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Published on: March 5, 2016
Catheterization-based intervention in low birth weight infants less than 2.5 kg with acute and long-term outcome
Daisuke Kobayashi1, Salaam Sallaam, Sanjeev Aggarwal
1Division of Pediatric Cardiology, Children's Hospital of Michigan, Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan.
Insights
Cardiac catheterizations in low birth weight infants (< 2.5 kg) show low procedural risk. This palliative procedure stabilizes high-risk infants, with balloon valvuloplasty effective for certain conditions.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Neonatal Medicine
Background:
- Congenital heart disease in low birth weight infants is rising.
- Cardiac catheterization poses potential risks in these vulnerable infants.
Purpose of the Study:
- To evaluate the outcomes and complications of cardiac catheterizations in infants weighing less than 2.5 kg.
- To assess the safety and efficacy of interventional procedures in this high-risk population.
Main Methods:
- Retrospective review of cardiac catheterization records from 1995 to 2010.
- Analysis of demographic, procedural, outcome, and follow-up data for infants weighing < 2.5 kg.
Main Results:
- 101 catheterizations were performed in 88 infants; 45% were interventional.
- Infants < 2.5 kg had a higher adverse event rate (13%) compared to those 2.5-3.5 kg (6.6%).
- No procedural deaths occurred; significant adverse events included vascular complications and arrhythmias.
Conclusions:
- Interventional cardiac catheterization is feasible with low procedural morbidity/mortality in infants < 2.5 kg.
- Catheterization serves as a palliative measure for stabilization before definitive treatment.
- Balloon valvuloplasty shows promise for isolated valvar pulmonary stenosis in this cohort.
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.
Objectives:
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).
Conclusion:
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.
