Diagnostic and Interventional Catheterization in Congenital Heart Disease PDF
Preview Diagnostic and Interventional Catheterization in Congenital Heart Disease
DIAGNOSTIC AND INTERVENTIONAL CATHETERIZATION IN CONGENITAL HEART DISEASE SECOND EDITION DIAGNOSTIC AND INTERVENTIONAL CATHETERIZATION IN CONGENITAL HEART DISEASE edited by James E. Lock, M.D. John F. Keane, M.D. Stanton B. Perry, M.D. Department of Cardiology Children's Hospital, Boston .... " SPRINGER SCIENCE+BUSINESS MEDIA, LLC Library of Congress Cataloging-in-Publication Lock, James E. Diagnostic and interventional catheterization in congenital heart Disease I by James E. Lock, John F. Keane, Stanton B. Perry. - 2nd ed. p. cm. -(Developments in cardiovascular medicine; v.221) Includes bibliographical references and index. ISBN 978-1-4757-3175-0 ISBN 978-1-4757-3173-6 (eBook) DOI 10.1007/978-1-4757-3173-6 1. Cardiac catheterization in children. 2. Congenital heart diseases. I. Keane, John F., 1934- . II. Perry, Stanton B. III. Title. IV. Series. [DNLM: I.Heart Defects, Congenital-<iiagnosis-Child. 2. Heart Catheterization Child. 3. Heart Catheterization-methods. 4. Heart Defects, Congenital-therapy Child. WS 290 L8I3d 2000] RJ423.5.C36L63 2000 617.4' 12-<ic21 99-27712 DNLM/DLC for Library of Congress CIP Copyright © 2000 by Springer Science+Business Media New York. Fifth printing 2004. Originally published by Kluwer Academic Publishers in 2000 Softcover reprint of the hardcover 2nd edition 2000 This printing is a digital duplication of the original edition. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photo-copying, microfilming, recording, or otherwise, without the prior written permission of the publisher, with the exception of any material supplied specifically for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Permission for books published in the USA: [email protected] Permissions for books published in Europe: [email protected] Printed on acid-free paper. Developments in Cardiovascular Medicine 198. Antoine Lafont, Eric Topol (eds.): Arterial Remodeling: A Critical Factor in Restenosis. 1997 ISBN 0-7923-8008-8 199. Michele Mercuri, David D. McPherson, Hisham Bassiouny, Seymour Glagov (eds.):Non-Invasive Imaging ofA therosclerosis ISBN 0-7923-8036-3 200. Walmor C. DeMello, Michiel J. Janse(eds.): Heart Cell Communication in Health and Disease ISBN 0-7923-8052-5 201. P.E. Vardas (ed.): Cardiac Arrhythmias Pacing and Electrophysiology. The Expert View. 1998 ISBN 0-7923-4908-3 202. E.E. van der Wall, P.K. Blanksma, M.G. Niemeyer, W. Vaalburg and H.J.G.M. Crijns (eds.) Advanced Imaging in Coronary Artery Disease, PET. SPECT. MRI. IVUS, EBCT. 1998 ISBN 0-7923-5083-9 203. R.L. Wilensky (ed.) Unstable Coronary Artery Syndromes, Pathophysiology, Diagnosis and Treatment. 1998. ISBN 0-7923-8201-3 204. J.H.C. Reiber, E.E. van der Wall (eds.): What's New in Cardiovascular Imaging? 1998 ISBN 0-7923-5121-5 205. Juan Carlos Kaski, David W. Holt (eds.): Myocardial Damage Early Detection by Novel Biochemical Markers. 1998. ISBN 0-7923-5140-1 207. Gary F. Baxter, Derek M. Yellon, Delayed Preconditioning and Adaptive Cardioprotection. 1998. ISBN 0-7923-5259-9 208. Bernard Swynghedauw, Molecular Cardiology for the Cardiologist, Second Edition 1998. ISBN 0-7923-8323-0 209. Geoffrey Bumstock, James G.Dobson, Jr., Bruce T. Liang, Joel Linden (eds): Cardiovascular Biology ofP urines. 1998. ISBN: 0-7923-8334-6 210. Brian D. Hoit, Richard A. Walsh (eds): Cardiovascular Physiology in the Genetically Engineered Mouse. 1998. ISBN: 0-7923-8356-7 211. Peter Whittaker, George S. Abela (eds.): Direct Myocardial Revascularization: History, Methodology, Technology 1998. ISBN: 0-7923-8398-2 212. C.A. Nienaber, R Fattori (eds.): Diagnosis and Treatment of Aortic Diseases. 1999. ISBN: 0-7923-5517-2 213. Juan Carlos Kaski (ed.): Chest Pain with Normal Coronary Angiograms: Pathogenesis, Diagnosis and Management. 1999. ISBN: 0-7923-8421-0 214. P.A. Doevendans, RS. Reneman and M. Van Bilsen (eds): Cardiovascular Specific Gene Expression. 1999 ISBN:0-7923-5633-0 215. G. Pons-L1ad6, F. Carreras, X. Borras, Subirana and L.J. Jimenez-Borreguero (eds.): Atlas ofP ractical Cardiac ApplicatiOns ofM R!. 1999 ISBN: 0-7923-5636-5 216. L.W. Klein, J.E. Calvin, Resource Utilization in Cardiac Disease. 1999. ISBN:0-7923-8509-8 217. R. Gorlin, G. Dangas, P. K. Toutouzas, M.M Konstadoulakis, Contemporary Concepts in Cardiology, Pathophysiology and Clinical Management. 