Skip to main content Accessibility help
×
Home

Rationalising the use of cardiac catheterisation before Glenn completion

  • Lorraine James (a1), Animesh Tandon (a1), Alan Nugent (a1), Sadia Malik (a1), Claudio Ramaciotti (a1), Gerald Greil (a1), Luis Zabala (a1), Joseph Forbess (a1) and Tarique Hussain (a1)...

Abstract

Previous studies have shown that cardiac MRI can be used to evaluate the suitability for infants to undergo the Glenn operation after having undergone the Norwood procedure. We sought to analyse our institutional data retrospectively to identify whether such a policy would be advisable in the current era. We reviewed patients who underwent the Norwood procedure between 1 January, 2006 and 1 January, 2016. All patients undergoing evaluation for the Glenn procedure received clinical evaluation, echocardiography, and cardiac catheterisation. A total of 179 patients were identified; 154 patients (86%) survived to undergo cardiac catheterisation as part of evaluation for the Glenn, and all who were evaluated did not eventually receive the Glenn. Using said algorithm, if cardiac MRI or CT were to be used to rationalise the use of catheterisation, 26 of 154 patients would have required catheterisation after cross-sectional imaging identified vascular obstruction; 83 of 154 patients would have received cross-sectional imaging only; and 45 of 154 would have had catheterisation only. All cases that required intervention, excluding aortopulmonary collaterals, and all cases that were not suitable to progress would have been correctly identified using clinical and echocardiographic criteria in addition to cardiac cross-sectional imaging to rationalise the use of catheterisation. Thus, in cases with acceptable clinical, echocardiographic, and angiographic findings, the additional haemodynamic information from catheterisation is rarely of use for decision-making, and interventions can largely be predicted by angiographic imaging modalities.

Copyright

Corresponding author

Author for correspondence: L. James, Pediatric Cardiology, Department of Pediatrics, UT Southwestern Children’s Medical Center, 1935 Medical District Drive, Dallas, TX 75235-7701, USA. Tel: 214 456 0647; Fax: 214 456 6154; E-mail: lorraine.james@utsouthwestern.edu

References

Hide All
1. Muthurangu, V, Taylor, AM, Hegde, SR, et al. Cardiac magnetic resonance imaging after stage I Norwood operation for hypoplastic left heart syndrome. Circulation. 2005; 112: 32563263.
2. McMahon, CJ, Eidem, BW, Bezold, LI, et al. Is cardiac catheterization a prerequisite in all patients undergoing bidirectional cavopulmonary anastomosis? J Am Soc Echocardiogr 2003; 16: 10681072.
3. Brown, DW, Gauvreau, K, Moran, AM, et al. Clinical outcomes and utility of cardiac catheterization prior to superior cavopulmonary anastomosis. J Thorac Cardiovasc Surg 2003; 126: 272281.
4. Daudt, NS, Zielinsky, P. Late outcomes of congenital heart disease. Transl Pediatr 2013; 2: 8486.
5. Banka, P, Sleeper, LA, Atz, AM, et al. Practice variability and outcomes of coil embolization of aortopulmonary collaterals before Fontan completion: a report from the Pediatric Heart Network Fontan Cross-Sectional Study. Am Heart J 2011; 162: 125130.
6. Brown, DW, Gauvreau, K, Powell, AJ, et al. Cardiac magnetic resonance versus routine cardiac catheterization before bidirectional Glenn anastomosis in infants with functional single ventricle: a prospective randomized trial. Circulation 2007; 116: 27182725.
7. Vitiello, R, McCrindle, BW, Nykanen, D, Freedom, RM, Benson, LN. Complications associated with pediatric cardiac catheterization. J Am Coll Cardiol 1998; 32: 14331440.
8. White, MC. Anaesthetic implications of congenital heart disease for children undergoing non-cardiac surgery. Anaesth Intensive Care Med 2009; 10: 504509.
9. Belson, M, Kingsley, B, Holmes, A. Risk factors for acute leukemia in children: a review. Environ Health Perspect 2007; 115: 138.
10. Bartley, K, Metayer, C, Selvin, S, Ducore, J, Buffler, P. Diagnostic X-rays and risk of childhood leukaemia. Int J Epidemiol 2010; 39: 16281637.
11. Sury, M, Harker, H, Begent, J, Chong, W. The management of infants and children for painless imaging. Clin Radiol 2005; 60: 731741.
12. Brown, DW, Gauvreau, K, Powell, AJ, et al. Cardiac magnetic resonance versus routine cardiac catheterization before bidirectional Glenn anastomosis: long-term follow-up of a prospective randomized trial. J Thorac Cardiovasc Surg 2013; 146: 11721178.
13. Fogel, MA, Pawlowski, TW, Whitehead, KK, et al. Cardiac magnetic resonance and the need for routine cardiac catheterization in single ventricle patients prior to Fontan: a comparison of 3 groups: pre-Fontan CMR versus cath evaluation. J Am Coll Cardiol 2012; 60: 10941102.
14. Fogel, M. Is routine cardiac catheterization necessary in the management of patients with single ventricles across staged Fontan reconstruction? No!. Pediatr Cardiol 2005; 26: 154158.
15. Yassin, H, Bhat, AN, Tysarowski, P, Masud, F, Dilawar, M. Noninvasive evaluation of single-ventricle patients before Fontan operation. Asian Cardiovasc Thorac Ann 2015; 23: 412417.
16. Nakanishi, T. Cardiac catheterization is necessary before bidirectional Glenn and Fontan procedures in single ventricle physiology. Pediatr Cardiol 2005; 26: 159161.

Keywords

Related content

Powered by UNSILO

Rationalising the use of cardiac catheterisation before Glenn completion

  • Lorraine James (a1), Animesh Tandon (a1), Alan Nugent (a1), Sadia Malik (a1), Claudio Ramaciotti (a1), Gerald Greil (a1), Luis Zabala (a1), Joseph Forbess (a1) and Tarique Hussain (a1)...

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.