Cardiac catheterization has long been an important tool for diagnosing congenital heart disease and helping to direct appropriate surgical intervention. Today, much of that work can be done non-invasively with echocardiography and magnetic resonance imaging. Cardiac catheterization has now moved into the therapeutic realm with catheter-based intervention becoming increasingly utilized as a curative therapy for many types of congenital heart disease. Congenital lesions such as atrial septal defects (Figure 1), ventricular septal defects, and patent ductus arteriosus can be closed with specialized devices that are delivered through catheters that are smaller than a drinking straw. Similarly, congenitally obstructed valves and blood vessels, such as pulmonary valve stenosis (Figure 2), or coarctation of the aorta can be completely opened with current stent technology. More recent interventions such as transcatheter transcatheter valve placement are now performed regularly extending further the therapeutic capabilities of cardiac catheterization (Figure 3).
“It is exciting to be able to completely fix a patient’s heart defect with no surgical incisions and essentially no recovery time,” says Jon Donnelly M.D., Director of the Pediatric Cardiac Catheterization Laboratory. “Our efforts continue to be in collaboration with our surgical colleagues (hybrid procedure) as many of the emerging catheter interventions take place in the operating room to augment a complex surgical repair” (Figures 4 & 5).
The Pediatric Catheterization laboratory at Maine Medical Center offers all FDA-approved procedures and devices used to treat children and adults with congenital heart disease. Because this is the only Pediatric Cardiac Catheterization laboratory in the state, both volume and variety of cases are high. This translates into experienced operators and quality care for the patient. A recent review of the last 1000 cases reveals a mortality rate of 0.2% and a major complication rate of 0.8%, both of which are well below the national average.
What to Expect:
The need for a cardiac catheterization will be determined by your cardiologist and communicated with you during an office visit. Your cardiologist will then create a “clinical summary sheet” which includes you or your child’s history, exam, diagnostic testing and proposed transcatheter intervention. This is discussed in great detail at a Monday morning conference with the Congenital Heart Team so that all of the clinical services that may participate in the care of your child are knowledgeable about the clinical condition and goals of therapy. An appointment will be scheduled in the office with Dr. Donnelly to answer any questions about the procedure, obtain pre-procedural labwork, and sign informed consent. This is usually a brief meeting, but should be attended by all those who may have questions regarding the procedure.
Day of Procedure
On the day of the procedure, you will need to be in admitting at 6:00 AM (if you are the first case) or 7:30 AM (second case). They will take demographic information and you will have a blue hospital card made. If you have been admitted to MMC previously, please submit your blue medical card upon arrival. Within 10-20 minutes you will arrive at your room in Barbara Bush Children’s Hospital (< 18yo) or ACCU (> 18yo). If you are the first case of the morning, you will get weighed and have your vital signs taken before being brought to the holding room in the catheterization suite. The anesthesiologist will meet with you there, discuss any anesthetic concerns, and have you sign the anesthesia consent form. Your child may receive an oral sedative in the holding room depending on their age. You and your child will then be brought into the catheterization lab where further anesthetic medication will be given, usually with an inhalation agent. Parents typically are allowed to be with their child until they drift off to sleep. Once the child is asleep, a peripheral IV is placed and the anesthetic is delivered through the vein for the remainder of the case. After leaving your child in the catheterization lab, we suggest that you return to your child’s room so that we can contact you during the case, if necessary. For those patients > 18yo, a peripheral IV will be placed in ACCU and IV sedation will commence in the catheterization lab.
At the conclusion of the procedure Dr. Donnelly will usually be able to discuss the results immediately while the patient is recovering in the lab. If the case is lengthy, or if the child is young, recovery will take place in PACU (Level B in MMC). Parents may be with their child in PACU for the 1-2 hours prior to transfer back to your room at BBCH. For older patients, recovery from anesthesia is conducted in the holding room adjacent to the catheterization lab for ~1hr prior to returning to your room in ACCU. If the procedure is diagnostic only, your child can be discharged 6 hours after withdrawal of the catheters. If there is any post-procedural bleeding from the groin or persistent nausea/vomiting from anesthesia, we may observe you or your child in the hospital overnight. For most interventional procedures, the patient will be observed in the hospital overnight.
You will be given a discharge instruction sheet when you leave the hospital. This document informs you of things to look for during the first few post-procedure days. Please do not hesitate to contact us if you have any concerns and we will address them with you.