Clinical outcomes and utility of cardiac catheterization prior to superior cavopulmonary anastomosis.
OBJECTIVE
We sought to characterize the outcomes of routine catheterization prior to superior cavopulmonary anastomosis and to determine if some patients were unlikely to benefit from catheterization and thus might be evaluated preoperatively with noninvasive methods alone.


BACKGROUND
Congenital heart disease patients with single ventricle physiology undergo routine echocardiography and cardiac catheterization prior to superior cavopulmonary anastomosis to determine anatomic and hemodynamic suitability for this procedure.


METHODS
We performed a retrospective review of all infants (n = 114) evaluated for potential superior cavopulmonary anastomosis at our institution from January 1997 to June 2000.


RESULTS
Patients' median age was 5.5 months. Full echocardiograms were obtained in 79 patients (69%). At catheterization a total of 41 interventions were performed in 35 patients (31%). Twenty-seven patients (24%) were transfused, 18 patients (17%) required cardiac intensive care unit admission, and median length of stay following catheterization was 1 day (range 0 to 22). Complications occurred in 28 patients (25%), most transient. Of 51 patients who had complete echocardiograms without indication for catheterization, none subsequently had significant interventions and only 2 had new findings at catheterization. Three candidates were excluded from operation; all 111 others underwent successful procedures and survived to hospital discharge.


CONCLUSIONS
Interventions were frequent at catheterization prior to superior cavopulmonary anastomosis, but transient complications, transfusion, intensive care unit admission, and prolonged hospital length of stay were common. For patients in whom no issues indicating need for catheterization are identified by echocardiogram, routine catheterization rarely results in new information or intervention. These patients may be more safely evaluated preoperatively using exclusively noninvasive techniques.
Brown
David W
DW
Department of Cardiology, Children's Hospital, Boston, MA 02115, USA. david.brown@cardio.chboston.org
Gauvreau
Kimberlee
K
Moran
Adrian M
AM
Jenkins
Kathy J
KJ
Perry
Stanton B
SB
del Nido
Pedro J
PJ
Colan
Steven D
SD
D000293:Adolescent; D001803:Blood Transfusion; D001900:Boston; D006328:Cardiac Catheterization; D002648:Child; D002669:Child Welfare; D002675:Child, Preschool; D004452:Echocardiography; D005471:Fluoroscopy; D018610:Heart Bypass, Right; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D006352:Heart Ventricles / Q000002:abnormalities / Q000601:surgery; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007223:Infant; D007229:Infant Welfare; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay; D015999:Multivariate Analysis; D010343:Patient Admission; D011183:Postoperative Complications / Q000209:etiology; D011300:Preoperative Care; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014683:Vena Cava, Superior / Q000002:abnormalities / Q000601:surgery*