Heart Center: Catheterization

A minimally invasive method of evaluating and treating heart problems using small tubes called catheters that are inserted into veins and arteries to reach the heart.

At the Frank S. and Mary Jane Ryburn Heart Institute Cardiac Catheterization Laboratory and The Pogue Pediatric Cardiac Catheterization Laboratory, the Children’s medical staff diagnoses and treats heart problems through the less-invasive procedure known as catheterization. Small tubes, called catheters, are inserted into the veins and arteries to the heart. More than 800 catheterization procedures will be performed at Children’s in 2010.

Cardiac catheterization uses X-rays to create images of the heart. Often a radiographic dye is injected through a catheter that has been placed in the heart or major blood vessels. Additionally measurements of pressures and oxygen levels within the heart chambers and veins and arteries are taken to assess the function of the heart and lungs.

This method is useful for diagnosing many forms of congenital heart defects and reevaluating previously repaired heart defects. A specialized device may also be used to obtain biopsies of the heart muscle to detect the rejection of a transplanted heart.

Most cardiac catheterization procedures are performed while the patient is asleep, and when necessary, sedative medications are administered to keep the patient comfortable and relaxed. Procedures also may require general anesthesia that is provided and monitored by a pediatric cardiac anesthesiologist.
Diagnostic catheterizations are used to determine the specific type of defects present, the need for surgery and the best treatment course for each patient.

Common catheterization treatment procedures, also known as interventions, include balloon dilation of narrowed heart valves, balloon dilation of narrowed arteries or veins, and insertion of stents that help to open narrowed blood vessels. We use Amplatzer, Helex and Cardioseal devices to close holes between the upper and lower chambers of the heart (ASD and VSD) and the Amplatzer PDA (patent ductus arterisosus) device. If appropriate, these types of catheterizations can prevent the need for open heart surgeries, resulting in less pain for the patient and shorter hospital stays.

Types of catheterizations

Heart Center: Before the Catheterization

When your child is scheduled for a cardiac catheterization, you will receive instructions from your cardiologist’s office regarding the time and day that your child needs to arrive at the hospital and where within the hospital to bring your child. If you have any questions about the time, date and/or place to bring your child, please call your cardiologist’s office.

A couple of weeks before the procedure, you should receive a packet in the mail reminding you of the date and time of the procedure and explaining the procedure that will be done. It will also include special instructions about feeding restrictions the day of the procedure and any medications that you must start or stop, if applicable, before the catheterization. The time and date listed in your packet refer only to the day of the catheterization. The cardiology clinic is on the third floor, just in front of the Wagon elevators.

After the admission paperwork is completed, you and your child will be escorted to a room in the preoperative assessment area. The doctors and nurses on the unit will make sure that any tests or lab work that need to be done before the catheterization are completed. Before the cardiac catheterization, you will meet with the cardiologist who will explain the procedure to you and then ask you to sign a consent form.

Any questions or concerns that you have about the procedure can be discussed with the cardiologist at that time. It is very important to us that you clearly understand what will be happening to your child, so we encourage you to ask any question, no matter how small it may seem to you.

It is very important that you do not give your child anything to eat or drink after you have been instructed to stop feeding. Doing so may make it necessary to cancel the heart catheterization.

The day of the catheterization

You will be given an exact time to arrive at the hospital before the heart catheterization. It is very important that you arrive on time, so please allow extra time for delays such as morning traffic and bad weather. If you are going to be late, please call the cardiology Administrative Assistant at (214) 456-2559. Patients who undergo heart catheterization receive medicine to make them sleep during the procedure. Your child’s stomach must be empty when he or she receives these medicines. Therefore, your child will not be allowed to take anything (food, water, drinks, gum or candy) by mouth for a minimum of two to six hours before his or her heart catheterization.

The time at which you stop feeding your child depends on the time the heart catheterization is scheduled and the age of your child. Your cardiologist’s office or a nurse will tell you exactly when to stop feeding your child. If you have not received these instructions by one to two days before the heart catheterization is scheduled, please call your cardiologist’s office for this information.

The night before the catheterization, feed your child regular food for the evening meal and for a nighttime snack. Do not feed your child fried, greasy or spicy foods as these take longer to digest and can cause nausea and vomiting during and after the procedure. It is very important that you do not give your child anything to eat or drink after you have been instructed to stop feeding. Doing so may make it necessary to cancel the heart catheterization.

