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Updated: Aug 17, 2026
Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
Evolving usage of pediatric cardiac catheterization
R P Beekman1, L H Filippini, E J Meijboom
1Wilhelmina Children's Hospital, University of Utrecht, The Netherlands.
Insights
Cardiac catheterization for congenital heart disease diagnosis is declining due to advanced imaging. Noninvasive techniques like MRI are replacing angiography, reserving it for interventions, necessitating economic evaluation.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Cardiac catheterization for congenital heart disease (CHD) diagnosis has significantly decreased.
- Two-dimensional Doppler echocardiography has revolutionized pediatric cardiology practice.
Purpose of the Study:
- To compare invasive cardiac imaging in catheterization labs with emerging noninvasive techniques.
- To assess the evolving role of diagnostic imaging in pediatric cardiology.
Main Methods:
- Review of current literature on diagnostic imaging modalities for CHD.
- Comparison of catheterization angiography with echocardiography, MRI, radionuclide angiography, and CT.
- Evaluation of noninvasive techniques for areas challenging for ultrasonography.
Main Results:
- Echocardiography provides both imaging and hemodynamic data, reducing the need for angiography.
- MRI shows promise as a leading noninvasive substitute for angiography in specific applications.
- Angiography is now primarily used for interventional procedures.
Conclusions:
- Noninvasive imaging modalities are increasingly replacing diagnostic cardiac catheterization.
- Magnetic resonance imaging is a highly promising alternative to angiography.
- The shift in imaging requires a responsible economic approach to healthcare resource allocation.
Abstract:
The use of catheterization for the diagnosis of congenital heart disease has decreased dramatically in the last decade. The development of two-dimensional Doppler echocardiography has changed the practice of pediatric cardiology, combining exquisite imaging with Doppler-derived hemodynamic information. Angiographic cardiac imaging is required for those areas inaccessible to ultrasonography, such as the distal great arteries and abnormal venous connections, and also in complex postoperative conditions. To further decrease the need for angiography, transesophageal echocardiography, magnetic resonance imaging, radionuclide angiography, and spiral computed tomography have been employed as noninvasive substitutes in those areas. Of these modalities, magnetic resonance imaging appears to be the most promising. Currently, angiography is used almost exclusively for interventional purposes. The increased imaging versatility afforded by these new modalities has important financial consequences, and requires a responsible economic approach. This article compares the role and requirements of invasive cardiac imaging in the catheterization laboratory with those of these newly developed techniques.
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