1999 ISBN :0-7923-8514-4 218. S. Gupta, J. Camm (eds.): Chronic Infection, Chlamydia and Coronary Heart Disease. 1999. ISBN:0-7923-5797-3 219. M. Rajskina: Ventricular Fibrillation in Sudden Coronary Death. 1999. ISBN :0-7923-8570-5 220. Z. Abedin, R Conner: Interpretation ofC ardiac Arrhythmias; SelfA ssessment Approach. 1999. ISBN:0-7923-8576-4 221. J. E. Lock, J.F. Keane, S. B. Perry: Diagnostic and Interventional Catheterization In Congenital Heart Disease. 2000. ISBN: 0-7923-8597-7 Previous volumes are still available KLUWER ACADEMIC PUBLISHERS - DORDRECHTIBOSTONILONDON DIAGNOSTIC AND INTERVENTIONAL CATHETERIZATION IN CONGENITAL HEART DISEASE CONTENTS Contributing Authors ix Preface xi Acknowledgements xiii The Surgeon's Perspective - John E. Mayer Jr., M.D. xv Chapters 1. Evaluation and Management Prior to Catheterization. J.E. Lock, M.D. 1 2. Manual Techniques of Cardiac Catheterization: Vessel Entry (Percutaneous, Cutdown, Umbilical, Transhepatic) Catheter Manipulation, Catheter and Wire Modification. S.B. Perry, M.D. 13 3. Hemodynamic Evaluation of Congenital Heart Disease: J.F. Keane, M.D., J.E. Lock, M.D. 37 4. Angiography of Congenital Heart Disease. T. Chung, M.D., P.E. Burrows, M.D. 73 5. Catheter Intervention: Balloon Angioplasty: Experimental Studies Technology and Methodology in Pulmonary Artery Stenosis, Coarctation, Obstructed Conduits, Stenotic Pulmonary Veins and Superior Vena Cavae, Collaterals, others). P. Moore, M.D., J.E. Lock, M.D. 119 6. Catheter Intervention: Balloon Valvotomy; (Technology: Methodology in Valvar Pulmonary, Aortic and Mitral Stenoses, others). S.B. Yeager, M.D., M.F. Flanagan, M.D., I.F. Keane, M.D. 151 7. Defect Closure: Umbrella Devices (Technology, Methodology in Atrial Septal Defect, Ventricular Septal Defect, Fenestrated Fontan, PDA, others. A.P. Rocchini, M.D., J.E. Lock, M.D. 179 8. Defect Closure - Coils Embolization, (Technology, Methodology in Aorto Pulmonary and Venous Collaterals; PDA; Coronary Arteriovenous fistulae: shunts, others). J.l. Rome, M.D., S.B. Perry, M.D. 199 viii 9. Stents: (Technology, Methodology in Pulmonary Artery stenoses, obstructions in homografis, veins and arteries; coarctation of Aorta, others). J. Kreutzer, M.D., S.B. Perry, M.D. 221 10. Other Catheterization Laboratory Techniques and Interventions: Atrial Septal Defect creation (Balloon, Blade): Biopsy, Exercise, Pericardial Drainage, Drugs, Fenestration dilation/creation, Transseptal, Others. P. Lang, M.D. 245 11. Catheterization of the Adult Patient with Congenital Heart Disease MJ. Landzberg, M.D. 269 12. Anesthesia in the Catheterization Laboratory P.C. Laussen, M.D., D.O. Hansen, M.D. 289 13. Specific Lesions - How to Catheterize Tetralogy of Fallot, Pulmonary Atresia with IVS, Single Ventricle (pre and post Fontan), others. J.F. Keane, M.D. 307 14. Intracardiac Electrophysiologic Studies E.P. Walsh, M.D. 325 15. Echocardiography in the Catheterization Laboratory M.E. Van der Velde, M.D. 355 16. Index 365 CO~UflNGAUTHORS Patricia E. Burrows, M.D. Michael J. Landzberg, M.D. Professor of Radiology Instructor in Pediatrics Harvard Medical School Instructor in Medicine Children's Hospital Harvard Medical School 300 Longwood Avenue Children's Hospital Boston, Massachusetts 300 Longwood Avenue Boston, Massachusetts Taylor Chung, M.D Instructor of Radiology Peter Lang, M.D. Harvard Medical School Associate Professor of Pediatrics Children's Hospital Harvard Medical School 300 Longwood Avenue Children's Hospital Boston, Massachusetts 300 Longwood Avenue Boston, Massachusetts Michael F. Flanagan, M.D. Assistant Professor in Pediatrics Peter C. Laussen, MB, BS Dartmouth Medical School Assistant Professor in Anaesthesia Dartmouth Hitchcock Med. Ctr. Harvard Medical School One Medical Center Drive Children's Hospital Lebanon, New Hampshire 300 Longwood Avenue Boston, Massachusetts Dolly D. Hansen, M.D. Associate Professor of Anaesthesia James E. Lock, M.D. (Pediatrics) Chair, Alexander S. Nadas Harvard Medical School Professor of Pediatrics Children's Hospital Harvard Medical School 300 Longwood Av enue Department of Cardiology Boston, Massachusetts Children's Hospital 300 Longwood Avenue John F. Keane, M.D. Boston, Massachusetts Professor of Pediatrics Harvard Medical School John E. Mayer, M.D. Children's Hospital Professor of Surgery 300 Longwood Avenue Harvard Medical School Boston, Massachusetts Children's