Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease: A Scientific Statement From the American Heart Association


The following are 10 points to remember about this Scientific Statement from the American Heart Association:

1. Complete cardiac echocardiographic imaging or alternative noninvasive imaging modes such as magnetic resonance imaging or computed tomography are indicated before invasive cardiac catheterization to facilitate planning of data collection and performance of an intervention.

2. It is recommended that cardiac catheterization be used to assess pulmonary resistance and reversibility of pulmonary hypertension in patients with congenital heart disease or primary pulmonary hypertension when accurate assessment of pulmonary resistance is needed to make surgical and medical decisions.

3. Cardiac catheterization is indicated in patients being assessed for cardiac transplantation unless the patient’s risk for catheterization outweighs the potential benefit.

4. Transseptal puncture is indicated for any patient for whom a transcatheter intervention is optimally performed from a left atrial approach (e.g., pulmonary vein dilation or stenting, closure of a paramitral valve leak) and in whom no interatrial communication exists.

5. Atrial septostomy is indicated to enhance atrial mixing (e.g., transposition of the great vessels with restrictive/intact atrial communication) or to decompress the left atrium.

6. Transcatheter secundum atrial septal defect (ASD) closure is indicated in patients with hemodynamically significant ASD with suitable anatomic features and contraindicated in patients with a secundum ASD and advanced pulmonary vascular obstructive disease.

7. It is reasonable for infants who weigh ≥5 kg, children, and adolescents with hemodynamically significant (left ventricular or left atrial volume overload or pulmonary-to-systemic blood flow ratio ≥2:1) muscular ventricular septal defect (VSD) to undergo percutaneous VSD device closure.

8. Pulmonary valvuloplasty is indicated for a patient with critical valvular pulmonary stenosis (defined as pulmonary stenosis present at birth with cyanosis and evidence of patent ductus arteriosus dependency), valvar pulmonic stenosis, and a peak-to-peak catheter gradient or echocardiographic peak instantaneous gradient of ≥40 mm Hg or clinically significant pulmonary valvar obstruction in the presence of right ventricular dysfunction.

9. Aortic valvuloplasty is indicated in children with isolated valvar aortic stenosis who have a resting peak systolic valve gradient (by catheter) of ≥50 mm Hg.

10. Transcatheter patent ductus arteriosus (PDA) occlusion is indicated for the treatment of a moderate-sized or large PDA with left-to-right shunt that results in any of the following: congestive heart failure, failure to thrive, pulmonary overcirculation (with or without pulmonary hypertension), or an enlarged left atrium or left ventricle, provided the anatomy and patient size are suitable.

Clinical Topics: Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Pulmonary Hypertension and Venous Thromboembolism, Valvular Heart Disease, Cardiac Surgery and CHD and Pediatrics, Cardiac Surgery and Heart Failure, Cardiac Surgery and VHD, Congenital Heart Disease, CHD and Pediatrics and Interventions, Acute Heart Failure, Heart Transplant, Pulmonary Hypertension, Interventions and Structural Heart Disease

Keywords: Cyanosis, Cardiac Catheterization, Heart Septal Defects, Atrial, Pulmonary Veins, Failure to Thrive, Pulmonary Valve Stenosis, Ventricular Dysfunction, Right, Ductus Arteriosus, Patent, Heart Transplantation, Heart Failure, Hypertension, Pulmonary, Heart Septal Defects, Ventricular, United States

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