Cardiac Catheterization In Infants Research Articles

Sedation versus General Anesthesia for Cardiac Catheterization in Infants: A Retrospective, Monocentric, Cohort Evaluation.

Background: Children with congenital heart disease require repeated catheterization. Anesthetic management influences the procedure and may influence outcome; however, data and recommendations are lacking for infants. We studied the influence of sedation versus general anesthesia (GA) on adverse events during catheterization for children <2 years old. Methods: We conducted a monocentric, retrospective study of all catheterization procedures (2008–2013). High-severity adverse event (HSAE) rates were compared using propensity-score-adjusted models, including pre- and intra-procedural variables. Results: 803 cases (619 patients) (368 (46%) GA, 435 (54%) sedation) with a mean age of 6.9 ± 6.1 months were studied. The conversion rate (GA after sedation) was 18 (4%). Hospital stay was 4.9 ± 4.0 and 4.1 ± 2.5 (p = 0.01) after GA or sedation, respectively. HSAE occurred in 75 (20%) versus 40 (9%) (p < 0.01) in GA versus sedation procedures, respectively. Risk factors (multivariable analysis) were older patients (p = 0.05), smaller weights (p < 0.01), palliated status (OR 3.2 [1.2–8.9], p = 0.02), two-ventricle physiology (OR 7.3 [2.7–20.2], p < 0.01), cyanosis (OR 4.6 [2.2–9.8], p < 0.01), pulmonary hypertension (OR 5.6 [2.0–15.5], p < 0.01), interventional catheterization (OR 1.8 [1.1–3.2], p = 0.02) and procedure-type risk category 4 (OR 28.9 [1.8–455.1], p = 0.02). Sedation did not increase the events rate and decreased the requirement for hemodynamic support (OR 5.2 [2.2–12.0], p < 0.01). Conclusion: Sedation versus GA for cardiac catheterization in children <2 years old is safe and effective with regard to HSAE. Sedation also decreases the requirement for hemodynamic support. Paradoxical effects (older age and two-ventricle physiology) on risk have been found for this specific age cluster.

Outcome of Interventional Cardiac Catheterization in Infants Weighing Less Than 2500 Grams: A Comparative Study

ABSTRACT Objectives: A retrospective study to evaluate the outcome of interventional cardiac catheterization in infants weighing &lt;2500 grams. Background: The mortality of small weight infants undergoing heart surgery remains high, so cardiac catheterization has been utilized to improve the outcome. Methods: The study included infants who underwent interventional cardiac catheterization within the first 60 days of life in New Children Cairo University Hospital, Cairo, Egypt from January 2015 to January 2018. The study group included infants &lt; 2500 grams while the comparative group included infants ≥ 2500 grams. Adverse events were classified according to the mechanism and seriousness. Results: The study group (37 patients) had a mean weight of 2.35 ±0.13 Kg, while the comparative group (164 patients) had a mean weight of 3.54 ±0.71 Kg. The procedures included balloon atrial septostomy, pulmonary balloon valvuloplasty, ductus arteriosus stenting and radiofrequency perforation of pulmonary atresia. The study group showed less success rates as compared with the comparative group (83.8% versus 93.9%, p = 0.04), and higher incidence of overall adverse events (48.6% versus 20.1 %, p&lt;0.001) as well as catheterization-related mortality (29.7% versus 4.9%, P&lt;0.001). In the study group, pulmonary balloon valvuloplasty showed the highest incidence of major adverse events while ductus arteriosus stenting had the highest incidence of mortality. Conclusions: Compared to normal weight infants, interventional cardiac catheterization in small weight infants is associated with lower success and higher morbidity and mortality rates. Pulmonary balloon valvuloplasty and ductus arteriosus stenting have the highest morbidity and mortality, respectively.

Accessing Femoral Arteries Less than 3mm in Diameter is Associated with Increased Incidence of Loss of Pulse Following Cardiac Catheterization in Infants.

