoët S, Jalal Z, Baruteau A, Mauri L, Chalard A, Bouzguenda I, Piéchaud JF, Thambo JB, Lefort B, Guérin P, Le Gloan L, Acar P, Houeijeh A, Godart F, Fraisse A. Stenting in paediatric and adult congenital heart diseases: A French multicentre study in the current era. Arch Cardiovasc Dis 2015; 108:650-60. [DOI: 10.1016/j.acvd.2015.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 06/12/2015] [Accepted: 07/31/2015] [Indexed: 10/23/2022]
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Torres A, Sanders SP, Vincent JA, El-Said HG, Leahy RA, Padera RF, McElhinney DB. Iatrogenic aortopulmonary communications after transcatheter interventions on the right ventricular outflow tract or pulmonary artery: Pathophysiologic, diagnostic, and management considerations. Catheter Cardiovasc Interv 2015; 86:438-52. [PMID: 25676815 DOI: 10.1002/ccd.25897] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 02/07/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To investigate the spectrum, etiology, and management of traumatic aortopulmonary (AP) communications after transcatheter interventions on the pulmonary circulation. BACKGROUND An iatrogenic AP communication is an unusual complication after balloon pulmonary artery (PA) angioplasty or stenting, or transcatheter pulmonary valve replacement (TPVR). However, with the increasing application of transcatheter therapies for postoperative PA stenosis and right ventricular outflow tract (RVOT) dysfunction, including percutaneous pulmonary valve replacement, consideration of the etiology, diagnosis, and management of this problem is important for interventional cardiologists performing such procedures. METHODS AND RESULTS We present three new cases, as well as gross anatomy and histopathology data, related to AP communications after PA interventions. We also review the literature relevant to this topic. Including these new cases, there have been 18 reported cases of iatrogenic AP communication after transcatheter interventions on the PAs or RVOT, primarily patients with transposition of the great arteries who underwent PA angioplasty after an arterial switch operation, or after TPVR in patients who had undergone a Ross procedure. The likely cause of such defects is PA trauma plus distortion of the neo-aortic anastomosis resulting from angioplasty or stenting of the RVOT or central PAs, with subsequent dissection through the extravascular connective tissue and into the closely adjacent vessel through the devitalized tissue at the anastomosis. CONCLUSIONS Cardiologists performing PA or RVOT interventions should be aware of the possibility of a traumatic AP communication and consider this diagnosis when confronted with suggestive signs and symptoms.
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Affiliation(s)
- Alejandro Torres
- Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Stephen P Sanders
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Julie A Vincent
- Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Howaida G El-Said
- Department of Pediatrics, University of California, San Diego, California
| | - Ryan A Leahy
- Department of Pediatrics, University of Louisville, Louisville, Kentucky
| | - Robert F Padera
- Department of Pathology, Brigham & Women's Hospital, Boston, Massachusetts
| | - Doff B McElhinney
- Department of Cardiothoracic Surgery, Lucille Packard Children's Hospital Stanford, Palo Alto, California
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Hascoët S, Baruteau A, Jalal Z, Mauri L, Acar P, Elbaz M, Boudjemline Y, Fraisse A. Stents in paediatric and adult congenital interventional cardiac catheterization. Arch Cardiovasc Dis 2014; 107:462-75. [PMID: 25128078 DOI: 10.1016/j.acvd.2014.06.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 06/12/2014] [Accepted: 06/13/2014] [Indexed: 11/15/2022]
Abstract
A 'stent' is a tubular meshed endoprosthesis that has contributed to the development of interventional catheterization over the past 30 years. In congenital heart diseases, stents have offered new solutions to the treatment of congenital vessel stenosis or postsurgical lesions, to maintain or close shunt patency, and to allow transcatheter valve replacement. First, stents were made of bare metal. Then, stent frameworks evolved to achieve a better compromise between radial strength and flexibility. However, almost all stents used currently in children have not been approved for vascular lesions in children and are therefore used 'off-label'. Furthermore, the inability of stents to follow natural vessel growth still limits their use in low-weight children and infants. Recently, bioresorbable stents have been manufactured and may overcome this issue; they are made from materials that may dissolve or be absorbed in the body. In this review, we aim to describe the history of stent development, the technical characteristics of stents used currently, the clinical applications and results, and the latest technological developments and perspectives in paediatric and adult congenital cardiac catheterization.
