Selective coronary angiography in pediatric patients
M Vranicar1, R Hirsch, C E Canter
1Department of Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, MO 63110, USA.
Insights
Selective coronary angiography (SCA) is a safe and feasible diagnostic tool for pediatric cardiology patients of all ages, including neonates. Complications are infrequent, with serious adverse events being rare, supporting its use in young individuals.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Diagnostic Imaging
Background:
- Selective coronary angiography (SCA) is crucial in pediatric cardiology.
- Limited data exists on SCA feasibility and safety in young patients.
Purpose of the Study:
- To evaluate the feasibility and safety of SCA in pediatric patients.
- To analyze complication rates associated with SCA in neonates, infants, and children.
Main Methods:
- Retrospective review of 158 cardiac catheterizations including SCA (July 1993 - December 1997).
- Patients ranged from 2 days to 46 years (median 5.3 years).
- Retrograde approach via femoral or umbilical artery; Judkins catheters used, size correlated with height.
Main Results:
- Common indication: post-heart transplant coronary vasculopathy surveillance.
- Complications: transient ST-T wave changes (11%), bradycardia (2.5%), ventricular fibrillation (0.6%).
- Vascular access complications: transient pulse loss (6%), hematoma (5%), rebleeding (0.6%); one femoral artery occlusion.
Conclusions:
- SCA is infrequently associated with complications in pediatric patients.
- Serious complications are rare, indicating a favorable safety profile.
- SCA can be safely performed in pediatric patients across all age groups, including neonates.
Abstract:
Selective coronary angiography (SCA) is an important diagnostic tool in pediatric cardiology; however, there are few reports on its feasibility and safety in young patients. We reviewed our experience with SCA from July 1, 1993 to December 31, 1997. There were 158 cardiac catheterizations that included SCA in patients whose ages ranged from 2 days to 46 years (median, 5.3 years). The most common indication was surveillance for coronary vasculopathy after heart transplantation. A retrograde approach was used in all patients through the femoral artery (n = 157) or umbilical artery (n = 1). Preformed coronary catheters were used and the Judkins left (JL) and Judkins right (JR) were the most common catheters, with the catheter curve size correlating with patient height (R(2) =.76 for JL, R(2) =. 673 for JR). Complications during SCA included brief ST-T wave changes (11%), bradycardia (2.5%), and ventricular fibrillation (0. 6%). Complications of vascular access were transient pulse loss (6%), hematoma (5%), and rebleeding (0.6%). Only one case of femoral artery occlusion was encountered on subsequent cath. In conclusion, complications of SCA were infrequent and serious complications were rare. SCA can be safely performed in pediatric patients at any age including neonates.
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