To evaluate whether avoidance of a risk factor associated with loss of pulse (LOP) following femoral artery (FA) catheterization in infants identified from previous study, was associated with decreased incidence of LOP during a prospective evaluation. Since initiation of routine ultrasound guided femoral arterial access (UGFAA) for infants undergoing catheterization in Jan 2003-Dec 2011 (Period-1), our incidence of LOP had stayed steady. Prospective evaluation between Jan 2012-Dec 2014 (Period-2), identified FA-diameter < 3mm as risk factor for LOP. Between Jan 2015-Dec 2018 (Period-3), an initiative to avoid UGFAA for FA-diameter < 3mm was implemented to determine whether that led to a decreased incidence of LOP. FA-diameter was measured prior to USGFAA and ratio of outer diameter of arterial sheath to luminal diameter of cannulated artery (OD/AD ratio) was calculated during Periods-2 and 3. The incidence and risk factors for LOP were assessed during the three periods. FA-access rates dropped significantly during Period-3 (56.7% vs. 93.8% and 90.4% during Periods-1 and 2, respectively, p < 0.001). Incidence of LOP in Period-3 decreased to 2.7% compared to 12.5% (Period-1) and 17.4% (Period-2) (p < 0.001). By multivariate analysis, FA size < 3mm and an OD/AD ratio > 40% were the only significant independent predictors for LOP (OR 6.48, 95% CI 2.3-11.42, p < 0.001 and OR 4.16, 95% CI 1.79-8.65, p < 0.01, respectively). Access of femoral artery < 3mm and OD/AD ratio > 50% are associated with increased incidence of LOP. Avoidance of these factors may help decrease complications in infants undergoing cardiac catheterizations.

Increased Cancer Incidence Following up to 15 Years after Cardiac Catheterization in Infants under One Year between 1980 and 1998—A Single Center Observational Study

Objective: To evaluate the incidence of cancer within the first 15 years of life in children who underwent cardiac catheterization under the age of one year. Methods: In this retrospective, single center study, 2770 infants (7.8% with trisomy 21) were studied. All infants underwent cardiac catheterization under one year of age between January 1980 and December 1998. Newly diagnosed cancer in the first 15 years of life was assessed through record linkage to the German Childhood Cancer Registry (GCCR). Cancer risk in study patients was compared to the GCCR population of children less than 15 years. Patients with trisomy 21 were compared to the Danish Cytogenic Register for trisomy 21. Effective radiation doses were calculated for each tumor patient and 60 randomly selected patients who did not develop cancer. Results: In total, 24,472.5 person-years were analyzed. Sixteen children developed cancer, while 3.64 were expected (standardized incidence ratio (SIR) = 4.4, 95% confidence interval (CI): 2.5–7.2, p < 0.001). There was no preferred cancer type. The observed incidence of leukemia and solid tumors in trisomy 21 was only slightly higher (1 in 476 py) than expected (1 in 609 py, p = 0.64). There was no direct relationship between the radiation dose and the incidence of cancer. Conclusion: Cardiac catherization in the first year of life was associated with a significantly increased cancer risk in a population with congenital heart disease.

Economic implications of outpatient cardiac catheterisation in infants with single ventricle congenital heart disease.

Resource utilisation for infants with single ventricle CHD remains high without well-studied ways to decrease economic burden. Same-day discharge following cardiac catheterisation has been shown to be safe and effective in children with CHD, but those with single ventricle physiology are commonly excluded. The purpose of this study was to investigate the economic implications of planned same-day discharge following cardiac catheterisation versus universal overnight hospital admission in infants with single ventricle CHD. A probabilistic decision-tree analysis with sensitivity analyses was performed. All included patients were categorised into four possible outcomes; discharge, readmission following discharge (within 48 hours), observation and prolonged hospitalisation. Baseline probabilities of each node of the tree were then combined with the cost data to evaluate the comparative dominance of one decision (immediately discharge) versus the other decision (routinely admit). Patients discharged on the same day as the procedure accrued the lowest attributed hospital cost ($5469), while patients readmitted to the hospital had the highest attributed cost ($11,851). Currently, no other studies have assessed the cost of hospitalisation following cardiac catheterisation in this population. Thus, we allowed for a wide range of cost variation, but same-day discharge dominated the decision outcome with a lower economic burden. Same-day discharge following routine cardiac catheterisation in patients with single ventricle physiology is less costly compared to universal overnight admission. This demonstrates an important cost-limiting step in a complex population of patients who have high resource utilisation.

