Cardiac Catheterization for Children

Cardiac catheterization is a procedure used to diagnose and treat certain heart problems. To do this, the doctor putsa long, flexible tube (catheter) into a blood vessel. The doctor then guides the catheter into the heart to find and treat any problems.  

In children, cardiac catheterization is done by a pediatric cardiologist. This is a doctor who diagnoses and treats heart problems in children. He or she has special training in cardiac catheterization.

A child may need a cardiac catheterization to diagnose a heart problem (diagnostic cardiac catheterization). Or a child may need a catheterization to fix a problem (interventional cardiac catheterization). The problem is often one that he or she was born with (congenital heart defect).

Diagnostic catheterization is used less often now. Other tests such as echocardiography, MRI, and CT scans are used instead. A diagnostic catheterization may be done to:

• Get a more accurate image of the heart or a heart defect
• Check the flow of blood through the heart
• Find pressures in different parts of the heart and lungs
• Check the heart valves to see if they are working correctly
• Measure oxygen levels in different areas of the heart, lungs, and blood vessels
• Measure electrical activity in the heart
• Check for problems after surgery
• Take tissue samples to be looked at in a lab (biopsy)
• Check the heart before or after heart transplant

Interventional catheterization has replaced surgery for some procedures. An interventional catheterization may be done to:

• Close an abnormal opening between the 2 sides of the heart
• Close abnormal blood vessels
• Widen a narrow blood vessel or heart valve
• Treat a heart beating too fast or too slow (abnormal heart rhythm)

Cardiac catheterizations in children are usually safe. But there are some risks, including:

• Risks from radiation
• Risks from general anesthesia, if it is used
• Serious drop in body temperature (hypothermia)
• Decreased oxygen levels (hypoxia)
• Irregular heart rhythm (arrhythmia)
• Injury to the heart, heart valves, or  blood vessels
• Blood loss, which could require transfusions
• Allergic reaction to contrast dye or medicines, including anesthesia
• Kidney damage from contrast dye
• Stroke
• Death

How you get your child ready depends on his or her age. If your child is old enough, explain what will happen in a way that he or she will understand. You might ask the doctor, nurse, or a child-life specialist to explain the procedure to your child. Before your child's catheterization, you should:

• Make sure your child has stopped eating or drinking at a certain time before the procedure.
• Try to keep your child healthy to prevent postponing the catheterization. Keep your child away from people with fevers, colds, or other viruses.
• Let the doctor know if your child gets sick before the procedure.

Your child's doctor will discuss the risks and benefits of the procedure with you. You will also need to give written permission (informed consent) to do the procedure.

The procedure is done in a cardiac catheterization lab in a hospital. Your child's doctor and a specially trained staff of nurses and technicians will be there during the procedure.

Your child is either given medicine to help him or her relax (sedation). Or your child will get general anesthesia so he or she is asleep during the procedure. Once in the cath lab, he or she will lie on a small table with a lot of equipment nearby. In general, here is what will happen:

• The healthcare team will give your child an injection of numbing medicine (local anesthetic) in the area where the catheter is going to be inserted. This is usually the groin. But other blood vessels may be used instead such as the vessels in the neck or bellybutton.
• The doctor will put a special tube (sheath) into the blood vessel. The doctor puts the catheter through the sheath. Sometimes more than one catheter is used.
• The doctor guides the catheter through the blood vessel to the heart. The doctor uses moving X-rays (fluoroscopy) to help see where the catheter is.

For diagnostic catheterization, the doctor may then:

• Take blood samples and measure oxygen levels in each of the 4 heart chambers and each blood vessel
• Measure blood pressure in each chamber and each blood vessel
• Inject contrast dye into the catheter and watch the path the dye takes through the heart (angiography)

If repairs are needed, the doctor may:

• Use a balloon to open a heart valve or narrowed blood vessel
• Put a small support (stent) in the blood vessel to keep it open
• Use special catheter tips to fix the walls between the upper or lower heart chambers (atria or ventricles) or abnormal blood vessels
• Use a special catheter tip to open a heart valve with heat
• Use a special catheter to examine and treat abnormal electrical activity in the heart

When the catheterization is done, the doctor will remove the catheter. Pressure will be applied to prevent bleeding. The healthcare team will put a bandage on the site where the catheter was put in.

Your child will be taken to a recovery room. The healthcare staff will watch your child closely for several hours. Some children stay in the hospital for a day or more. How long it takes your child to wake up after the procedure will depend on the medicines used. If blood vessels in the leg were used, your child will need to stay in bed and keep the leg straight for a few hours after the procedure. This makes the insertion site less likely to bleed. The site may be bruised and uncomfortable for a few days. 

The doctor will decide when your child is ready to go home. You will be given written instructions on:

• How to care for the insertion site
• What signs of infection to watch for. These include fever, redness, swelling, pain, or drainage.
• Bathing
• What your child may and may not do
• Any new medicines
• Taking your child for follow-up appointments
• When you should call the doctor

Depending on the results of the cardiac catheterization, your child may need more tests or procedures.

Before you agree to the test or the procedure for your child make sure you know:

• The name of the test or procedure
• The reason your child is having the test or procedure
• What results to expect and what they mean
• The risks and benefits of the test or procedure
• When and where your child is to have the test or procedure
• Who will do the procedure and what that person’s qualifications are
• What would happen if your child did not have the test or procedure
• Any alternative tests or procedures to think about
• When and how will you get the results
• Who to call after the test or procedure if you have questions or your child has problems
• How much will you have to pay for the test or procedure