Usually idiopathic or musculoskeletal

2. Study of valve and septal wall motion 3. LV function a. Shortening fraction (SF) b. Calculation

SF (%)=LVEDD-LVESD x 100 LVEDD

LVEDD = LV end diastolic dimension

LVESD = LV end systolic dimension

CARDIAC CATHETERIZATION

Indications A. Delineate anatomical features poorly visualized by non-invasive studies B. Determine precise physiologic parameters C. Electrophysiologic studies (EPS) D. Interventional catheterization; electrical or structural

Risks of Catheterization A. Highest morbidity/mortality in the newborn period B. Diagnostic procedure < 1% C. Interventional procedure < 5% D. Deaths overall < 1%

Post-catheterization care A. Check distal pulses and perfusion (temperature, color) 1. Pulseless foot = possible emergency; consider heparin or thrombolytic therapy e.g. tPA B. Check cath site for bleeding (remove dressing if bleeding suspected) C. Post cath HCT not routine: if known excessive blood loss or persistent tachycardia D. Fever; rarely infection in first 24 hours 1. May be secondary to contrast or vascular manipulation 2. Should perform complete physical evaluation nonetheless E. Cardiac tamponade; consider if acute change in clinical status, particularly after catheter ablation, biopsy, or intra-cardiac device (usually obvious while still in lab) F. Possible SBE prophylaxis for 6 months post procedure

Cardiac output (CO) and Qp/Qs calculations A. Fick equation = CO (L/min) = VO2 (ml/min/m2)/ 1.36 x 10 x Hgb x (AoO2 sat-MVO2sat); e.g. O2 sat=0.99 B. Qp/Qs=SA O2 sat-MV O2 sat/PV O2 sat-PA O2 sat O2 Sats (%) Average (mmHg) Range (mmHg)

R atrial mean ~ 70 1 to 4 -3 to 8 R ventricle, systolic ~ 70 24 to 29 13 to 42 R ventricle, end diastolic 3 to 5 0 to 10 PA, systolic ~ 70 20 to 22 11 to 36 PA, mean 11 to 12 6 to 22 PA wedge= LA, mean 95 6 to 9 2 to 14 LV, systolic 95 LV, diastolic 7 to 10 3 to 14 Systemic arterial,systolic 95 Systemic arterial,diastolic Systemic arterial, mean

A. L-to-R shunts have a “step-up” in O2 saturations on the R side B. R-to-L shunts have a “step-down” in O2 saturations on the L side C. Narrow valve/ vessel has higher proximal pressure

Interventional catheterization A. Rashkind procedure; dynamic balloon atrial septostomy (usually in TGA, Tricuspid/Pulmonary Atresia, HLHS) often performed at bedside with echo guidance B. Endomyocardial biopsy; specialized catheter with forceps at end (bioptome) is used to obtain heart muscle (usually RV) for diagnostic study (e.g. myocarditis, transplant follow-up) C. Balloon valvuloplasty; static balloon catheter is used to produce a semicontrolled leaflet tear to repair valvar obstruction D. Balloon angioplasty; static non-compliant balloon catheter is used to produce a semi-controlled vascular wall tear (into intima and media) to enlarge a vessel lumen E. Coil embolization; pre-formed elastic metal coil (+/- synthetic fibers) is used to occlude a vessel; e.g. PDA, aorto-pulmonary or venovenous collateral, coronary artery fistula F. Stent; expandable metal mesh tube (+/- nonporous covering) used to enlarge a vessel or hole G. Device vascular or septal defect occlusion (e.g. ASD, VSD, PDA, aortopulmonary or veno-venous collaterals, coronary artery fistula) H. Valve replacement; Melody pulmonary valve