Abstract

The purpose of this review is to discuss the common diagnostic and intervention pediatric cardiac catheterizations; their indications and timing for the most common congenital heart defects. Balloon pulmonary valvuloplasty is the treatment of choice for valvular pulmonary stenosis and the indication for intervention is peak-to-peak systolic pressure gradient >50mmHg across the pulmonary valve. For aortic valve stenosis, the indications for balloon dilatation of aortic valve are peak-to-peak systolic pressure gradient across the aortic valve more than 70mmHg irrespective of the symptoms or a gradient ≥50mmHg with either symptoms or electrocardiographic ST-T wave changes indicative of myocardial perfusion abnormality. The indications for intervention in coarctation of the aorta are significant hypertension and/or a pressure gradient in excess of 20mmHg across the coarctation. For post-surgical aortic recoarctation, balloon angioplasty in young children and stents in adolescents and adults are treatment options. Transcatheter closure methods are currently preferred for secundum type of atrial septal defects (ASDs); the indications for occlusion are right ventricular volume overload by echocardiogram. Muscular VSDs may be closed with Amplatzer muscular occluder device. Patent ductus arteriosus (PDA) may be closed with Amplatzer Duct Occluder if they are moderate to large and Cook detachable or PFM coils if they are small. The development of an increasingly wide range of interventional devices in a variety of sizes has led to a significant increase in the number of conditions which are now amenable to treatment in the cardiac catheter laboratory.