Interventional Catheterization
Unlike diagnostic cardiac catheterization, which is a procedure used to strictly diagnose a heart problem, interventional catheterization is a type of cardiac catheterization where actual treatments can be performed by use of specialized catheters. These interventional cardiac catheterizations are important, because if the heart problem can be treated in this manner, an operation can be avoided. Sometimes these interventions are only a short-term solution to delay the need for complete surgical repair until the child is older.
These specialized transcatheters include:
- Device catheters, where devices can be used to close extra vessels or "holes" in a child’s heart.
- Balloon catheters, that can open up narrowed valves or arteries.
- Coil catheters, where a coil can be used as a “plug” to stop blood flow in a blood vessel that shouldn’t have blood flow.
Pediatric cardiologists at Miller Children’s are trained to use these specialized interventional cardiac catheterizations for the following procedures:
Device Catheterization
Device catheterization is the most commonly used transcatheter for septal defect closures. The device catheterization deploys a device from the catheter to block the blood flow. This device allows “holes” to be closed in a child’s heart, by the device. Complication rates and hospital stays are significantly lower in the minimally invasive transcatheter closure than open surgery. Transcatheter septal closure can be performed in the catheterization laboratory under sedation or general anesthesia.
ASD is a condition that affects the upper chambers of the heart, where there is an opening in the wall (atrial septum) between the right and left atrium. A device can be implanted to close this “hole in the heart.”
There is a small opening between the two atria (foramen ovale) present at birth. Shortly after birth, the wall between the atriums (atrial septum) gradually grows and seals this opening. In infants with atrial septal defects, the atrial septum may not close properly or may be malformed during fetal development. This opening results in an increase in the workload on the right side of the heart and excessive blood flow to the lungs. A device can be implanted to close this hole.
VSD is a condition that affects the lower chambers of the heart, where there is an opening in the wall (ventricular septum) between the right ventricle and the left ventricle. A device can be implanted to close this “hole in the heart.”
Balloon Catheterization
A balloon catheterization is a procedure to dilate (open up) the narrow blood vessel and increase blood flow. Balloon catheterization can be performed in the catheterization laboratory under sedation or general anesthesia.
This minimally invasive procedure is considered the treatment of choice for patients with congenital stenosis (narrowing) of pulmonary and aortic valves. Balloon valvuloplasty has been proven to provide substantial relief of right ventricular outflow obstruction in patients and is less invasive than surgery. Valvuloplasty also treats pulmonary stenosis, a condition in which one of the four heart valves—the pulmonary valve—is so narrow that blood flow to the lungs is restricted.
During the catheterization, the doctor threads a special catheter through your child’s blood vessels to the narrowed area. Pictures and measurements of the coarctation (narrowed area) are taken. The balloon is then inflated to open up the narrowed area The pediatric cardiologist may decide to put a stent in to help keep the blood vessel open. A stent is a small metal tube that can be placed in the vessel to help widen the narrowed passage by supporting the walls of the blood vessel. Balloon and stent angioplasty can be used for:
- Pulmonary arteries
The pulmonary arteries are the two major vessels that carry blood from the heart to the lungs. Balloon and stent angioplasty of pulmonary arteries widens these vessels.
- Aortic coarctation
A coarctation is when part of the aorta is narrowed. This defect can affect the body's blood circulation because the left side of the heart has to work harder to pump blood through the narrowed aorta. Balloon and stent angioplasty of aortic coarctation widens part of the aorta.
Coil Catheterization
A coil embolization is a catheter-based procedure that allows precise occlusion (blocking) of abnormal blood flow in a blood vessel. A catheter with a metal coil is inserted into an area of the artery, where it will remain, until a blot clot forms around it, obstructing the abnormal blood flow. Coil catheterization can be performed in the catheterization laboratory under sedation or general anesthesia.
Collateral vessels are abnormal blood vessels that connect the aorta with the pulmonary arteries, but they are normally small and are not used. Children with congenital heart disease have enlarged collateral vessels, which can let blood flow from an artery to an adjacent artery or it may carry blood downstream and then back to the same artery. To stop this flow and pumping blood into the lungs, coil embolization creates a blood clot which stops this reverse flow.
In some babies, a small fetal blood vessel known as the ductus arteriosus fails to close at birth. This condition, known as patent ductus arteriosus, allows blood that is headed from the aorta to leak back into the pulmonary artery, placing the heart under added strain. In a newborn, the patent ductus arteriosus still has the potential to close on its own without intervention. However in older children this condition can be corrected with a coil catheterization to stop the abnormal blood flow. |
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