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Affiliation(s)
- Sebastien Hascoët
- Groupe de cathétérisme interventionnel pédiatrique et congénital, filiale de cardiologie pédiatrique et congénitale de la Société française de cardiologie, France; M3C CHU Toulouse, Paediatric and Congenital Cardiology, Children's Hospital, Paul-Sabatier University, 31059 Toulouse, France; Inserm UMR 1048, Équipe 8, I2MC, institut des maladies métaboliques et cardiovasculaires, Paul-Sabatier University, 31432 Toulouse, France; CHU Toulouse, Department of Cardiology, Rangueil Hospital, Paul-Sabatier University, 31400 Toulouse, France.
| | - Alban Baruteau
- Groupe de cathétérisme interventionnel pédiatrique et congénital, filiale de cardiologie pédiatrique et congénitale de la Société française de cardiologie, France; M3C Marie-Lannelongue Hospital, Paediatric and Congenital Cardiac Surgery, Paris Sud University, 92350 Paris, France; Inserm UMR 1087, CNRS UMR6291, institut du thorax, Nantes University, 70721 Nantes, France
| | - Zakaria Jalal
- Groupe de cathétérisme interventionnel pédiatrique et congénital, filiale de cardiologie pédiatrique et congénitale de la Société française de cardiologie, France; M3C CHU Bordeaux, Paediatric and Congenital Cardiology, Haut l'Évêque Hospital, 33600 Bordeaux, France
| | - Lucia Mauri
- Groupe de cathétérisme interventionnel pédiatrique et congénital, filiale de cardiologie pédiatrique et congénitale de la Société française de cardiologie, France; M3C CHU Marseille, Paediatric and Congenital Cardiology, La Timone Hospital, 13385 Marseille, France
| | - Philippe Acar
- Groupe de cathétérisme interventionnel pédiatrique et congénital, filiale de cardiologie pédiatrique et congénitale de la Société française de cardiologie, France; M3C CHU Toulouse, Paediatric and Congenital Cardiology, Children's Hospital, Paul-Sabatier University, 31059 Toulouse, France
| | - Meyer Elbaz
- CHU Toulouse, Department of Cardiology, Rangueil Hospital, Paul-Sabatier University, 31400 Toulouse, France
| | - Younes Boudjemline
- Groupe de cathétérisme interventionnel pédiatrique et congénital, filiale de cardiologie pédiatrique et congénitale de la Société française de cardiologie, France; M3C Necker Hospital for Sick Children, Paediatric Cardiology, Paris 5 René Descartes University, 75015 Paris, France; M3C Georges Pompidou European Hospital, Adult Congenital Cardiology, 75015 Paris, France
| | - Alain Fraisse
- Groupe de cathétérisme interventionnel pédiatrique et congénital, filiale de cardiologie pédiatrique et congénitale de la Société française de cardiologie, France; M3C CHU Marseille, Paediatric and Congenital Cardiology, La Timone Hospital, 13385 Marseille, France
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Abdelghany AM. Does balloon Eustachian tuboplasty increase the success rate in repair of subtotal tympanic membrane perforations with resistant tubal dysfunction? ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.ejenta.2013.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Poe DS, Silvola J, Pyykkö I. Balloon dilation of the cartilaginous eustachian tube. Otolaryngol Head Neck Surg 2011; 144:563-9. [PMID: 21493236 DOI: 10.1177/0194599811399866] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES (1) To translate techniques developed in a previous cadaver study of balloon dilation of the cartilaginous eustachian tube (ET) into clinical treatment for refractory dilatory dysfunction and (2) to study the safety/efficacy of the technique in a pilot clinical trial. STUDY DESIGN Prospective with subjects as their own historical controls since June 2009. SETTING Regional academic center. SUBJECTS AND METHODS Eleven consecutive adult patients with longstanding otitis media with effusion (OME) who were unable to autoinsufflate their ET by Valsalva, swallow, or yawn and who had previous tympanostomies (average, 4.7). At the time of intervention, 5 of 11 had a tube; 2 of 11 had a tympanic membrane (TM) perforation. Four of 11 had intact TMs, 2 with OME and tympanogram type B and 2 with TM retraction and tympanogram types B and C. Balloon dilation of the cartilaginous ET was performed with sinus dilation instruments via transnasal endoscopic approach under general anesthesia in a day surgery setting. Inflation was to a maximum of 12 atm for 1 minute. OUTCOME MEASURES ability to Valsalva, rating of ET mucosal inflammation, tympanogram, and otomicroscopy findings. RESULTS All cases successfully dilated. Eleven of 11 could self-insufflate by Valsalva (P < .001); tympanograms were A (4/11), C (1/11), or open (6/11). All atelectases resolved. Procedures were well tolerated, without pain or complications related to dilation. CONCLUSION Dilation of the cartilaginous ET appeared to be beneficial and without significant adverse effects in the treatment of ET dilatory dysfunction. Larger controlled trials with long-term results are now justified and needed.
