Name of the Procedure:

Combined Right Heart Catheterization and Transseptal Left Heart Catheterization through Existing Septal Opening (with or without Retrograde Left Heart Catheterization) for Congenital Cardiac Anomalies

Summary

This procedure involves inserting catheters into both the right and left sides of the heart through an existing opening in the heart's septum. This is primarily done to diagnose and sometimes treat congenital heart anomalies. The catheters help measure pressures and oxygen levels within the heart chambers and blood vessels.

Purpose

The procedure is performed to assess and sometimes treat heart defects present from birth. It helps doctors understand the pressures within the heart, oxygen levels, and blood flow, and to decide on the best treatment plan.

Indications

• Symptoms of congenital heart disease such as shortness of breath, fatigue, or chest pain.
• Prior diagnosis of congenital heart defects needing detailed assessment.
• Abnormal findings in non-invasive tests like echocardiograms that suggest complex heart issues.

Preparation

• Patients may need to fast for 6-8 hours before the procedure.
• Medication adjustments may be required, particularly for blood thinners.
• Pre-procedure tests often include blood work, an ECG, and an echocardiogram or MRI.

Procedure Description

1. The patient is given local anesthesia along with sedation or general anesthesia.
2. A catheter is inserted into a vein in the groin or neck and guided to the right side of the heart.
3. Using imaging guidance, another catheter is passed through an existing septal opening to the left side of the heart.
4. Measurements and imaging are taken to assess pressures and blood flow between heart chambers.
5. If necessary, a retrograde catheter may be used to further assess the left side of the heart by entering through an artery.
6. The catheters are then removed, and the insertion site is bandaged.

Duration

The procedure usually takes between 1 to 3 hours.

Setting

Typically performed in a hospital, specifically in a cardiac catheterization lab.

Personnel

• Interventional cardiologist or pediatric cardiologist
• Cardiac nurses
• Anesthesiologist
• Radiology technician

Risks and Complications

• Arrhythmias (irregular heartbeats)
• Bleeding or hematoma at the catheter insertion site
• Infection
• Heart attack or stroke (rare)
• Puncture of the heart or blood vessels
• Contrast dye reaction

Benefits

• Accurate diagnosis of complex congenital heart defects
• Guides effective treatment planning
• Immediate assessment during any interventions

Recovery

• Patients are usually monitored for several hours after the procedure.
• Bed rest for 4-6 hours is common to prevent bleeding from the insertion site.
• Most patients can go home the same day or the next day.
• Avoiding strenuous activity for a few days is advised.
• Follow-up appointments with the cardiologist are necessary.

Alternatives

• Non-invasive imaging like MRI, CT scans, or echocardiograms.
• Possible surgical exploration depending on the heart defect.
• Pros: Non-invasive alternatives have less risk.
• Cons: May provide less detailed information compared to catheterization.

Patient Experience

During the procedure, the patient will be sedated or under general anesthesia, so there should be minimal discomfort. Post-procedure, there may be soreness at the catheter insertion site. Pain management includes over-the-counter pain relievers and applying ice packs to the insertion site.