Arévalo-Salas LA, Solano-Fiesco L, Segura-Stanford B, Vizcaíno-Alarcón A

Language: Spanish
References: 21
Page: 126-134
PDF size: 140.63 Kb.

ABSTRACT

Introduction. The aim of this study was to determine the relative risks of diagnostic and interventional catheterization in the neonate and to evaluate outcomes.
Methods. A study of 95 consecutive cardiac catheterizations in neonates was undertaken (3.2% of 2 879 paediatric procedures done from 1991 to 2006) at the Hospital Infantil de Mexico Federico Gomez.
Results. Mean age was 17.5 ± 0.7 days, mean weight of 2.9 ± 0.98 kg, 59% were males. A therapeutic catheterization (Cat-T) was performed in 73 patients (77%), and a diagnostic procedure (Cat-D) in the remaining 22 (23%). The Cat-T procedures included: atrial septostomy in 54, aortic valvuloplasty in 8, pulmonary valvuloplasty in 5, aortic angioplasty in 3, transvenous pacemaker in 2 and stenting of ductus arteriosus in 1. In the 22 Cat-D procedures, the results correlated well with surgical findings, while a satisfactory palliation or correction was achieved in 94.6% of the 73 Cat-T. One or more complications occurred in 32/73 (40%) Cat-T, and in 6/22 (27.2%) Cat-D procedures. Considering the whole experience, 24 (25.2%) complications were qualified as major and 14 (14.7%) as minor. Of the former, arrhythmias and vascular lesions were the most common; however, only 5 patients (5.2%) required urgent surgical intervention. Death as a result of catheterization occurred in 2 cases (2.1%). An excellent correlation with surgical findings was obtained in the 22 Cat-D cases, whereas a satisfactory palliation was achieved in 69 of 73 Cat-T procedures (94.6%).
Conclusions. These results confirm that cardiac catheterization in the neonate can be performed with good results and should not be withheld purely on the basis of age or critical clinical status.

REFERENCES

1. Lurie P, Grajo M. Accidental cardiac puncture during right heart catheterization. Pediatrics. 1962; 29: 283.

2. Vestermark S. Cardiac angiocardiography and catheterization in infants. An assessment of the risk based 711 cases. Cardiology. 1964; 45: 91.

3. Varghese P, Celermajer J, Izukawa T, Haller J, Rowe R. Cardiac catheterization in the newborn: experience with 100 cases. Pediatrics. 1969; 44: 24.

4. Castañeda A, Jonas R, Mayer J, Hanley F. Cardiac surgery of the neonate and infant. Philadelphia: W.B. Saunders Company; 1994.

5. Huhta J, Glasow P, Murphy D, Gutgesell H, Ott D, McNamara D, et al. Surgery without catheterization for congenital heart defects: management of 100 patients. JACC. 1987; 9: 823-9.

6. Rodríguez-López A, González-Cerna J, Vizcaíno A, Marin D, Arévalo A, Quibrera J. Evaluación preoperatoria de las cardiopatías congénitas por ecocardiografía bidimensional. Cirugía sin cateterismo en 343 casos. Abstract. Badajoz, España: Sociedad Latina de Cardiología Pediátrica. V. Congreso; 1992. p. 17.

7. Jaquiss R, Tweddell J. The neonate with congenital heart disease: What the cardiac surgeon needs to know from the neonatologist and the cardiologist. Clin Perinatol. 2005; 32: 947-61.

8. Rashkind W, Miller W. Creation of an atrial septal defect without thoracotomy: A palliative approach to complete transposition of the great vessels. JAMA. 1966; 196: 991-2.

9. Kan J, White R, Mitchell S, Anderson J, Gardiner T. Percutaneous balloon valvuloplasty: A new method for treating congenital pulmonary valve stenosis. N Engl J Med. 1982; 307: 540-2.

10. Lock J, Niemi T, Burke B, Einzig S, Castañeda-Zúñiga W. Transcutaneous angioplasty of experimental aortic coartaction. Circulation. 1982; 66: 1280-6.

11. Lababidi Z, Wu J, Wallis J. Percutaneous balloon aortic valvuloplasty: Results in 23 patients. Am J Cardiol. 1984; 53: 194-7.

12. Stanger P, Heymann M, Tarnoff H, Hoffman J, Rudolph A. Complications of cardiac catheterization of neonates, infants, and children. A three year study. Circulation. 1974; 50: 595-608.

13. Cohn H, Freed M, Hellenbrand W, Fyler D. Complications and mortality associated with cardiac catheterization in infants under one year: a prospective study. Pediatr Cardiol. 1985; 6: 123-31.

14. Rhodes J, Asnes J, Blaufox A, Sommer R. Impact of low body weight on frequency of pediatric cardiac catheterization complications. Am J Cardiol. 2000; 86: 1275-8.

15. Simpson J, Moore P, Teitel D. Cardiac catheterization of low birth weighing infants. Am J Cardiol. 2001; 87: 1372-7.

16. Vitiello R, McCrindle B, Nykanen D, Freedom R, Benson L. Complications associated with pediatric cardiac catheterization. Pediatr Cardiol. 1998; 5: 1433-40.

17. Lock J, Keane J, Perry S. Diagnostic and Interventional catheterization in congenital heart disease. 2nd ed. Boston: Kluwer Academic Publishers; 2000.

18. Quibrera J, Zárate C, Erdmenger J, Arévalo A, Vizcaíno A. Estenosis pulmonar valvular crítica del recién nacido; valvuloplastia con globo efectuada usando un asa arterio-venosa y dilataciones secuenciales. Arch Inst Cardiol Mex. 1998; 68: 521-5.

19. Geva T, Greil T, Marshall A, Lanzberg M, Powell A. Gadolinium-enhanced 3.dimentional magnetic resonance angiography of pulmonary blood supply in patients with complex pulmonary stenosis or atresia: comparison with X-ray angiography. Circulation. 2002; 106: 473-8.

20. McMahon C, Price J, Salerno J, El-Said H, Taylor M, Vargo T, et al. Cardiac catheterization in infants weighing less than 2 500 grams. Cardiol Young. 2003; 13: 117-22.

21. McCrindle B, Blackstone E, Williams W, Sittiwangkul R, Spray T, Azakie A, et al. Are outcomes of surgical versus transcatheter balloon valvotomy equivalent in neonatal aortic critical stenosis? Circulation. 2001; 104 Supl I: 152-8.