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Affiliation(s)
- Dennis S Poe
- Department of Otolaryngology, University of Tampere Medical School, Tampere, Finland.
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Poe DS, Hanna BMN. Balloon dilation of the cartilaginous portion of the eustachian tube: initial safety and feasibility analysis in a cadaver model. Am J Otolaryngol 2011; 32:115-23. [PMID: 20392533 DOI: 10.1016/j.amjoto.2009.11.008] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2009] [Accepted: 11/16/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND Balloon catheter dilation of diseased sinus ostia has recently demonstrated efficacy and safety in the treatment of chronic sinus disease with 2 years of follow-up. Similar to sinus surgery, initial studies of partial resection of inflamed mucosa from within the cartilaginous eustachian tube (ET) have demonstrated efficacy and safety in the treatment of medically refractory otitis media with effusion. Therefore, balloon dilation of the cartilaginous ET was investigated as a possible treatment modality for otitis media. METHODS A protocol for sinus balloon catheter dilation was evaluated in each of the cartilaginous ETs in 8 fresh human cadaver heads. Computed tomographic scans and detailed endoscopic inspections with video or photographic documentation were performed pre- and posttreatment, and gross anatomical dissections were done to analyze the effects of treatment and to look for evidence of undesired injury. RESULTS Catheters successfully dilated all cartilaginous ETs without any significant injuries. There were no bony or cartilaginous fractures, and 3 specimens showed minor mucosal tears in the anterolateral or inferior walls. Volumetric measurements of the cartilaginous ET lumens showed a change from an average of 0.16 to 0.49 cm(3) (SD, 0.12), representing an average increase of 357% (range, 20-965%). CONCLUSIONS Balloon catheter dilation of the nasopharyngeal orifice of the ET was shown to be feasible and without evidence of untoward injury. A significant increase in volume of the cartilaginous ET was achieved. A clinical study is now indicated to determine whether balloon dilation will demonstrate lasting benefits and safety in the treatment of otitis media.
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Affiliation(s)
- Dennis S Poe
- Department of Otolaryngology, Children's Hospital and Harvard Medical School, Boston, MA, USA; Tampere University Medical School, Finland.
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Abstract
Endocardial fibroelastosis is not a disease but a reaction of the endocardium. I review the history of the term with emphasis on the gradual understanding of the many causes of this reaction. I include a comprehensive list of diseases or other cardiac stresses that authors have reported in association, and I try to explain the mechanism of the reaction. Although endocardial fibroelastosis is rare today, I issue a warning of a possible epidemic recrudescence of some of the associated diseases. My hope is for nosologic purity, therefore that outworn but surviving concepts will be firmly rejected.
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Coartación aórtica en el adulto. CIRUGIA CARDIOVASCULAR 2009. [DOI: 10.1016/s1134-0096(09)70134-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Mehta R, Lee KJ, Chaturvedi R, Benson L. Complications of pediatric cardiac catheterization: a review in the current era. Catheter Cardiovasc Interv 2008; 72:278-85. [PMID: 18546231 DOI: 10.1002/ccd.21580] [Citation(s) in RCA: 129] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To determine types of complications and risks associated with pediatric cardiac catheterization in the current era. BACKGROUND Pediatric cardiac catheterization is an important diagnostic and therapeutic tool. Although in the last decade, there have been significant improvements in technology and equipment, the risk for complications remains, adversely effecting outcomes. DESIGN The clinical records of 11,073 children undergoing cardiac catheterizations between January 1994 and March 2006 were reviewed to identify procedures associated with complications within the first 24 h after catheterization. All children's electronic and paper chart records were reviewed to obtain demographic, procedural, and treatment data. RESULTS A total of 858 (7.3%) complications (classified as major or minor) occurred in 816 studies (510 males, 63%), in children ranging in age from 8 h to 20 years (median 4.13 years). There were 195 major (22%) and 663 (78%) minor complications. Vascular complications represented the majority (n = 278; 32.4%) and were major in 53 instances (P < 0.0001). Twenty-five children died within 24 h (0.23% of total case numbers). Independent risk factors for a complication included young patient age (<6 months), male gender, inpatient status, and year of catheterization. CONCLUSIONS Complications continue to be associated with pediatric cardiac catheterization, although overall incidence appears to be decreasing. Patient age, gender, and inpatient status continue to be risk factors for morbidity and mortality. Efforts at improving equipment for flexibility and size, and developing strategies for the use of alternative methods for catheter access should be encouraged.