Cardiac catheterisation in infants weighing less than 2500 grams.

The aim of the study was to report the outcome of cardiac catheterisation in low-weight patients. Data regarding cardiac catheterisation in infants weighing &lt;2500 g are scarce. We reviewed all cardiac catheterisations performed in infants weighing &lt;2500 g between January 2000 and May 2016. An analysis with respect to the type of procedure, the complexity of procedure (procedure type risk), and haemodynamic vulnerability index was finally carried out. We report the occurrence of deaths and complications using the adverse event severity score. A total of 218 procedures were performed on 211 patients. The mean age and weight were, respectively, 15 ± 26 days (range, 0-152) and 2111 ± 338 g (range, 1000-2500). Procedures were interventional and diagnostic, respectively, in 174 (80%) and 44 (20%) patients. Out of 218, 205 (94%) were successful. Eleven complications (5%) occurred - six with an adverse event severity score of 4 and five with an adverse event severity score of 3. Ten patients (91%) showed a favourable outcome, and one died (stent thrombosis few hours after patent ductus arteriosus stenting). No correlation was found between lower weight and occurrence of death (p = 0.68) or complications (p = 0.23). The gravity scores (procedure type risk and haemodynamic vulnerability index) were not predictive of complications. Cardiac catheterisation in infants weighing &lt;2500 g appears feasible and effective with low risk. The weight should not discourage from performing cardiac catheterisation in this population.

CO6-21 - Cardiac catheterization in infants weighing less than 2500g

CO6-21 - Cardiac catheterization in infants weighing less than 2500g

Evaluation of Residual Coarctation in Infants with a Single Right Ventricle after Stage I Palliation.

In infants with a single right ventricle (RV), stage I palliation involves aortic reconstruction, systemic-to-pulmonary shunt placement, and atrial septectomy. Many require re-intervention for residual coarctation of the aorta (CoA). Doppler echocardiography can detect residual CoA in most infants, but its ability to predict severity has not been studied. This study compares gradients from Doppler interrogation to those from cardiac catheterization in infants with residual CoA. We performed a retrospective study of infants after stage I palliation from 2000 to 2014. Infants with an echocardiogram and catheterization before the second-stage palliative surgery were included. Infants with an echocardiogram >30days before catheterization were excluded. Doppler-derived gradients were compared to catheterization-derived gradients. Echocardiographic assessment of tricuspid valve (TV) and RV function were recorded. The cohort included 95 infants, and thirty-three (35%) had CoA. Doppler-derived and catheterization-derived gradients correlated weakly in infants with CoA (r=0.37, p=0.036) and without CoA (r=0.35, p=0.005). Among infants with CoA, 17/33 had none or trivial tricuspid regurgitation (TR) and normal RV function, and Doppler-derived gradients correlated with catheterization gradients in this group (r=0.71, p=0.001). In 16/33 infants with ≥moderate TR or RV dysfunction, gradients did not correlate (r=-0.003, p=0.992). After a stage I palliation in infants with single RV and CoA, Doppler-derived gradients poorly predicted the severity of CoA. Infants with normal TV or RV function had Doppler-derived gradients more predictive of catheterization-derived gradients. Doppler-derived gradients have limited utility in determining the severity of CoA after a stage I palliation.

