Cardiac Catheterization for Congenital Heart Defects in Children

Specialists at the Pediatric Congenital Heart Program, part of Hassenfeld Children’s Hospital at NYU Langone, can diagnose and repair some types of congenital heart defects using cardiac catheterization, a minimally invasive procedure.

Cardiac catheterization is used in conjunction with other tests, including heart sonograms, which are called echocardiograms, and MRI scans of the heart, to help diagnose congenital heart defects. After diagnosis, cardiac catheterization can also be used to provide treatment for babies and children with certain types of congenital heart defects. 

Before a catheterization, a baby or child usually receives general anesthesia to prevent discomfort and unwanted movement during the procedure. The cardiologist may also give an injection of a local anesthetic to numb the skin where the catheter—a thin, flexible tube—is to be inserted. 

The doctor then threads the catheter through an artery or vein, usually in the leg near the groin, and into the heart. A liquid dye is injected through the catheter to highlight blood flow through the heart. Continuous X-ray images of this blood flow appear on a monitor. This technique is called fluoroscopy.

The doctor can insert small tools or devices, such as inflatable balloons, scaffold-like structures called stents, wire coils, and other devices through the catheter to perform a variety of procedures. Learn more about preparing for cardiac catheterization.

Types of Cardiac Catheterization

There are several types of cardiac catheterization used by experts at Hassenfeld Children’s Hospital, including the following.

Angioplasty and Stent Implantation

During angioplasty and stent implantation, a doctor inserts a balloon into a narrowed artery or vein to widen the blood vessel and improve blood flow. For some children, a metal mesh tube called a stent is expanded over the balloon and is left permanently in the blood vessel. The body then grows tissue over it.

These procedures are often used to manage conditions such as pulmonary artery stenosis or coarctation of the aorta.

Balloon Atrial Septostomy

Balloon atrial septostomy is often used to treat babies younger than 6 weeks old who have transposition of the great arteries or other congenital heart defects that restrict the flow of oxygenated blood. The doctor inserts a balloon into the heart and expands it to enlarge the hole between the two upper heart chambers, the left and right atria. This allows oxygenated blood to flow more freely between the left and right atria until the child can have open heart surgery.

Balloon Valvuloplasty

A balloon valvuloplasty may be used to manage conditions, such as aortic valve stenosis or pulmonary valve stenosis, caused by a narrowed heart valve. In this procedure, the doctor inserts a balloon across the narrowed valve and expands it to dilate the valve opening.

Device Implantation

The doctor may implant coils or other devices, made of flexible metal mesh and fabric, into an unwanted connection between blood vessels, such as a patent ductus arteriosus or arteriovenous malformation. This technique closes off the unwanted communication between the blood vessels.

The doctor may implant larger devices, made of similar flexible metal mesh, to close unwanted openings between the heart chambers, such as an atrial septal defect. These devices are folded into a very thin tube before being inserted and are then opened up inside the heart to block the unwanted opening. The body then grows tissue over the device.

Percutaneous Pulmonary Valve Replacement

The doctor may use a new heart valve, constructed of tissue mounted within a metal mesh tube, to replace nonfunctioning heart valves in children with conditions such as in truncus arteriosus or tetralogy of Fallot. In a percutaneous pulmonary valve replacement, the new valve is folded over a balloon before being inserted through a tube in the blood vessel. The balloon is then expanded to open the new valve and seat it in place.

Recovery from Catheterization Procedures

Most children return home the same day after cardiac catheterization. However, some children may need to remain in the hospital for monitoring overnight after more complex procedures to ensure complete recovery before leaving the hospital.

Children usually are able to return to their normal activities the next day after catheterization. Older children and adolescents may need to avoid vigorous physical activity for a few days.