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Affiliation(s)
- Rohit Mehta
- The Hospital for Sick Children, Department of Pediatrics, The Labatt Family Heart Center, The University of Toronto School of Medicine, Toronto, Canada
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Bergersen L, Gauvreau K, Jenkins KJ, Lock JE. Adverse Event Rates in Congenital Cardiac Catheterization: A New Understanding of Risks. CONGENIT HEART DIS 2008; 3:90-105. [DOI: 10.1111/j.1747-0803.2008.00176.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Agnoletti G, Bonnet C, Boudjemline Y, Le Bihan C, Bonnet D, Sidi D, Bonhoeffer P. Complications of paediatric interventional catheterisation: an analysis of risk factors. Cardiol Young 2005; 15:402-8. [PMID: 16014189 DOI: 10.1017/s1047951105000843] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To identify predictive factors of complications occurring during paediatric interventional catheterisation. BACKGROUND Interventional paediatric catheterisation is still burdened by a substantial risk. Risk factors, however, have rarely been investigated. METHODS We analysed prospectively 1,022 interventional procedures performed over a period of 8 years, excluding 260 procedures for atrial septostomy. We considered several patient-related variables, specifically age, weight, and gender, type of procedure, times required for fluoroscopy and the overall procedure, technical challenge, and the severity of the clinical condition. We also analysed variables linked to the environment, specifically the date of the examination, whether the operator remained in training, the novelty of the material, any breakdown in the installation, and errors made by the operator. We classified complications as those without clinical consequence, those which proved lethal, those requiring cardiopulmonary resuscitation, elective or emergency surgery, hospitalisation in the intensive care unit, and those leading to recatheterisation. RESULTS Our average incidence of complications was 4.1 per cent, which did not change significantly during the period of study. Of the patients, 4 died, 7 needed urgent surgery, 5 elective surgery, 3 hospitalisation in intensive care unit, and 8 recatheterisation. Independent risk factors for complications were technical challenge, critical clinical condition, operator in training, operator error, and breakdown of the installation. Young age was not associated with a higher risk of complications. Patients in whom no cause for complication could be found, either related to their own features or the environment, had a risk of complication of 1.4 per cent (95 per cent confidence intervals from 0.7 to 2.5 per cent). CONCLUSIONS Our data show that variables relating either to the patient or the environment of catheterisation are associated with an increased risk of procedural complications. Knowledge of the risk factors can improve the odds of paediatric interventional catheterisation.
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Schroeder VA, Shim D, Spicer RL, Pearl JM, Manning PJ, Beekman RH. Surgical emergencies during pediatric interventional catheterization. J Pediatr 2002; 140:570-5. [PMID: 12032524 DOI: 10.1067/mpd.2002.122723] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the incidence of catheter-related surgical emergencies during pediatric interventional catheterization procedures. STUDY DESIGN We reviewed all interventional catheter procedures (n = 578) over a 4-year period (April 1996 to April 2000) to determine any complication during interventional catheterization that required surgery within 24 hours after catheterization. RESULTS The overall incidence of surgical emergencies was 1.9% (70% confidence limits, 1.5% to 2.7%). Complications that required surgical intervention occurred with balloon dilation (valvuloplasty, angioplasty, n = 4), device deployment (coils, stents, atrial-septal defect devices, n = 5), transhepatic access (n = 1), and atrial transseptal puncture (n = 1). For the majority of interventions, the incidence of surgical emergencies was <4% except for two procedures (conduit and pulmonary artery angioplasty) with limited numbers of patients. There were no surgical emergencies during endomyocardial biopsy, coarctation angioplasty, or balloon atrial septostomy. CONCLUSIONS Surgery was required in 1.9% of all interventional catheter procedures. Surgical emergencies occurred during a wide variety of catheter interventions and could not be predicted by the type of procedure performed.
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Affiliation(s)
- Valerie A Schroeder
- Heart Center, Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA
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Bernath MA, Sekarski N. Management of paediatric patients undergoing diagnostic and invasive cardiology procedures. Curr Opin Anaesthesiol 2001; 14:441-6. [PMID: 17019128 DOI: 10.1097/00001503-200108000-00011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Since diagnostic cardiac catheterization in children with congenital heart disease was first reported in 1947, echocardiography has been used as a non-invasive diagnostic tool in congenital heart disease, resulting in a decrease in diagnostic cardiac catheterizations. However, the total number of cardiac catheterizations remained at a steady level until the mid-1980s and has since increased progressively. This is a result of the introduction of interventional transcatheter techniques to improve or correct congenital heart malformations. Since the first description of balloon atrial septostomy, the range of indications for such techniques has steadily increased, particularly in the past 15 years. 'Deep' sedation or general anaesthesia is essential for the conduct of cardiac catheterization in children, particularly in the younger age group.
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Affiliation(s)
- M A Bernath
- Anesthesiology Department, CHUV, CH-1011 Lausanne, Switzerland.
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