1. Pediatric Interventions Cardiac Catheterization and Valvuloplasty

2. Pediatric Interventions Have become increasingly common Have become increasingly common Widely accepted and very successful Widely accepted and very successful Common successful interventional procedures: Common successful interventional procedures: Atrial balloon Atrial balloon Mixing of arterial and venous blood supply. Mixing of arterial and venous blood supply. Dilation of aortic coarctations Dilation of aortic coarctations Opens the narrowed descending aorta. Opens the narrowed descending aorta. Embolization of atrial or spetal defects Embolization of atrial or spetal defects Closure devices are deployed to close a hole. Closure devices are deployed to close a hole. Valvuloplasty Valvuloplasty Opening of a stenotic valve through the use of a balloon tipped catheter. Opening of a stenotic valve through the use of a balloon tipped catheter.

3. Cardiac Catheterization Diagnostic tool Diagnostic tool Commonly rules out the need for surgery. Commonly rules out the need for surgery. Catheterization may be preformed for several reasons: Catheterization may be preformed for several reasons: Atherosclerosis Atherosclerosis Cardiomyopathy Cardiomyopathy Congenital heart disease Congenital heart disease Valvular heart disease Valvular heart disease

4. Procedure Same as an adult cardiac catheterization Sterile technique used Catheter introduced through femoral vein Very small catheter’s used due to the size of the patient. Less contrast media injected. May provide information suggesting a cardiac treatment option, or may provide info that indicates the need for surgery.

5. Risks Always risks, but do the benefits out weigh the risk? Always risks, but do the benefits out weigh the risk? Commonly seen side effects: Commonly seen side effects: Bleeding where the catheter is introduced Bleeding where the catheter is introduced Blood clot or damage to the vessel itself Blood clot or damage to the vessel itself Heart beats out of rhythm Heart beats out of rhythm Allergic reaction to contrast Allergic reaction to contrast Chest pain, angina, stroke Chest pain, angina, stroke

6. Valvuloplasty Actual treatment procedure Actual treatment procedure Equivalent to mitral commisurotomy, a more invasive procedure. Equivalent to mitral commisurotomy, a more invasive procedure. Minimally invasive technique Minimally invasive technique Can be used on any of the 4 valves in the heart, most commonly preformed on the mitral. Can be used on any of the 4 valves in the heart, most commonly preformed on the mitral. Is now preformed on the Pulmonary valve, to treat congenital pulmonary stenosis. Is now preformed on the Pulmonary valve, to treat congenital pulmonary stenosis. Most favorable results occur in pediatrics with congenital aortic stenosis. Most favorable results occur in pediatrics with congenital aortic stenosis.

7. A balloon tipped Catheter is used. The inflating/deflating of the catheter causes the dilation and tearing of fused stenotic valves. The inflating/deflating of the catheter causes the dilation and tearing of fused stenotic valves. Commissural separation and fracture of valvular calcification also occurs. Commissural separation and fracture of valvular calcification also occurs. More than one balloon-tipped catheter may need to be used. More than one balloon-tipped catheter may need to be used. Opening the mitral valve may require 2 balloon catheters. Opening the mitral valve may require 2 balloon catheters.

8. Before, during and after…

9. Balloon before inflation…

10. Procedure Surgical preparation Surgical preparation Injection of lidocaine, incision, catheter placement Injection of lidocaine, incision, catheter placement Contrast dye and fluro are used during this procedure as well. Contrast dye and fluro are used during this procedure as well. The catheter used is specific to the procedure. It has s balloon tip that is capable of inflating and deflating. The catheter used is specific to the procedure. It has s balloon tip that is capable of inflating and deflating.

11. Possible complications Benefits outweigh the risks. Benefits outweigh the risks. Bleeding at the puncture site Bleeding at the puncture site Blood clot or damage to the vessel Blood clot or damage to the vessel Rupture of the valve Rupture of the valve Dysrhythmias Dysrhythmias Stroke Stroke Allergic reactions Allergic reactions

12. All things considered Using cardiac interventions on pediatric patients is valuable. Using cardiac interventions on pediatric patients is valuable. Any time surgery, especially open heart surgery, can be avoided the procedure has proven worthy. Any time surgery, especially open heart surgery, can be avoided the procedure has proven worthy. Technology advances will continue to improve and advance the accuracy and reliability of these techniques. Technology advances will continue to improve and advance the accuracy and reliability of these techniques.