Congenital heart diseases (CHDs) are the most common congenital defects that child is having at birth.
Pediatric cardiac interventions has been increased dramatically both in number as well as type of procedures performed. CHDs are classified according to their physiological characteristics. Most common is left-to-right shunt CHDs (e. g. ASD, VSD, PDA); others are right-to-left shunt/obstructive lesions (pulmonary stenosis, right ventricular outflow tract obstruction); left heart stenotic diseases (aortic stenosis, coarctation of the aorta).
Child may have pink colour (acyanotic congenital heart defects) or may have bluish discolouration of lips and fingers (cyanotic congenital heart defects).
Majority of acyanotic CHDs can be managed without open heart surgery i.e. by doing non-surgical closure of holes in heart etc (pediatric cardiac interventions). Few cyanotic CHDs can also be palliated in cath lab by cardiac interventions.
Cardiac interventions are done in cath lab under fluoroscopic guidance. Procedures are usually done under sedation in early hours of day. After giving local anesthesia at the site of puncture, usually in groins where femoral blood vessels are there (femoral vessels are connected with the heart), we use various types of catheters and wires for entering into various chambers and tubes/holes of heart. We can also collect blood samples as well as can measure pressures in various chambers of heart for assessing whether child is operable or not.
Depending on type of procedures, we can close various types of holes in heart (ASD/VSD/PDA/coronary fistulas/ruptured sinus of Valsalvaetc), can open heart valves with balloon (aortic or pulmonary valve stenosis), open narrowed heart tubes by balloon (coarctation of aorta/pulmonary artery stenosis), can open narrowed heart tubes by putting a stent across it (coarctation of aorta or pulmonary artery stenting). In case of excessive collection of fluid around the heart, we can save life of patient by draining the fluid (pericardiactemponade or effusion).
We can also perform procedures on heart in first 28 days of life i.e. in newborn age group.e.g. in cyanotic babies those who are dependent on patent ductusarteriosus (PDA), we can palliate by putting a stent in PDA so that by doing PDA stenting; can put stent in inter-atrial septum or can do ballooning of atrial septum in cases where small patent foramen ovale is small and is needed for survival of the newborn. Newborn babies also can have stenosis in aortic and pulmonary valves and ballooning of these valves can be done with due safety in cath lab by interventions and can avoid surgery in these small babies. Neonates can have severe narrowing in aorta in the form of coarctation of aorta; same can be palliated by doing ballooning of coarctation of aorta.
Performing interventional cardiac catheterization in children requires high skills and training. Only trained pediatric cardiologists with expertise in interventional cardiac therapy should perform such complex procedures.
Fully equipped catheterization laboratory and surgical backup should be available in any center planning to perform pediatric cardiac interventional procedures.