Cardiac Catheterization for Children
Because of technological advances, children with some serious heart defects can now be treated with a minimally invasive treatment, called cardiac catheterization, instead of using surgery at Hassenfeld Children’s Hospital of New York at NYU Langone. For some children with congenital heart defects, a combined surgery and catheterization is needed.
In our state-of-the-art hybrid catheterization lab, also known as our hybrid operating room, doctors have access to both the technology required for cardiac catheterizations as well as to advanced surgical equipment. This allows our teams who specialize in cardiac catheterization and cardiac surgery to work side by side in the same operating room to perform one or both procedures, without ever moving the patient.
Our unique setup provides for shortened procedure times, less risk for patients, and improved outcomes for most people with complex heart defects.
Preparing for Cardiac Catheterization
At Hassenfeld Children’s Hospital, we understand that staying in the hospital may seem frightening, especially to young children, and we make every effort to provide a warm, caring environment for children and their families. Here is what you and your child can expect during the procedure.
During the Cardiac Catheterization Procedure
Your child is given a sedative to relax prior to the procedure. Intravenous (IV) sedation or general anesthesia is used, and your child may be given a breathing tube.
When the procedure begins, your child’s NYU Langone cardiologist inserts a catheter into a vein or artery, usually in the leg near the groin. A fluoroscopy is then used to guide the catheter into the heart. This imaging technique gives the doctor real-time images of your child’s blood vessels and heart.
Your doctor evaluates the heart structures and the pattern of blood flow inside the heart by measuring the oxygen content and blood pressures in different parts of the heart. Liquid dye is injected into the heart and X-ray films are used to produce a movie of how the blood flows inside the heart.
The procedure can last between one and several hours. Throughout this process, your child's wellbeing is supervised by a professional staff that has been specifically trained in providing support to the physicians who are performing this procedure.
After the Cardiac Catheterization Procedure
After the procedure is complete, the catheter is removed from the heart and the blood vessels. A pressure dressing is placed on the site where the catheter was inserted to prevent bleeding. If the catheter was inserted into the leg, your child needs to keep his or her leg straight for a few hours to lessen the chances of bleeding at the site of the catheterization.
Your child will then be monitored in the hospital by nursing staff for several hours. The length of time it takes for your child to wake up after the procedure depends on the type of medicine used. Our nurses monitor the pulses and skin temperature in the leg or arm where the catheter was inserted.
Your child can go home when we determine that he or she does not need additional treatment or monitoring. We’ll give you instructions on how to care for the catheterization site and bathe, as well as any necessary activity restrictions or medications your child may need to take at home.
Leaving the Hospital
Children usually recover quickly from cardiac catheterization. Your child's cardiologist or nurse will give you specific discharge instructions before you leave the hospital.
Infants and young children can usually return to their normal activities the day after the procedure. Older children and adolescents are encouraged to rest the day after the procedure, but are typically able to walk and participate in most routine activities the following day. Vigorous physical activity is discouraged for a few days, but most children are able to return to full unrestricted physical activity within a week.
Discomfort following a catheterization procedure is typically very mild. If necessary, it can easily be treated with a mild pain medicine like acetaminophen (Tylenol®) for a day or two.
Your child can typically return to a normal diet the same day or the day after the procedure.
Types of Cardiac Catheterization
There are several types of cardiac catheterization used by experts at Hassenfeld Children’s Hospital, including the following.
Angioplasty and Stent Implantation
During angioplasty and stent implantation, a doctor inserts a balloon into a narrowed artery or vein to widen the blood vessel and improve blood flow. For some children, a metal mesh tube called a stent is expanded over the balloon and is left permanently in the blood vessel. The body then grows tissue over it.
These procedures are often used to manage conditions such as pulmonary artery stenosis or coarctation of the aorta.
Balloon Atrial Septostomy
Balloon atrial septostomy is often used to treat babies younger than six weeks old who have transposition of the great arteries or other congenital heart defects that restrict the flow of oxygenated blood. The doctor inserts a balloon into the heart and expands it to enlarge the hole between the two upper heart chambers, the left and right atria. This allows oxygenated blood to flow more freely between the left and right atria until the child can have open heart surgery.
A balloon valvuloplasty may be used to manage conditions, such as aortic valve stenosis or pulmonary valve stenosis, caused by a narrowed heart valve. In this procedure, the doctor inserts a balloon across the narrowed valve and expands it to dilate the valve opening.
The doctor may implant coils or other devices, made of flexible metal mesh and fabric, into an unwanted connection between blood vessels, such as a patent ductus arteriosus or arteriovenous malformation. This technique closes off the unwanted communication between the blood vessels.
The doctor may implant larger devices, made of similar flexible metal mesh, to close unwanted openings between the heart chambers, such as an atrial septal defect. These devices are folded into a very thin tube before being inserted and are then opened up inside the heart to block the unwanted opening. The body then grows tissue over the device.
Percutaneous Pulmonary Valve Replacement
The doctor may use a new heart valve, constructed of tissue mounted within a metal mesh tube, to replace nonfunctioning heart valves in children with conditions such as in truncus arteriosus or tetralogy of Fallot. In a percutaneous pulmonary valve replacement, the new valve is folded over a balloon before being inserted through a tube in the blood vessel. The balloon is then expanded to open the new valve and seat it in place.