Single ventricle heart - how can catheterisation help?
For a parent bringing the child for a procedure to the overwhelming Cardiac Catheterisation Laboratory (Cath Lab) does not necessarily make any difference with bringing the child to the operating theatre. The process is the same - putting the scared child on the table, showering him or her with kisses, praying the hugs will make a difference, but mostly just hoping the anaesthetic will work fast. The realization that almost everything is out of your hands is heart-breaking.
However, factually, there is a huge difference between a catheterisation and a surgery.
Cardiac catheterization is generally used to diagnose heart conditions and to better understand the structure and function of the heart, but also to treat certain heart problems (interventional catheterization).
A diagnostic cardiac catheterization...
...can shed a light on pressures, on how well the heart is pumping, how much blood flows and where it goes. Blood samples can be drawn with catheters, but also an X-ray dye can be injected through them to color and to lighten up the anatomic details of the heart.
- diagnose a heart problem
- learn more about a heart problem
- obtain cardiac tissue samples (by biopsy) for lab testing and pathology examination
- conduct an invasive electrophysiology study (EPS) if there is an abnormal heartbeat, which can help locate the origin of the arrhythmia and determine how best to treat it
Patients with single ventricle anomalies will have a cardiac catheterization at least before the second open heart surgery (Glenn shunt), and another one before the third surgery (Fontan procedure). These cardiac catheterizations are needed to look at the anatomy, and to get pressure measurements in the heart. These pressure measurements are important in deciding about the timing of the surgery and if it is a good option for a patient.
Interventional catheterization...
... can serve as a tool for corrective or therapeutic procedures to either treat heart defects without surgery or to complement a surgical procedure.
- closure of atrial septal defects (ASD), patent ductus arteriosus (PDA), ventricular septal defects (VSD), and a variety of other abnormal blood vessels
- balloon valvuloplasty to treat various stenosis (narrowings)
- balloon dilation and / or stent placement to treat blood vessel narrowings
- pulmonary valve replacement procedures
Apart from all these, what is specific to single ventricle patients is the use of catheterisation to close the fenestration (a hole between the Fontan circuit and the right atrium that is left open so that if pressures become very high, is serves as a "pop-off" into the heart).
Almost every patient with single ventricle circulation will have at least one or two catheterisations. There is a patient that had nine of them. But speaking about all the above enumerated interventions, there is a sizable group of patients that didn't need any of it, but then there is also a big group that had one or two.
(MUDr. Ondřej Materna, Ph. D., paediatric cardiologist at the University hospital Motol, Prague, Czech Republic)
(Summarized from Children's Hospital of Philadelphia and Cincinnati Children's Hospital web pages.)