Cardiac Catheterisation, Electrophysiology & Intervention
What is cardiac catheterisation?
In children, a cardiac catheterisation is performed using a general anaesthetic and x-ray. This means that patients are asleep throughout the procedure.
During the procedure a fine narrow tube is inserted into the blood vessels, normally in the groin area, at the top of a patient's leg. Very occasionally, the blood vessels in the arm or the side of the neck may be used. The tube is then passed gently into the heart via the blood vessels. The doctor will move the catheter around and measure the pressures in different parts of the heart and take blood samples if necessary.
A special dye is injected through the catheter into the heart (this can be filmed and viewed at a later date). All this information gives the team a more detailed picture of your child’s heart. When the procedure is over, the catheter is taken out and a pressure bandage is put over the entry site to help stop any bleeding.
Another test, known as a trans-oesophageal echocardiogram (T.O.E.) can be done at the same time as the catheter. A TOE involves a probe (a tube) being passed down the back of the throat. This allows the cardiologist to get some very clear pictures of your child’s heart from a different angle and can be very helpful in getting a more detailed picture of your child’s heart condition. If your child is having a TOE the cardiologist will discuss this with you during consent.
The results of the cardiac catheter are usually available straight away. The consultant will see you the same day to explain the results and answer any of your questions. It may be that the Cardiologist needs to discuss a patient with other members of the team, for example the surgeons, and therefore you may be given more information at a later date. You will be told this on the day of the catheter if this is the case.
There are three types of Cardiac Catheters:
(i) Diagnostic Cardiac Catheter
To obtain more information, confirm a diagnosis or help the team decide appropriate timing for your child to have their heart operation. .
(ii) Interventional Cardiac Catheter
To stretch ("balloon") narrow valves or vessels, close a hole or a vessel using a device. This can be done instead of heart surgery in some but not all cases.
(iii) Electrophysiology Study and Ablation
This is to diagnose heart rhythm problems and destroy (ablate) abnormal or irregular heart rhythm tissue. Using an electrode catheter the doctor locates the abnormal rhythm and radio frequency or freezing energy is used to destroy the areas causing the problem.
Alder Hey Cardiology department offers a fully comprehensive range of non-invasive electrophysiology testing. We recently began offering a selection of newer technologies including commercially available mobile telephone compatible ECG recording devices and longer term non invasive remote monitoring ‘patches’.
The paediatric electrophysiology service works closely with the cardiology team at Liverpool Heart and Chest Hospital to provide a robust and comprehensive electrical and device service to children with structurally normal hearts, and both children and adults with congenital heart disease. The close working of the teams over both sites have recently allowed for several paediatric patients to undergo device lead extractions on both sites, as well as providing a patient in a difficult clinical position with a ‘leadless pacemaker’ with the patient being at the time, the smallest in the world to receive the device.
Alder Hey has a dedicated Phillips bi-plane cardiac catheterisation laboratory and single plane Hybrid Suite, both with multi-channel recording facilities that are used in the diagnosis and treatment of children heart conditions.
Approximately 420 cardiac catheters, (combined diagnostic, interventional and hybrid cases) are carried out annually by the consultant team. ACHD work is divided between CHD interventionists (currently carried out jointly with adult structural interventionist with experience in congenital heart disease). The North West ACHD intervention program at LHC has been established over the last 18 months, activity is steadily increasing.