Interventional Catheterization Procedure
What is an interventional catheterization procedure?
Children with congenital heart disease may benefit from procedures performed in the cardiac catheterization lab to treat their heart problems. Treatments offered in the Cardiac Catheterization Laboratory at the Inova Heart Center are performed by specially trained pediatric cardiologists. The procedures treat congenital heart defects by using special catheters, balloons,coils and umbrellas that are threaded into the heart during a minimally invasive procedure. These tiny instruments open or dilate critically narrow blood vessels and heart valves or close areas that are not supposed to have blood flow.
The Cardiac Catheterization Laboratory at the Inova Heart Center is equipped with specially designed cameras and technology to fit the bodies of small infants and children.
Interventional procedures offered at Inova include:
- balloon atrial septostomy for treating complex cyanotic congenital heart disease.
- angioplasty and stent placement to dilate critically narrowed vessels
- coil occlusion to block the flow in specific blood vessels
- valvuloplasty to repair congenital valve defects
- umbrella closure device placement
What is a balloon atrial septostomy?
The balloon atrial septostomy is a procedure that creates a hole between the two upper chambers of the heart (the right and left atria). This hole allows more mixing of blood within the upper two chambers of the heart. Specifically, a catheter is guided into the heart and across a tiny hole that exists or is made between the two atria. A blade or balloon is then used to tear the wall between the atria, making a hole. This allows increased mixing of oxygenated and non-oxygenated blood between the two atria.
This procedure is helpful in certain congenital heart defects such as transposition of the great arteries to improve the body's oxygen supply and reduce the degree of cyanosis (blueness).
What is an angioplasty that dilates critically narrowed vessels/valves?
Children who are born with narrow blood vessels or heart valves may require a procedure to widen the affected area. If the vessel or valve is labeled "critically" narrow, the area is so small that it must widen to allow the heart to function more efficiently. A procedure that is performed in Inova's Cardiac Catheterization Laboratory may be required to widen the narrowed area.
Specifically, the pediatric cardiologist guides a balloon-tipped catheter into the heart. Once the narrow area is located, the balloon is passed into that area. The balloon is then inflated inside the narrow area to stretch or enlarge it. The balloon can also open valve tissue that is stuck together (see below for balloon valvuloplasty).
This procedure is helpful in certain congenital heart defects such as pulmonary or aortic stenosis, pulmonary artery stenosis and coarctation of the aorta.
What is a stent procedure?
Stents are placed if a narrowed blood vessel or area in the heart renarrows after it has been dialated with a balloon. The stent itself is a small hollow metal tube. Because it is metal, there is a period of time during which the stent is stabilizing in the body and being covered by endothelium. During this time an MRI is not recommended but after this time, MRI or security detectors have no effect.
What is a patent ductus arteriosus coil embolization?
The ductus arteriosus is a blood vessel that connects the aorta and the pulmonary artery in the fetus. If the ductus does not close, the congenital heart defect is called a patent ductus arteriosus. A procedure that is performed in Inova's Cardiac Catheterization Laboratory may be required to correct the problem.
Specifically, the pediatric cardiologist will guide a catheter into the heart. He or she will place the catheter into the ductus arteriosus and release coils that fill the space inside the blood vessel. These coils will close the ductus arteriosus and prevent blood flow between the aorta and the pulmonary artery.
What is a Cardioseal Device Closure?
Nonoperative closure of a hole in the heart is available for selected patients.
The patient may have
- atrial septal defect
- patent foramen ovale
- complex ventricular septal defect
- residual shunt after correction of complex congenital heart disease. (i.e., fenetrated Fontans).
Specifically, the pediatric cardiologist guides a catheter into the heart with the device collapsed and inside the catheter. The device is opened and seated in the area of the hole and once placed, released from the catheter. This fills the hole in the heart.
Post-procedure instructions:
Immediately following all interventional procedures
Any time an intravenous catheter is placed in a big blood vessel, there is a period of observation to watch for bleeding where the catheter was inserted. The child's heart rate, blood pressure, breathing and oxygen level will be watched also. Depending on a variety of circumstances (the time of day of the procedure, type of sedation used, risk for complications, child's overall health status and complexity of the case), the child may go home the day of the procedure or the next day. In either case, the child is brought to a pediatric unit to recover and be observed.
Post-procedure instructions:
Immediately following all interventional procedures
After the child is discharged, instructions include the following:
- Quiet play or bed rest the day of the procedure.
- No baths or swimming until the access site scab is healed. Showers are OK.
- No jarring exercise or repeated bending of the leg with the access site (e.g., jump rope, bike riding, contact sports) on the day of the catheterzation.
- If there is any bleeding from the insertion site, apply direct pressure immediately for 10 minutes (while the child is lying down). Do not remove the pressure. If it continues bleeding, call 911 for immediate assistance while continuing to hold pressure on the site.