Incidence and predictors of cardiac catheterisation-related arterial thrombosis in children

ObjectiveArterial thrombosis is one of the most reported complications of cardiac catheterisation (CC) in children. The aim of the study was to evaluate the incidence and predictors of arterial thrombosis...

Small is beautiful but fragile and hazardous in the cath lab

Catheterization and Cardiovascular InterventionsVolume 82, Issue 5 p. 795-796 Pediatric and Congenital Heart Disease Small is beautiful but fragile and hazardous in the cath lab Neil Wilson MB BS DCH FRCP FRCP(CH) FSCAI, Corresponding Author Neil Wilson MB BS DCH FRCP FRCP(CH) FSCAI Children's Hospital, ColoradoCorrespondence to: Neil Wilson, dr; 13123 East 16th Avenue, Box 100, Aurora, CO 80045. E-mail: Neilwil1@aol.comSearch for more papers by this author Neil Wilson MB BS DCH FRCP FRCP(CH) FSCAI, Corresponding Author Neil Wilson MB BS DCH FRCP FRCP(CH) FSCAI Children's Hospital, ColoradoCorrespondence to: Neil Wilson, dr; 13123 East 16th Avenue, Box 100, Aurora, CO 80045. E-mail: Neilwil1@aol.comSearch for more papers by this author First published: 26 October 2013 https://doi.org/10.1002/ccd.25196 Conflict of interest: Nothing to report. Low weight as an independent risk factor for adverse events during cardiac catheterization of infants. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume82, Issue51 November 2013Pages 795-796 SCAI Member Sign in RelatedInformation

The early and mid‐term fate of the axillary artery following axillary artery cut‐down and cardiac catheterization in infants and young children

To study the early and mid-term vascular complications of axillary artery catheterization in children <2 years by clinical and ultrasound examination. Femoral arterial access for cardiac catheterization in young children is associated with significant morbidity. Early complications of axillary artery catheterization have been reported but no long-term vascular follow-up data are available. Prospective case-control study using standard vascular ultrasound techniques to examine the upper limbs in study participants (n = 10). In total, 23% of axillary artery catheterizarions (56 procedures in 54 patients) resulted in acute arterial insufficiency requiring heparin. Of the survivors under follow-up (n = 33), none had symptoms of chronic arterial insufficiency. At a median follow-up of 8 years postprocedure, three out of the ten study participants had a weak brachial pulse in the test arm but no significant difference in arm measurements. Color Doppler revealed occlusion of the axillary artery in the test arm with collateralization in three patients. The brachial peak systolic velocity (V(max)) was significantly lower in the test arm than the control arm of all the patients with a mean difference of 30 cm/sec (P = 0.007). Our study is the first to examine the long-term vascular sequelae of axillary artery catheterization using ultrasound examination and highlights the importance of careful surveillance of vascular access sites. Although axillary artery cut-down for cardiac catheterization in infants and young children does not appear to result in clinical signs of chronic arterial insufficiency, we demonstrate clear evidence of flow abnormalities on vascular ultrasound which are of uncertain long-term significance.

Preliminary Experience With a Combination of Dexmedetomidine and Propofol Infusions for Diagnostic Cardiac Catheterization in Children

No specific regimen has been universally accepted as ideal for procedural sedation during cardiac catheterization in infants and children. In this paper, we retrospectively describe our preliminary experience with a continuous infusion of dexmedetomidine and propofol for sedation during cardiac catheterization in children with congenital heart disease. The short-half life of these two drugs creates a potential for easier titration, quicker recovery and less prolonged sedation-related adverse effects. This combination was not only able to limit the dose of either drugs, but was also very stable from cardio-respiratory standpoint. There were no adverse effects noted in our two patients. This initial experience showed that the combination of propofol and dexmedetomidine as a continuous infusion may be a suitable alternative for sedation in spontaneously breathing children undergoing cardiac catheterization.

