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Cardiac Catheterization

What is a cardiac catheterization ("cath")?

A cardiac catheterization is a specialized minimally invasive procedure that may be performed for either "diagnostic" or "therapeutic" purposes. A cardiac catheterization is NOT a surgical procedure. Most often, children will be able to go home the same day, although sometimes may require overnight observation. 

The type of catheterization procedure that is performed depends on the underlying heart condition.

Some catheterization are performed because of abnormalities with the electrical activity of the heart. These procedures are called "electrophysiology" studies and often involve "mapping" (creating a unique map of the electric circuit of the heart) and/or "ablation" (eradication of extra circuits in the heart).

Other catheterizations are performed because of abnormalities with the structure of the heart; this may include persistence of congenital structures (ie, patent ductus arteriosus), holes between the top or bottom chambers of the heart (atrial or ventricular septal defects, respectively), or narrowing of valves or blood vessels. The "diagnostic" component of this type of catheterization includes gathering invaluable data such as the oxygen levels and pressure measurements in the different chambers of the heart; radiographs are also obtained, which provide invalvuable views of the heart from any desired angle. This data provides critical information about a patient's heart function, size of a heart defect and it's effect on the patient's circulation, degree of narrowing of a blood vessel or heart valve, etc.  

The "therapeutic" component of a catheterization procedure depends on the specific defect. For instance, residual vessels or holes in the heart may be closed with a plug or "occluder" device. Narrow valves can be expanded with a "balloon". Narrow vessels can be propped open with a "stent".

Where does a catheterization take place?

Cardiac catheterizations take place in a hospital, in a catheterization laboratory. The "cath lab" looks much like an operating room and is equipped in much the same way. However, a catheterization procedure is NOT surgery.

Not all hospitals have cath labs for children. The reasons for catheterizations in children vary quite differently from those for adults. Therefore, pediatric cath labs require equipment and personnel specific for and unique to pediatric cardiology. Therefore, not all hospitals have the equipment and expertise to accomodate children with heart disease.   

How long does a catheterization take?

The precise length of time varies depending on the purpose and type of catheterization. Regardless, however, your child's safety comes first. The average time for a cath is approximately 3 hours. This time includes time for preparation (all equipment must be opened and prepared in a sterile fashion), for sedation to ensure your child is safely and comfortably asleep, for data gathering and analysis, for therapeutic interventions if needed, 

How do I prepare for my child's catheterization?  

Specific recommendations may be given for your child's specific procedure. In general, your child should have nothing to eat or during after midnight on the night before the procedure. Your child may continue to take his or her required medications, unless specifically instructed otherwise; check with your doctor several days in advance of the procedure. Your child will spend several hours in recovery, so you may choose to bring books, music, videos, etc. Some procedures will require that your child stay in the hospital overnight for observation, so you may choose to pack extra clothes, etc. Ask your doctor specifically if this is anticipated.     

 

What is the recovery time? (short term - the recovery room)

After your child's catheterization procedure is complete, he or she will be taken to the pediatric recovery room. Depending on the type of procedure performed (and which type of blood vessels are used - artery, vein, or both), your child will stay in recovery for 4 to 6 hours after the procedure. He or she will be required to remain recumbent (lying down) for that time period to allow proper healing & clotting of the catheterization site(s). There will be pressure-dressings in place (applied in the catheterization lab at the end of the procedure) to facilitate proper clotting and prevent continued bleeding. Your child will go home with these dressings, which can be removed 24 hours following the procedure. Once your child is fully awake and alert enough, he or she may start eating and drinking; we typically start with clear liquids and gradually advance to light solids to assess the patient's readiness and any potential gastroenterologic effects of anesthesia. An echocardiogram may be performed to make sure that no inflammatory fluid has developed around your child's heart. 

 

What is the recovery time? (long term - after hospital discharge)

Depending on the type of procedure performed, your child will need to gradually return to activity. If possible, he or she should rest completely (including avoiding stairs if possible) for approximately 24-48 hours. He or she will also need to avoid strenuous activities for one week following the procedure. Further restrictions may be required based on the type of procedure performed.

 

When do I have to follow-up with my cardiologist?

Specific followup will be determined by your cardiologist. Your cardiologist will typically ask you to followup one week after the procedure to make sure the catheterization site(s) are healing appropriately; an echocardiogram will most likely be performed to make sure that no inflammatory fluid has developed around your child's heart. 

 

What are the risks involved?

Cardiac catheterizations are overall very safe and well tolerated. The specific risks involved are individual to each patient; the patient's age, size (weight), and type of procedure being performed are determinants of individual risk. Your cardiologist will speak to you regarding your child's specific risk(s).

In general, the most common "side effects" of catheterization include sore throat (if general anesthesia is used) and bleeding or bruising and soreness around the catheterization site(s). Risks of the procedure itself include bleeding, clotting, infection.

Bleeding

Small catheters (similar to IV tubing) are placed into the veins and/or arteries of the body. The groin(s) are the most common site of intravenous access, although the neck is occasionally used, especially for electrophysiology studies. The risk of bleeding depends on how easy it is to access the blood vessel - size of the blood vessel and distance from the skin surface are important factors. For instance, access is more difficult in small, premature infants. Typically, however, less than a tea-spoon of blood is lost during access attempts. 

Clotting

Since the catheters remain in the blood vessels for an extended period of time, there is the risk of clots forming either within or at the tip of the catheter (blood naturally has proteins that are sticky and help blood clot - useful when there is a wound to be healed). To safeguard against clot formation, a blood-thinning medication (typically Heparin) is used throughout the procedure. This minimizes the risk of clot formation. Your child's blood is tested periodically throughout the procedure to determine how thin the blood has become and if more blood-thinning medication is needed. 

Infection

As with any invasive procedure, there is always the risk of infection. However, exhaustive attempts are made to ensure an completely sterile work environment. All catheters, etc. are new (never re-used), and extensive precautions are taken to maintain sterility throughout the procedure. If a device, stent, or coil are placed during the procedure, your child will receive a dose of antibiotics at the start of the case, and for several doses following. 

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