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| Vol. 22, No. 2 |
| February 1, 2000 |
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Certain Heart Ailments Treated With Therapeutic Catheterization by ANNE LUPTON Texas Children's Hospital Once destined for surgery, a number of patients with heart defects now can be treated with interventional or therapeutic cardiac catheterization procedures. At Texas Children's Hospital, the only Houston-area hospital to offer such a service for infants, children and adolescents, approximately 400 of the 700 catheterization procedures performed annually are therapeutic. The remaining 300 procedures are diagnostic. "For certain cardiac defects, an interventional cardiac catheterization procedure can achieve the same result as an operation," explains Dr. Ronald Grifka, director of the cardiac catheterization laboratories at Texas Children's. "Also, we can perform procedures in concert with surgery to help make the operation more directed and effective." The diagnostic catheterization process involves advancing a small catheter, which resembles a long straw, into a large vein up into the heart. A vein in an arm or leg usually is chosen. The catheter is directed into the different heart chambers to measure the pressures, check the amount of oxygen, and to inject dye to take pictures of the heart. Cardiologists use this information to better determine the child's cardiac abnormalities, and decide if surgery is needed. Using the same technique, the cardiologist can manipulate special catheters through the heart chambers to perform various interventional procedures. These procedures include opening heart valves which are closed or not completely open; closing certain abnormal blood vessels and connections in the heart, arteries and veins; and closing certain holes in the heart. In some patients, holes can be made in the heart to decompress the pressure in one of the chambers. Although therapeutic cardiac catheterization was pioneered with children in the early 1970s, it was not until the mid- to late-1980s that these procedures occurred with regularity, Dr. Grifka says. "In some ways, therapeutic catheterization is a young field," he points out. "In the last five years, we have had an explosion in the number of ideas and equipment that we can use to improve the care of children with heart defects. We are able to apply these techniques to many children, including kids with heart transplants, by obtaining biopsies of their heart muscle to see how the heart is surviving, or by retrieving a broken catheter that has embolized into the heart or lungs." The child receives intravenous sedation during the cardiac catheterization. The patient may go home that evening or the next morning. In many cases, the child is resuming normal activities and back at school within a day.
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