If your child is on any medications, speak with your cardiologist before the day of the procedure to find out whether to continue taking prescribed medications. Please continue all respiratory medications/treatments, if needed, up until the time of the catheterization.

If your child is a teenage girl, she may be tested for pregnancy. Because the cardiac catheterization requires the use of X-ray and involves exposure to radiation, we want to be sure that there is no chance of pregnancy.

If your child wears contact lenses, a removable retainer or any type of dental bridge, he/she will be asked to remove them before the heart catheterization starts. It may be best to leave these things at home. Any makeup, nail polish, hair ornaments and jewelry (including earrings and posts) must also be removed before the procedure.

Some children will require general anesthesia during the heart catheterization. These children will be seen by an anesthesiologist before the heart catheterization begins. If your child has any loose teeth, please notify the anesthesiologist at that time.

About 15 to 30 minutes before the heart catheterization starts, your child may be given medication by the catheterization lab nurses to help him or her to relax (typically Valium or Versed). The catheterization lab nurses will take your child to the catheterization lab after he/she is drowsy. Most heart catheterizations last between two to three hours. You will be asked to wait in the cardiology clinic waiting room while your child has his/her heart catheterization performed.

If there is an emergency during the heart catheterization, you will be notified immediately. Your cardiologist will come to the waiting room to discuss the findings after the heart catheterization is completed. We prefer that at least one family member stays in or near the waiting room. If you absolutely must leave the waiting room area, please let one of the receptionists sitting at the front desk knows where you will be.

What happens during the catheterization

Once your child is taken into the catheterization lab, he/she will be asked to lie down on a large X-ray table. Your child’s temperature, heart rate, blood pressure, respirations and oxygen saturation will be monitored continuously during the procedure. A special surgical cleanser will be used to wash the areas of the body where the catheters will be inserted.

An IV will be started in a vein in order to give fluids and medications to your child during the procedure. The medicines given before and during the catheterization will cause most children to sleep during the entire procedure. After your child is asleep, the cardiologist will inject numbing medication into the areas of the skin where the catheters will be inserted-usually the groin area (the top of the legs), and sometimes the neck.

After the area is numb, small plastic tubes (sheaths), which are approximately the size of a piece of spaghetti, are inserted into the large blood vessels. Through these sheaths, long plastic tubes (catheters) are guided into the heart. X-ray helps the doctor guide the catheters into the correct place. Once the catheters are in place, small amounts of blood are taken through the catheters from the various chambers and blood vessels in the heart to determine the amount of oxygen in the blood. The blood pressure in the heart is also measured at the same time.

Next, a special dye (contrast) is injected through the catheters, into the chambers and blood vessels of the heart. The dye appears as a bright white shadow on X-ray film, and allows your doctor to see the shape of the structures and the flow of the blood through the heart and lungs. Motion X-ray pictures are recorded as the dye passes through the heart.

The dye appears as a bright white shadow on X-ray film, and allows your doctor to see the shape of the structures and the flow of the blood through the heart and lungs.

After the cardiac catheterization, your child will go to the post anesthesia care unit, or recovery room. Usually one parent is allowed to stay in the recovery room with the child. Other family members may wait in the surgery waiting room located on the third floor. Once your child is awake enough, he/she will be allowed to take clear liquids (Pedialyte, Sprite, apple juice, popsicles). After a couple of hours, your child will be transferred to the extended care unit, where he or she will stay until you can go home. If your child needs to stay in the hospital, he or she will be transferred to his or her room from the recovery room.

When you get home

Once your child is at home, there is little that needs to be done with the catheterization site. Before you leave the hospital, your doctor will explain when you can remove the dressing, when your child may take a bath and any restrictions to activity. If you have any questions about these things, please call your cardiologist.

  • Care of the catheterization site: Small amounts of bruising and slight discomfort at the site are normal, and should diminish within one to two weeks. There may also be occasional, small drops of blood at the site caused by irritation. The catheterization site itself should be kept clean and dry. Parents of diapered babies should be especially careful to keep the site from getting soiled. If the site should become dirty, wash the area with soap and water.
  • Pain: Most patients do not need any medicine for pain by the time they go home.
  • Diet: In most cases, a normal diet will be resumed before your child goes home. Clear liquids (Pedialyte, Sprite, apple juice, popsicles) will be given to your child after the procedure, when he or she is fully awake. Once clear liquids are tolerated, your child may have a full liquid diet (milk, formula) and then a regular diet. If any nausea or vomiting occurs, all food and liquid are stopped for a couple of hours, and then your child will be started again with clear liquids.