Hospital 300 Longwood Avenue Jacqueline Kreutzer, M.D. Boston, Massachusetts Instructor in Pediatrics Harvard Medical School Children's Hospital 300 Longwood Avenue Boston, Massachusetts x Phillip Moore, M.D. Mary E. Van der Velde, M.D. Assistant Clinical Professor of Assistant Professor of Pediatrics Pediatrics. Harvard Medical School U.C.S.F. Children's Hospital Box 0544, House 1403 300 Longwood Av enue 505 Parnassuss Avenue Boston, Massachusetts San Francisco, California Edward P. Walsh, M.D. Stanton B. Perry, M.D. Associate Professor of Pediatrics Assistant Professor of Pediatrics Harvard Medical School Harvard Medical School Children's Hospital Children's Hospital 300 Longwood Avenue 300 Longwood Avenue Boston, Massachusetts Boston, Massachusetts Scott B.Yeager, M.D. Albert Rocchini, M.D. Associate Professor in Ped. Card. Professor of Pediatrics University of Vermont Univ. of Michigan Health System Fletcher Allen Health Care Director of Pediatric Cardiology McClure 1, MCHV C.S. Mott Children's Hospital Burlington, Vermont Box 0204 Ann Arbor, Michigan lohnathan Rome, M.D. Assistant Professor of Pediatrics Univ. of Penn. School of Medicine Children's Hospital of Philadelphia 324 South 34th Street Philadelphia, Pennsylvania PREFACE By all appearances, the field of cardiac catheterization for congenital heart disease is nearing the end of a period of rapid expansion, change, and diversification. Now is a good time to identify and assess many of these changes. This kind of retrospective view serves more purposes than self-congratulation: it allows a clearer prediction of where the field is likely to go, and how it gets there. The first and most obvious change is the continued rapid growth of catheter-directed interventional procedures. Balloon valvotomies are well established, as are coil closure of PDA's and stent enlargement of central pulmonary arteries. Even the more exotic procedures such as closure of VSD and paravalvar leaks, and coil embolization of coronary fistula have become commonplace in some centers. The next decade will see a consolidation of these gains, with incremental improvements in devices and sharpening of indications, patient selection, and follow up studies. A less dramatic but equally pervasive change has been the improvement in non-invasive diagnosis, primarily by ultrasound but increasingly via magnetic resonance imaging. Diagnostic studies account for fewer than 40% of our catheterizations. That percentage will continue to shrink, but the pace of change will slow until we provide much better non-invasive assessments in two areas which have resisted change: the non-invasive measurement of intracavitary pressure, and the non-invasive diagnosis of rejection following cardiac transplantation. One non-invasive diagnostic arena that does seem poised for a rapid change is the use of magnetic resonance angiography to measure instantaneous flows and velocities. This will not only obviate the need to measure cardiac output, it may provide accurate measurements of regurgitant volumes, and hence accurate evaluations of procedures that produce or relieve valve regurgitation. A much less obvious but highly revolutionary change has been the consolidation and shrinkage of cardiologists who perform interventional procedures. Higher standards, more demanding technical skills, and an increased awareness of institutional and individual learning curves for complex procedures has made the part-time invasive cardiologist an endangered species. An interesting converse of this trend has been the emergence of the outpatient specialist for congenital heart disease, a development that has major implications for training programs and departmental organization. Where will the next decade take the catheterizer and his or her colleagues? Perhaps into catheter delivery of gene therapy to treat inherited myopathies or vasculopathies. Even likelier is the use of catheters to implant pulmonary valves made from a patient's own tissue. Likelier still will be the demise of film and the continued emergence of the multimedia laboratory. Underlying the success of any and all of these changes will be a commitment to rigorous self-criticism and unbiased analysis. A renewed commitment to these values is especially important at this time for the field of diagnostic and interventional catheterization in congenital heart disease.
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