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Cardiac catheterization of low birth weight infants
J M Simpson1, P Moore, D F Teitel
1Department of Congenital Heart Disease, Guy's Hospital, London, United Kingdom. John.Simpson@gstt.sthames.nhs.uk
Insights
Cardiac catheterization is feasible in low birth weight infants, with successful interventions like balloon pulmonary valvuloplasty. However, interventional procedures carry higher complication risks, particularly respiratory issues, necessitating elective ventilation.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
Background:
- Increased survival of low birth weight (LBW) infants leads to more candidates for cardiac interventions.
- Limited data exist on the outcomes of cardiac catheterization in LBW infants.
Purpose of the Study:
- To retrospectively analyze cardiac catheterization outcomes in infants weighing ≤2.5 kg.
- To evaluate the success and complication rates of interventional procedures in this population.
Main Methods:
- Retrospective analysis of 111 cardiac catheterizations in 107 LBW infants (1985-1998).
- Comparison of complication rates between interventional (n=31) and diagnostic (n=80) procedures.
- Detailed review of specific interventional techniques and outcomes.
Main Results:
- Cardiac catheterization was technically feasible in all LBW infants.
- Successful interventions included balloon atrial septostomy and balloon pulmonary valvuloplasty.
- Interventional procedures had significantly higher complication rates (42%) than diagnostic procedures (16%), with arrhythmias and respiratory deterioration being most common.
- Reintervention rates for pulmonary valve stenosis were high (71% by 1 year).
Conclusions:
- Interventional cardiac catheterization is feasible in LBW infants, offering good palliation for conditions like pulmonary stenosis.
- Higher complication rates, especially respiratory, suggest the need for elective ventilation during interventional procedures.
- Further research into optimizing interventional strategies for LBW infants is warranted.
Abstract:
The increased survival of low birth weight infants means that more of these infants may be candidates for catheter interventions. There are few data on the results of cardiac catheterization in this group. This study aimed to analyze, retrospectively, cardiac catheterization of infants weighing < or =2.5 kg, with emphasis on the results of interventions. The complication rates of interventional and diagnostic procedures were compared. One hundred eleven catheterizations were performed in 107 patients between 1985 and 1998. Thirty-one procedures were interventional. Balloon atrial septostomy (n = 16), balloon pulmonary valvuloplasty (n = 10), balloon pulmonary angioplasty (n = 1), and coil occlusion of collateral vessels (n = 3) were all performed successfully. One infant (3%) died while undergoing myocardial biopsy. The reintervention rate for isolated pulmonary valve stenosis was 25% (2 of 8) at 1 month, 57% (4 of 7) at 6 months, and 71% (5 of 7) at 1 year. Complications were significantly more frequent during interventional (13 of 31, 42%) than during diagnostic (13 of 80, 16%) procedures. The most common complications during interventions were arrhythmias (3 of 31, 10%) and respiratory deterioration (3 of 31, 10%). Cardiac catheterization was technically feasible in all patients. Balloon pulmonary valvuloplasty and atrial septostomy provided good palliation in this patient group. The mortality of interventional procedures was low. The high incidence of respiratory complications suggests that low birth weight infants should undergo elective ventilation for interventional cardiac catheterization.