Cardiac catheterization in congenital heart disease

Abstract

Recent advances in the image quality of magnetic resonance imaging and cardiac computed tomography have challenged the role of heart catheterization in the management of adult patients with congenital heart disease (CHD). Indeed, the indications for diagnostic catheterization have been reduced to three major ones: 1.Complete anatomic diagnosis or necessary hemodynamic information cannot be obtained by noninvasive methods. 2. Clinical signs and symptoms are not consistent with the patient’s diagnosis. 3. The patient’s clinical course is not progressing as expected. On the other hand, catheterization is the only gold standard for hemodynamic measurement and saturation study in adult patients with CHD. Furthermore, catheterism is drawn upon in the management planning for the measurement of pulmonary artery pressure, pulmonary artery resistance, pulmonary vasculature reactivity, and shunt calculations. What is more, pulmonary arterial pressure and pulmonary vascular resistance should be evaluated in patients with pulmonary hypertension, and it is necessary to conduct the challenge test with O2 or NO for the evaluation of pulmonary vascular resistance in a borderline patient. Angiography can evaluate the shunting site (if present), magnitude of left-to-right and right-to-left shunting, and significance of the defects. Chamber angiography is another important part of angiography in this field, requiring the operator’s in-depth knowledge of the anatomy of the heart in order to choose the best projection and obtain further necessary information. Coronary anomalies are quite frequent in adult patients with CHD. If the origin of the coronary artery is abnormal, the operator should seek to define the course of the coronary artery as well. In a nutshell, aside from a thorough understanding of the structural anatomy of the heart, the operator should know the patient’s previous medications and interventions to be able to obtain valuable information during catheterization.