Monitored Anesthesia Care With a Combination of Ketamine and Dexmedetomidine During Cardiac Catheterization

No specific regimen has been universally accepted as ideal for sedation during cardiac catheterization in infants and children. We evaluated a combination of ketamine and dexmedetomidine for sedation during cardiac catheterization in children with congenital heart disease. The study design included a retrospective analysis of data sheets and hospital records. The protocol for sedation was standardized and data collected prospectively for an ongoing quality assurance project. Heart rate, blood pressure, and oxygen saturation were recorded every 1 minute for the first 5 minutes and then at 5-minute intervals. The efficacy of sedation was judged by the need for supplemental ketamine doses. The study cohort included 16 infants and children undergoing either diagnostic or therapeutic cardiac catheterization. Sedation was initiated with a bolus dose of ketamine (2 mg/kg) and dexmedetomidine (1 microg/kg) administered over 3 minutes followed by a continuous infusion of dexmedetomidine (2 microg/kg per hour for the initial 30 minutes followed by 1 microg/kg per hour for the duration of the case). Supplemental analgesia/sedation was provided by ketamine (1 mg/kg) as needed. The baseline heart rate was 103 +/- 21 beats/minute. After the bolus dose of ketamine and dexmedetomidine, the heart rate increased by 7 +/- 5 beats/minute. The greatest increase was 15 beats/minute. The low heart rate after the bolus dose of ketamine/dexmedetomidine or during the subsequent dexmedetomidine infusion was 91 +/- 20 beats/minute (P < 0.001 compared with baseline) and the high heart rate was 110 +/- 25 beats/minute (P < 0.01 compared with baseline). In two patients, the dexmedetomidine infusion was decreased from 2 to 1 microg/kg per hour at 12 to 15 minutes instead of 30 minutes as a result of a decreased heart rate. No clinically significant changes in blood pressure or respiratory rate were noted. Two patients developed upper airway obstruction, which responded to repositioning of the airway. No apnea was noted. During the procedure, the PaCO2 varied from 37.5 to 48 mm Hg and was > or =45 mm Hg in seven patients. No patient responded to local infiltration of the groin and placement of the arterial and venous cannulae. Three patients required a supplemental dose of ketamine (1 mg/kg) during the procedure. In two of these patients, this was required before changing the cannulae. Our preliminary data suggest that a combination of ketamine and dexmedetomidine provides effective sedation for cardiac catheterization in infants and children without significant effects on cardiovascular or ventilatory function.

Cardiac catheterization in infants weighing less than 1,500 grams

The improved survival of very low-birth-weight (<1,500 g) infants justifies more aggressive attempts to treat underlying congenital heart disease than in the past. We retrospectively reviewed all catheterizations performed at our institution between January 1, 1990 and June 1, 2004 in infants weighing <1,500 g. We performed a 3:1 case-control study. Comparisons were randomly selected from a group of patients catheterized within 6 months of the cases and weighing 2-3 kg. All catheterization data, angiograms, and hospital charts were reviewed. Eighteen patients weighing <1,500 g underwent catheterization. Fifty-four patients were selected as comparisons. There were no significant differences in the age at catheterization, procedure time, fluoroscopy time, or contrast amount (cc/kg). The lower-birth-weight infants were more likely to be premature (median age 29 vs. 37 weeks, P < 0.001), and to have left-sided obstructive lesions including aortic stenosis or coarctation. The comparison patients were more likely to be postoperative (28% vs. 0%, P = 0.02), and included a higher number with hypoplastic left heart syndrome. There was an increased incidence of interventions performed in the lower-birth-weight infants (83% vs. 41%, P = 0.002). There was a difference in the interventions performed between the two groups: the comparisons had more atrial septal procedures, and the lower-birth-weight infants had more coarctation dilations and aortic valve dilations. There were no significant differences in the acute success rate of the procedures (100% vs. 95%), overall complication rate (56 vs. 57%), incidence of blood transfusions (44 vs. 30%), or major complications (11 vs. 13%) between the lower-birth-weight and comparison groups respectively. There was a trend towards higher survival rate in the comparison group in this small study population, but it did not reach significance (80 vs. 61%, P = 0.13). Cardiac catheterization in neonates <1,500 g is more likely to include percutaneous intervention, especially on the left side, but is generally successful with a complication rate similar to procedures performed in larger infants. Although these procedures are rare, improved miniaturization of equipment would facilitate safer interventions.

