Cardiac Catherization
A cardiac catheterization is a special test that the Pediatric Cardiologist can perform to study how your child's heart looks and to obtain information about oxygen levels, pressures, and blood flow within the heart.

The test involves the insertion of thin, flexible plastic tubes called cardiac catheters into the vein or artery of your child's upper leg. Occasionally the vein in the neck is used to insert a catheter. Your Pediatric Cardiologist will inform you if this is necessary. The catheters are advanced up into the heart and are guided by the cardiologist from chamber to chamber inside the heart. The catheters show up on X-ray, so the cardiologist can see exactly where the catheter is and where it needs to go next. As the catheter progresses from one chamber to the next a pressure measurement is made and a small sample of blood is analyzed for oxygen content. The heart continues to work normally throughout the test. During the test some iodine based dye, or contrast will be injected into the catheter. As the contrast is pumped through the heart it will be filmed under X-ray. This is called a "cine-angiogram", The cine-angiogram will show how blood moves from chamber to chamber and then out to the lungs and body. This will also show how forcefully the heart pumps and if there are any unusual communications inside the heart or blood vessels. This contrast solution can make your child feel warm or flushed for a few seconds. This is normal and will pass quickly. The contrast will be removed from the blood by the kidneys and is passed out of the body in urine within 1 - 2 hours.

The cardiac catheterization is performed in a special X-ray room at the hospital. Strict sterile technique is used, including gowns, gloves, and masks to minimize the risk of infection. Your child will be given medication to make him/her sleepy throughout the test, and will be monitored closely. Two Pediatric Cardiologists will be present during the catheterization. Sometimes a Pediatric Anesthesiologist will also help with the test. If this is necessary your Pediatric Cardiologist will inform you when your child's test is scheduled. The Cath Lab Staff will include at least one nurse and two or three X-ray technicians, all of whom are experienced in the care of children undergoing cardiac catheterization. During the test it is helpful if you or one of your family members can wait in the designated waiting area, so that any information can be delivered to you in a timely manner. Please let the nurse coordinator know if you need to leave the hospital for any reason.

Your child will sleep through the test with extra sedation given as needed in the I.V. The procedure will usually take between 1 1/2 and 3 hours. As soon as the test is over your Pediatric Cardiologist will come out to see you on your child's condition and the results of the catheterization. The complete results will be available later in the week after the findings have been studied, calculations performed based on the information obtained, and your child's case discussed fully with the other Pediatric Cardiologists and the Pediatric Cardiac Surgeons.

Possible Risks Of Heart Catheterization

Cardiac Catheterizations are performed on may children and very few problems are encountered. However, it is important that you know the general nature and extent of the risks so that you can give informed consent.

• Clot Formation
  Clot formation in the vein or artery in which the catheter was inserted. A clot in the vein can be associated with swelling or inflammation of the limb and rarely with dislodgment of the clot which may then float to the lung, (Pulmonary Embolus). A clot in the artery may be associated with coolness and discoloration of the extremity and loss of pulses. If the blood flow to the leg is significantly decreased, medication may be given to dissolve the clot, or a minor operation may be needed to remove the clot.
• Arrhythmia
  The catheter touching the inside of the heart can cause irregular heartbeats to occur. These are usually minor and go away once the catheter is removed from that area of the heart, however, occasional medications may be required or a brief DC electrical impulse delivered across the chest to restore normal rhythm.
• Perforation
  Rarely, the catheter could penetrate the wall of the heart or a blood vessel. Such a perforation will usually seal itself, however, if an accumulation of blood occurs around the heart it may need to be removed with a syringe and needle (Pericardial Tap), or an operation.
• Infection
  Rarely, infection could occur at the catheterization site or in the blood stream. If your child develops a fever within a week of the catheterization, check with your pediatrician to rule out infection.
• Bleeding
  Blood loss during the catheterization procedure is usually minimal, however, excessive blood loss may necessitate transfusion with blood or blood products.
• Death
  Death has occurred in less than 1% of cases and is usually secondary to one of the above complications.
• Contrast Reactions
  Adverse reactions to contrast material (dye) have been reported, but are extremely rare in children.
• Medication Reactions
  adverse reactions to the sedation medication or local anesthetic agent have been reported.
• "Blue Spell"
  If your child has a heart defect in which there is less than normal blood flow to the lungs, it is possible that the catheter touching inside the heart could induce a "Blue Spell". Should this occur medications will be given to reverse the episode.
• Neurologic
  A cerebrovascular accident (stroke) may rarely occur secondary to embolization of air, clot, or catheter fragments to the brain. Very rarely a weakness (usually temporary) of the arm may occur due to stretching of nerves, related to positioning on the procedure table.

If you have any questions about the test you should talk with the nurse coordinator or your Pediatric Cardiologist before the test begins.

The Morning Of The Cardiac Catheterization

A few days before the test you should talk to your child about coming to the hospital. Explain that the test is necessary and that the doctors and nurses are there to help. Many hospitals have pre-admission programs to help children deal with the hospital experience. Ask you cardiologist if this is available. One or two days before the test you will need to take your child to the hospital pre-admission area to complete forms and have blood and urine tests. The office will infirm you where and when to go.

On the day of the test your child is allowed clear liquids, such as apple juice or water until 2 hours before the test, but should not eat anything. If your child is having general anesthesia these times will be different. Check with your cardiologist's office or nurse coordinator. At the hospital an I.V. will be started in your child's hand. This is to insure that your child gets enough fluids during the test and also to allow I.V. sedation medicine to be given during the test to help your child sleep. EMLA, a local anesthetic cream, will be placed on your child's groin, over the artery and vein. This cream will numb the skin and make catheter insertion less uncomfortable. Local anesthetic, carbocaine, (like dentists use), will be used to numb the area fully before the catheter is placed.

About 45 minutes before the test your child will get a premedication. This may be a medicine to drink for young children, or a shot for older children. After this your child will become drowsy and should not be left unsupervised. The staff will transport your child to the Cath Lab for the test.

After The Catheterization

After the test is completed your child will be moved to the recovery room, ICU, or intermediate care unit, and will need to rest in bed for the remainder of the day. The nurse will check vital signs, catheter insertion site(s) and pulses frequently. The catheter site will be observed for bleeding. Usually no stitches will be used, just a large bandage, which should be replaced with a Band-Aid the morning after the test. Some bruising may be present at the catheter insertion site. This is normal. The site may be tender for a day or two but not enough to limit your child's activity.

When awake from the sedation your child may drink and eat normally. Some children complain of nausea for a short time after the cardiac catheterization, especially if general anesthesia was given. Encourage you child to sip clear liquids initially. Fever may occur for a short time after the catheterization, especially if contrast solution was used, but this should subside as the contrast is excreted by the body. Drinking clear liquids will help to speed up this process.

If your child's test required the use of an artery for catheter insertion they will be required to rest in bed for 6 - 8 hours before being allowed home. If a vein alone was accessed, then your child will usually be able to come home after resting for 4 hours.

The rest period is so we can observe the catheter site for signs of bruising or bleeding.

The evening after the test your child should rest as much as possible and resume normal activities on the following day.