Advances in invasive cardiac diagnosis and management

Cardiac catheterization is now a relatively safe procedure when performed by an experienced pediatric cardiology team in a medical center with full ancillary pediatric services as well as cardiac surgery available on a 24 hour basis. Advances in equipment and techniques such as improved radiological equipment, newer catheters, and angled angiocardiographic views have improved diagnostic studies such that intraoperative changes in the preoperative diagnoses fortunately are rare. The use of prostaglandin E1 in neonates with either pulmonary atresia or the coarctation syndrome to achieve ductal dilatation with resultant marked clinical improvement preoperatively is a major advance that should become a standard method of therapy over the next few years. Newer catheterization techniques include devices for enlarging atrial septal defects (balloons and blades), closing atrial septal defects, closing a patent ductus, and performing myocardial biopsies in infants. All of these latter techniques hold promise for extending the pediatric cardiologist's role in providing newer diagnostic as well as therapeutic techniques in the care of infants and children with heart disease.