How to stock an adult cardiac catheterization laboratory for congenital and structural heart disease

Abstract

Until recently, cardiac catheterization procedures in patients with adult congenital heart disease (ACHD) have been performed predominantly by pediatric cardiologists in pediatric cardiac catheterization laboratories. However, as the result of improved medical and surgical therapies for children with congenital heart disease, there has been a rapidly growing population of patients reaching adulthood, many of whom have residual complex lesions.1 Furthermore, the aging ACHD population frequently suffers from comorbidities not commonly seen in childhood, such as obstructive coronary disease, obesity, chronic lung disease, peripheral atherosclerosis, etc., beyond the level of comfort of many pediatric interventional cardiologists and catheterization laboratory staff for the care of these patients. Technologic advances and the better understanding of the mechanisms and long-term results of individual procedures currently allow for the percutaneous treatment of various forms of congenital, valve, and myocardial heart diseases. For example, percutaneous mitral and pulmonary valvuloplasty is now considered standard of care in patients with suitable anatomy and there is an increasing experience in the percutaneous repair of mitral insufficiency, replacement of pulmonary and aortic valves, and alcohol septal ablation for hypertrophic cardiomyopathy. Consequently, there is a growing need for developing the necessary operator, supporting staff, and technician expertise as well as infrastructure in adult cardiac catheterization laboratories for the optimal care of adult patients with complex congenital and structural heart disease. In this chapter, we discuss the basic organization,infrastructure, and stocking of the cardiac catheterization laboratory required for the performance of adult congenital and structural heart disease procedures.