Assessment of Radiocontrast Nephropathy after Cardiac Catheterization in infants and children with Congenital Heart diseases.

ABSRTACT Background: Increasing numbers of patients are exposed to contrast medium (CM) during Cardiac Catheterization procedures. Radiocontrast use in all branches of medicine is reported to be the third most common cause of new onset renal failure in hospital patients. Objectives: To assess renal dysfunction induced by use of contrast media (CM) in infants and children with congenital heart diseases (CHD) undergoing Cardiac Catheterization. Methods: Serum creatinine (Cr), corrected creatinine clearance (c.Cr.Cl.), serum Beta 2 microglobulin (β2MG), urinary retinol binding protein (uRBP), fractional excretion of sodium (FENa), and urine to serum osmolality ratio (u/sOSM) were measured in 19 patients with congenital cyanotic heart diseases (CCHD) and 26 patients with congenital cyanotic heart diseases (CCHD) 24 hours before and 72 hours after cardiac Catheterization using low osmolar nonionic CM. Patients were compared to 31 healthy controls of matched age and sex. Results: Before Cardiac Catheterization, there was no significant difference in the studied parameters between CCHD and CAHD patients when compared either to each other or to the healthy controls. Only u/s OSM ratio was significantly reduced in CCHD patients when compared to CAHD (P=0.02) or controls (P=0.01). After cardiac Catheterization, all patients showed significant reduction of their c.Cr.Cl, u/s OSM (P <0.001& 0.002 respectively) and a significant increase of β2MG, uRBP & FENa (p <0.001, 0.002 and 0.003 respectively) and a non-significant change of Cr (p=0.23). Both before and after cardiac Catheterization; c.Cr.Cl correlated more significantly with β2MG (r=-0.65 & -0.79, p=0.001& 0.005 respectively) rather than with Cr (r=-0.41& -0.52, p=0.02 & 0.01 respectively). Out of the studied 45 patients; only 3patients matched the definition of CM nephropathy despite the significant change in different renal parameters. Conclusions: Children with CHD develop significant defects in glomerular and tubular parameters after CM use despite that their Cr may not increase. Revision of the currently used definition of CM nephropathy may be required.

Cardiac catheterisation in infants weighing less than 2500 grams.

To investigate the indications for, and outcome of, cardiac catheterisation in infants weighing less than 2500 g at a single institution over an 8-year period. We assessed all infants who were less than 2500 g at the time of cardiac catheterisation at Texas Children's Hospital from January 1993 to January 2001. Comparisons of morbidity and mortality were drawn with an equivalent number of infants of similar age weighing greater than 2500 g seen over the same period of time. We performed interventional procedures in 22, and diagnostic catheterisations in 12 infants weighing less than 2500 g. Interventions included pulmonary valvoplasty in six patients, balloon angioplasty of critical coarctation in one, aortic valvoplasty in two, septostomy in ten, and coil occlusion of an arteriovenous malformation, redirection of a subclavian venous line, and coil occlusion of a patent arterial duct in one patient each. The median age at catheterisation was 5 days for children less than 2500 g, and 10 days for those above 2500 g. The median weights were 2.3 kg and 3.3 kg, and the median gestational ages were 35 weeks and 38 weeks, for the two respective groups. Of those weighing less than 2500 g, two died (6%), with no deaths occurring in those weighing more than 2500 g. In 3 patients weighing less than 2500 g (9%), there was vascular compromise, one child with bilateral femoral venous obstruction requiring fasciotomy compared, to one in the group weighing greater than 2500 g (2%). There is a significantly increased risk of mortality and vascular compromise in infants weighing less than 2500 g. Interventional catheterisation in these infants may be lifesaving, but given the aforementioned risks, diagnostic catheterisation should be deferred if possible in favor of noninvasive modalities.

