Pediatric Catheterization Protocol

During the last decade, significant technological progress has taken place in the pediatric cardiac catheterization laboratory. Improved noninvasive diagnostic techniques have narrowed down the indications for diagnostic cardiac catheterization, and these techniques are now increasingly being applied to therapeutic procedures. Recently, concern has been raised about the appropriateness of some these applications in pediatric therapeutic cardiac catheterization because of sheer increase in number of techniques being applied, the increase in the number of persons and centers using these techniques, and the increase in the number of lesion types thought to be amenable to catheter therapy. In comparison to diagnostic cardiac catheterization, therapeutic catheterization require more time and resources, involve higher cost and risk, and demand more technical competence and expertise. Higher level of skill and competency is requirement for the operator who performs the various therapeutic catheterization techniques. These procedures should only be performed in institutions equipped with appropriate facilities, personnel, and programs. These considerations, combined with the rapid increase in the number of laboratories and cardiologists performing therapeutic catheterization procedures, raises concern about the safety of patients and human subjects as well as credentials of hospital and level of training and skill of physician involved. Therapeutic catheterization training programs vary in type, extent, and quality. Due to the complexity and potential risks of these procedures, specific skill and competency benchmark should be developed for personnel undergoing training in therapeutic catheterization as well as for those who continue to perform various procedures. Competency in therapeutic catheterization in children requires specific training. Pediatric cardiology fellows should receive therapeutic catheterization training in one or more centers that specializes in angioplasties, valvuloplasties, and/or vascular occlusion procedures. Before performing a therapeutic catheterization as the primary operator, the fellow or practicing pediatric cardiologist should be required to receive procedure-specific training under the supervision of a qualified individual. Credential should be procedure specific. To maintain his or her credentials and skills, the cardiologist should perform or supervise an adequate number of cases annually, and the results must compare favorably with national experience. The cardiologist must keep himself up to date of new trends and progress in the field through scientific reading and attendance of meetings. Interventional pediatric cardiology has grown remarkably over the last two decades. Catheter based interventional procedures have become the treatment of choice for many cardiac lesions, and these procedures serve as alternatives or adjuncts to surgical treatment for many other relevant conditions. Keeping with the pace of development worldwide, catheter based interventional procedures are making good progress in Bangladesh as well.