title: Catheterization-based intervention in low birth weight infants less than 2.5 kg with acute and long-term outcome.
abstract: BACKGROUND
  The number of low birth weight infants with congenital heart disease is increasing and catheterizations may have an increased risk for mortality and morbidity.
  
  
  OBJECTIVE
  We investigate the outcome and complications of cardiac catheterizations in infants weighing < 2.5 kg.
  
  
  METHODS
  Retrospective review of catheterization records from 1995 to 2010 in infants weighing < 2.5 kg. The demographics, procedure, outcome, and follow-up data were collected.
  
  
  RESULTS
  Of 101 catheterizations performed in 88 patients, 45 (45%) catheterizations were interventional. Balloon atrial septostomy (n = 23), pulmonary valvuloplasty (14), aortic valvuloplasty (4), stent placement (3), balloon angioplasty (2), and temporary pacemaker insertion (1) were successfully performed. Balloon atrial septostomy was performed with pulmonary or aortic valvuloplasty in two catheterizations. Infants < 2.5 kg had higher significant adverse event rate that those 2.5-3.5 kg (13% versus 6.6%, P < 0.05). No procedural death was noted. Significant adverse events (n = 13) included cardiopulmonary resuscitation three, vascular six, arrhythmia three, and apnea requiring intubation one. On median follow-up of 3 years (0.03 to 14), n = 69, mortality rate was 36%. In six patients with valvar pulmonary stenosis with median follow-up of 6 years (0.75-13), four (67%) did not require re-intervention. Of two patients with aortic stenosis, one did not require repeat intervention for 6 years (last follow-up).
  
  
  CONCLUSIONS
  Interventional catheterization is feasible with low procedural morbidity and mortality in high risk infants < 2.5 kg. Catheterization primarily serves as a palliative procedure to stabilize infants for definitive treatment. Balloon valvuloplasty may be effective for isolated valvar pulmonary stenosis in infants < 2.5 kg.
authors.affiliation: Division of Pediatric Cardiology, Children's Hospital of Michigan, Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kobayashi
authors.forename: Salaam
authors.initials: S
authors.lastname: Sallaam
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Aggarwal
authors.forename: Harinder R
authors.initials: HR
authors.lastname: Singh
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Turner
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Forbes
authors.forename: Srinath T
authors.initials: ST
authors.lastname: Gowda
mesh_terms: D000367:Age Factors; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D063126:Balloon Valvuloplasty / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D001724:Birth Weight; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects / Q000401:mortality; D005240:Feasibility Studies; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D010138:Pacemaker, Artificial; D010166:Palliative Care; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
keywords: <2.5 kg; cardiac catheterization; complications; intervention