Cardiac Catheterization Laboratory
Cardiac catheterization is a common procedure used to diagnose and treat a wide variety of heart problems in children and adults. Often, definitive repair of heart problems that once required open-heart surgery can now be provided in a cardiac catheterization laboratory.
Because children have smaller hearts and blood vessels, physicians performing pediatric cardiac catheterizations need special equipment, technical expertise and excellent clinical judgment to safely perform procedures. The nursing and technical staffs are also specially trained to work with pediatric patients who require special sedation and monitoring because of their size, age and level of cooperation.
The catherization laboratory is equipped with digital imaging equipment and computers for fluoroscopy and cineangiogram (movies of the heart) that allow for precise quantitative evaluation of heart problems. A diagnostic cardiac catheterization provides information that assists cardiologists and cardiac surgeons in treating patients with heart defects. An interventional catheterization can provide a non-surgical treatment of a congenital or acquired cardiovascular disorder.
Cardiac Catheterization Procedures
During a cardiac catheterization, catheters — thin, flexible narrow tubes — are threaded through the blood vessels to the heart. Catheters can carry miniature instruments or devices specially designed to repair defects such as blocked blood vessels or holes.
Typically, a tiny incision is made in the groin or neck to insert a catheter into an artery and vein.
Catheterization can determine if blood vessels in the heart have narrowed, if the heart is pumping and blood is flowing normally, if valves of the heart are functioning correctly and if there are any heart abnormalities. Blood oxygen and pressures are measured directly in each part of the heart. Contrast injection (angiography) and a movie of the heart (cineangiogram) can be used to obtain a high quality dynamic image of the problem.
In some cases, catheterization is used to treat heart disease. During these therapeutic procedures, the catheter can carry patches to repair holes in the heart, coils or plugs to close abnormal blood vessels, "balloons" to open restricted vessels and metal tubes called stents to keep vessels open. Frequent therapeutic procedures performed in the lab include:
- Balloon valvuloplasty (dilation) of stenotic (narrow) aortic and pulmonary valves
- A balloon at the tip of the catheter is inserted into the narrow, deformed heart valve and then inflated to stretch the valve open and separate the valve leaflets.
- Balloon angioplasty to open narrowed arteries and veins
- A balloon at the tip of the catheter is inserted into the narrow opening of a blocked blood vessel and then inflated to open the vessel.
- Stent angioplasty to open narrowed arteries and veins
- Stents can be used to open blocked blood vessels. After a narrowed vessel is measured, a stent is selected. Sometimes, more than one stent is needed to repair the vessel. The stent is placed over a deflated balloon at the catheter's tip. When the balloon reaches the narrow site, the balloon is inflated to widen the blood vessel. The stent will support the newly widened vessel walls once the catheter and balloon are withdrawn.
- Patching or device closure of holes in the heart using the Amplatzer or Helex devices
- Several devices are available to patch holes in the heart. The type and size of the device is chosen after X-ray and echocardiogram images determine the size and location of the hole. Sometimes more than one device is needed to close the hole. The folded patch is guided through the catheter until it reaches the proper position. Then it is unfolded to fit over the opening. Within three months the lining of the heart wall grows over the patch and seals the hole.
- Coils, “Occluder” or “Plugs” for abnormal veins or arteries
- Catheters are used as conduits to place small metal coils or specially designed “Occluders” or “Plugs” in the abnormal blood vessel that will block blood flow.
- Radiofrequency perforation of atretic pulmonary valve (valve without opening) for balloon valvuloplasty
- Balloon atrial septostomy to improve mixing of oxygen-rich and oxygen-poor blood to ensure that the body's oxygen saturation remains in a safe range
- Pericardiocentesis to drain fluid around the heart
The Electrophysiology Laboratory
Pediatric cardiac electrophysiology, the study of the heart’s electrical system, is a highly specialized area that provides diagnostic and interventional therapy to children with abnormal congenital or acquired heart rhythms. A pediatric cardiac electrophysiologist often uses electrophysiologic testing to read the heart's electrical signals and determine the cause of an abnormal heart rhythm (arrhythmia). Possible treatments may include medication and non-surgical options such as catheter ablation and pacemaker and defibrillator implants.
For more information, please call (215) 427-4820.
St. Christopher's Hospital for Children in Philadelphia has highly qualified experts who are specially trained to work with the individual and unique needs of infants and pediatric patients. The team is led by C. Igor Mesia, MD, Director, Cardiac Catheterization Laboratory. To view a list of our specialists, please click here.