Procedural complications during congenital cardiac catheterization.

Published on Mar 1, 2010in Congenital Heart Disease2.007
· DOI :10.1111/J.1747-0803.2010.00385.X
Brandon Lane Phillips2
Estimated H-index: 2
,
Allison K. Cabalka31
Estimated H-index: 31
+ 2 AuthorsFrank Cetta46
Estimated H-index: 46
Sources
Abstract
Objective.  We sought to identify complications that occurred during congenital cardiac catheterization (CCC) and determine factors that could improve the quality of care provided to patients with congenital heart disease during this procedure. Design.  We reviewed the electronic medical record for 903 CCC cases, (455 female; mean age = 29 ± 22 years, range = birth to 91 years) performed in our catheterization laboratory from 2005 to 2007. Included in this cohort are 342 cases performed on patients less than 18 years of age. Clinical follow-up data were reviewed for 3 months postcatheterization. Complications were assigned a grade from 1 to 4 based on severity. Results.  The indication for catheterization was diagnostic in 459 (51%) patients, interventional in 386 (43%) patients, and endomyocardial biopsy in 58 (6%) patients. Mean intravenous contrast dose = 1.9 ± 1.8 mL/kg. Mean fluoroscopy exposure = 22 ± 13 minutes. Mean procedure duration = 122 ± 42 minutes. Although 806 cases (89%) were performed without complication, 102 complications were observed in 97 cases. There were no deaths. Emergent surgery was performed in four patients. One patient notified us 16 days after catheterization that she was pregnant. The result of that pregnancy was normal. Thirty complications occurred during the CCC procedure and a first year fellow was involved in 17. Patient age, weight, gender, attending physician, or type of procedure (diagnostic vs. intervention) did not impact risk of complications. Conclusions.  Patients of all ages with congenital heart disease can expect a safe procedure with minimal risk of serious complications. Procedural changes that have been implemented include pregnancy testing on all menstruating females prior to CCC regardless of history of sexual activity, and first-year fellows are now directly supervised by the attending physician rather than a more senior fellow throughout the procedure.
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References6
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#1Lisa Bergersen (Boston Children's Hospital)H-Index: 34
#2Kimberlee Gauvreau (Boston Children's Hospital)H-Index: 85
Last. James E. Lock (Boston Children's Hospital)H-Index: 128
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We sought to characterize the frequency, severity, and attributability of adverse events (AE) in congenital cardiac catheterization and identify patient and procedural characteristics associated with AE. Risk for any AE was associated with age < 1 year (odds ratio [OR] 2.3), interventional cases (OR 2.2), increasing procedure type risk group (OR 1, 2.0, 2.5), and indicator of hemodynamic vulnerability (OR 1.6), all p < 0.001. Each of these and weight were also associated with increased risk for ...
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OBJECTIVE: To assess the safety of performing diagnostic and interventional cardiac catheterization of neonates, infants and children in a laboratory located in an adult hospital. DESIGN: Retrospective medical record review. SETTING: Children's Hospital of Western Ontario. PATIENTS: All patients 18 years or younger undergoing cardiac catheterization procedures performed by pediatric cardiologists between January 1986 and December 1989. MAIN RESULTS: The total number of procedures performed was 2...
#1Kenneth E. Fellows (Harvard University)H-Index: 28
#2Wolfgang Radtke (Harvard University)H-Index: 14
Last. James E. Lock (Harvard University)H-Index: 128
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Abstract Although therapeutic catheter procedures for congenital heart disease are still developing, the number of procedures being performed allows statistically relevant review of the acute complications. Between January 1, 1984, and February 1, 1987, 417 such procedures were performed at The Children's Hospital, Boston; the age range of the patients was 1 day to 51 years (median 4 years, 6 months). Catheter procedures consisted predominantly of vascular dilations (peripheral pulmonic stenosis...
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#1Herbert E. Cohn (Harvard University)H-Index: 14
#2Michael D. Freed (Boston Children's Hospital)H-Index: 50
Last. Donald C. Fyler (Boston Children's Hospital)H-Index: 28
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To evaluate complications and mortality following cardiac catheterization (CC) in patients under one year of age, we prospectively examined 312 CC on 273 patients from the centers in the New England Regional Infant Cardiac Program during a one-year period. Among CC performed on patients less than four months old, the incidence of complications requiring treatment was 12%; for patients 4–12 months, it was 1.5% (p<0.02). By pre-CC risk assessment, 13% of CC were high risk, 21% medium risk, and 66%...
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This communication concerns the problem of establishing the therapeutic equivalence of two treatments that are being compared on the basis of ordered categorical data. The problem is formulated as a significance test in which the null hypothesis specifies a treatment difference. An efficient numerical algorithm for computing the exact significance level is provided, along with a simple method for obtaining the asymptotic significance level. Both methods are applied to a clinical trial of a new a...
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Abstract Background Despite recent technical advances, interventional cardiac catheterization is still challenging in neonatal age and no specific data concerning early outcome are so far published in literature. Methods Neonatal trans-catheter cardiac interventions performed in high-volume Italian referral centers were retrospectively analyzed. Primary outcomes were procedural major adverse events, in-hospital mortality and procedural failure. Secondary outcomes were minor adverse events and ne...
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To evaluate whether avoidance of a risk factor associated with loss of pulse (LOP) following femoral artery (FA) catheterization in infants identified from previous study, was associated with decreased incidence of LOP during a prospective evaluation. Since initiation of routine ultrasound guided femoral arterial access (UGFAA) for infants undergoing catheterization in Jan 2003-Dec 2011 (Period-1), our incidence of LOP had stayed steady. Prospective evaluation between Jan 2012-Dec 2014 (Period-2...
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#2A.H. Christensen (Oslo University Hospital)H-Index: 1
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#1John Alexander (UTHSC: University of Tennessee Health Science Center)H-Index: 3
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