Patency of the interatrial septum in children undergoing cardiac catheterization.

Abstract

AbstractCatheter passage into the left atrium from the right atrium greatly facilitates invasive cardiovascular evaluation and reduces the risks attendant on cardiac catheterization studies. We reviewed 371 consecutive cardiac catheterizations to establish the presence of natural interatrial communications. Catheter course, pressure equalization, and left‐to‐right atrial shunt on recirculation angiography were considered to determine intact interatrial septum (IIS), patent foramen ovale (PFO) or atrial septal defect (ASD).During the first year of life, 88% of infants had PFO or ASD; in 12%, the interatrial septum was intact. In children 1–10 years old, 49% had IIS, 27% had PFO, and 24% had ASD. In children 10–21 years old, 24% had PFO, or ASD. Though there seems to be a greater likelihood of ISS in those with left heart obstruction, hemodynamic factors did not completely explain the timing of closure of the foramen ovale.Presence of an interatrial communication allows catheter entrance into all left heart structures including the aorta; therefore, in patients with PFO or ASD, retrograde arterial procedure or transseptal puncture technique can be avoided when performing left heart catheterization. This appears possible in 88% of those under 1 year of age, in 51% of those 1–10 years old, and in 24% of children 10–21 years old.