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Rationalising the use of cardiac catheterisation before Glenn completion

Published online by Cambridge University Press:  06 March 2018

Lorraine James ,
Animesh Tandon ,
Alan Nugent Open the ORCID record for Alan Nugent [Opens in a new window] ,
Sadia Malik ,
Claudio Ramaciotti ,
Gerald Greil ,
Luis Zabala ,
Joseph Forbess  and
Tarique Hussain
Lorraine James*
Affiliation:
Pediatric Cardiology, Department of Pediatrics, UT Southwestern Children’s Medical Center, Dallas, TX, USA
Animesh Tandon
Affiliation:
Pediatric Cardiology, Department of Pediatrics, UT Southwestern Children’s Medical Center, Dallas, TX, USA
Alan Nugent
Affiliation:
Pediatric Cardiology, Department of Pediatrics, UT Southwestern Children’s Medical Center, Dallas, TX, USA
Sadia Malik
Affiliation:
Pediatric Cardiology, Department of Pediatrics, UT Southwestern Children’s Medical Center, Dallas, TX, USA
Claudio Ramaciotti
Affiliation:
Pediatric Cardiology, Department of Pediatrics, UT Southwestern Children’s Medical Center, Dallas, TX, USA
Gerald Greil
Affiliation:
Pediatric Cardiology, Department of Pediatrics, UT Southwestern Children’s Medical Center, Dallas, TX, USA
Luis Zabala
Affiliation:
Pediatric Cardiology, Department of Pediatrics, UT Southwestern Children’s Medical Center, Dallas, TX, USA
Joseph Forbess
Affiliation:
Pediatric Cardiology, Department of Pediatrics, UT Southwestern Children’s Medical Center, Dallas, TX, USA
Tarique Hussain
Affiliation:
Pediatric Cardiology, Department of Pediatrics, UT Southwestern Children’s Medical Center, Dallas, TX, USA
*
Author for correspondence: L. James, Pediatric Cardiology, Department of Pediatrics, UT Southwestern Children’s Medical Center, 1935 Medical District Drive, Dallas, TX 75235-7701, USA. Tel: 214 456 0647; Fax: 214 456 6154; E-mail: [email protected]
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Abstract

Previous studies have shown that cardiac MRI can be used to evaluate the suitability for infants to undergo the Glenn operation after having undergone the Norwood procedure. We sought to analyse our institutional data retrospectively to identify whether such a policy would be advisable in the current era. We reviewed patients who underwent the Norwood procedure between 1 January, 2006 and 1 January, 2016. All patients undergoing evaluation for the Glenn procedure received clinical evaluation, echocardiography, and cardiac catheterisation. A total of 179 patients were identified; 154 patients (86%) survived to undergo cardiac catheterisation as part of evaluation for the Glenn, and all who were evaluated did not eventually receive the Glenn. Using said algorithm, if cardiac MRI or CT were to be used to rationalise the use of catheterisation, 26 of 154 patients would have required catheterisation after cross-sectional imaging identified vascular obstruction; 83 of 154 patients would have received cross-sectional imaging only; and 45 of 154 would have had catheterisation only. All cases that required intervention, excluding aortopulmonary collaterals, and all cases that were not suitable to progress would have been correctly identified using clinical and echocardiographic criteria in addition to cardiac cross-sectional imaging to rationalise the use of catheterisation. Thus, in cases with acceptable clinical, echocardiographic, and angiographic findings, the additional haemodynamic information from catheterisation is rarely of use for decision-making, and interventions can largely be predicted by angiographic imaging modalities.

Keywords

CatheterisationchildcardiacGlenn procedurecardiac MRIcardiac CTEchocardiography and Scans
Type
Original Articles
Information
Cardiology in the Young , Volume 28 , Issue 5 , May 2018 , pp. 719 - 724
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Copyright
© Cambridge University Press 2018 

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