Cardiac Catheterisation
Indications
1) Diagnosis
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Haemodynamic: pulm flow, Pulm Vasc Res, Systemic to pulm shunt ratio
Staged palliation for Pulm /tricusp atresia, single ventricle, HLHS, other lesions where bivent repair not possible.
1) Norwood procedure:
OR modified Blalock–Taussig shunt: artificial tube from a carotid/subclav art to pump art
2) Bidirectional glenn shunt: SVC connected to Pulm Art, Aorta grafted to RV via trunk of PA
3) Fontan competion: IVC connected to Pulm Arteries via RA with Baffle
nb can be contraindicated in Pulm HTN as passive flow not enough to overcome
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CC Angiography
MRA / CTA also an option
Used in
Pulm atresia w VSD to define collaterals
TOF to define pulm vessels
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Intracardiac pressure
Qp/Qs = Sats Aort-RA/LA-PA (i.e. O2 taken out by body / O2 put in by lungs) looks upside down because simplified from VO2/sats i.e. inverse
PA MAP alway 15 in normal children
Qp/Qs > 2 indication to close VSD
ECG
Isolate RVH - ?PS, ?Pulm HTN
Bivent hypertrophy - ? VSD, (if dom RVH ?TOF)
Isolated LVH ?coarct, ? PDA
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Rerefer VSD if
TOF
L-R shunt at VSD AND R>L shunt at overriding aorta
6 levels of obstruction
nb: ECHO doesn't show distal pulm arteries. William's or Alagille syndrome can have distal pulm artery stenosis so need CTA/catheter screening.
ECHO screens also for anomalous coronary arteries
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TGA kept alive by PFO and PDA
presents with screening of sats OR crash with closure of the duct
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ASD pressure not volume load
close to prevent RV dilatation, aryth, failure
Can cause FTT
50% are amenable to catheter closure
--------------
Williams syndrome
Elfin facies, cocktail demeanour
Supravalvular AS and PS
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AS triad
1) Diagnosis
- Haemodynamics
- Angiography (ECHO for heart, angio for extra cardiac vessels)
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Haemodynamic: pulm flow, Pulm Vasc Res, Systemic to pulm shunt ratio
- Used for screening (VSD, AVSD, PDA, truncus) for pulm vascular obstructive disease
- Pre bidirectional Glenn shunt (part 2 of 3 staged palliation)
- pre Fontan procedure (3 part)
- Pulmonary hypertension
Staged palliation for Pulm /tricusp atresia, single ventricle, HLHS, other lesions where bivent repair not possible.
1) Norwood procedure:
OR modified Blalock–Taussig shunt: artificial tube from a carotid/subclav art to pump art
2) Bidirectional glenn shunt: SVC connected to Pulm Art, Aorta grafted to RV via trunk of PA
3) Fontan competion: IVC connected to Pulm Arteries via RA with Baffle
nb can be contraindicated in Pulm HTN as passive flow not enough to overcome
--------------
CC Angiography
MRA / CTA also an option
Used in
Pulm atresia w VSD to define collaterals
TOF to define pulm vessels
----------
Intracardiac pressure
Qp/Qs = Sats Aort-RA/LA-PA (i.e. O2 taken out by body / O2 put in by lungs) looks upside down because simplified from VO2/sats i.e. inverse
PA MAP alway 15 in normal children
Qp/Qs > 2 indication to close VSD
ECG
Isolate RVH - ?PS, ?Pulm HTN
Bivent hypertrophy - ? VSD, (if dom RVH ?TOF)
Isolated LVH ?coarct, ? PDA
------------
Rerefer VSD if
- was <1y at diagnosis
- RVH on ECG (HF)
- murmur increasing
- diastolic murmur (AR)
- FTT
- parental concern
TOF
L-R shunt at VSD AND R>L shunt at overriding aorta
6 levels of obstruction
- sub-valve: infundibula (Hallmark)
- Valve: domed and thickened
- supravalvular:
- annulus
- MPA (main pulm. art)
- Branches (5+6)
nb: ECHO doesn't show distal pulm arteries. William's or Alagille syndrome can have distal pulm artery stenosis so need CTA/catheter screening.
ECHO screens also for anomalous coronary arteries
---------------
TGA kept alive by PFO and PDA
presents with screening of sats OR crash with closure of the duct
--------------
ASD pressure not volume load
close to prevent RV dilatation, aryth, failure
Can cause FTT
50% are amenable to catheter closure
--------------
Williams syndrome
Elfin facies, cocktail demeanour
Supravalvular AS and PS
--------------
AS triad
- Chest pain
- breathless
- syncope