Early and late results of thrombolytic therapy using Tissue-Type plasminogen activator to restore arterial pulse after cardiac catheterization in infants and small children

Pulse loss after cardiac catheterization has been reported to occur in 8% to 39% of infants weighing <14 kg1–3 despite prophylactic use of heparin,4 notably after retrograde balloon angioplasty or valvuloplasty.5 Impaired limb growth is a possible late complication6,7 and access is lost for future catheterization. Thrombolytic therapy using streptokinase5,8,9 and urokinase,10 and, recently, tissue-type plasminogen activator (t-PA)11–14 has been reported but without assessing long-term patency of the target vessel. The reports on t-PA11–14 were based on a variety of doses given >24 hours after catheterization and patient numbers were small. We report our experience using a uniform t-PA dosing protocol that began 4 to 6 hours after cardiac catheterization with regard to safety, efficacy, and long-term patency of the target vessel.

Scheduled autologous blood donation at the time of cardiac catheterization in infants and children

Preoperative autologous blood donation is commonly performed to avoid homologous blood transfusion during cardiac operations in adult patients. 1 However, autologous blood donation for children is hampered by technical problems including lack of an adequate blood collection system and acute anemia after blood collection. Given the life span of children, it is most important to avoid the complications of homologous transfusion. 2 We describe a technique of scheduled autologous blood donation during preoperative cardiac catheterization and examine the efficacy and safety of this method for use in infants and children. Technique. Cardiac catheterization was performed about 2 weeks before elective operations in infants and children weighing at least 5 kg. Autologous blood donation was performed in patients with a hematocrit value of 33% or more and a hemoglobin value of 11 gm/dl or more. Sedation was achieved with thiopental sodium and local anesthesia was achieved with lidocaine hydrochloride. Sheaths were inserted into the femoral artery and vein. After hemodynamic measurements, but before contrast angiography, 10 ml/kg of blood was collected via the arterial sheath. The same volume of lactated Ringer's solution was infused at the same rate through the venous sheath. Collected blood was stored as packed red cells and plasma or as whole blood. Blood erythropoietin concentrations were measured before and after blood collection, and recombinant human erythropoietin (100 U/kg) was administered intravenously to acyanotic patients on the first and seventh days after blood collection. Cyanotic patients were not treated with recombinant human erythropoietin. Each patient was given ferrous sulfate (2 mg/ kg) orally every day. Results. From October 1995 through September 1997, preoperative autologous blood donation was performed in 27 children, including 13 infants (16 boys and 11 girls). Their ages ranged from 6 months to 6 years, 8 months (average 1.9 -+ 2.1 years). Their body weights ranged from 5.8 kg to 20.2 kg (average 9.7 -+ 5.5 kg). The patients

Predictors of arterial thrombosis after diagnostic cardiac catheterization in infants and children randomized to two heparin dosages

Arterial thrombosis is the most frequent major complication of percutaneous arterial catheterization in children. We prospectively studied the effect of randomized dosage of heparin, 50 IU/kg-group I and 100 IU/kg-group II, on the incidence of arterial thrombosis in 366 children and analysed the various factors which may influence the occurrence of this complication. The age of patients ranged from 17 d to 11 yr (mean age 39.5 +/- 40.9 mo) and mean weight was 11.2 +/- 7.8 kg (range 3 to 39 kg). The incidence of arterial thrombosis was 9.8% in group I and 9.3% in group II (P = NS). There was no statistical difference in precatheterization and procedure variables in the two groups and also in the group with absent pulse (n = 35) to the group with pulse present post cath (n = 331). There were 24.9% infants in our study and 14.3% of these had arterial thrombosis. The loss of pulse was more often seen with more number of attempts at arterial puncture (P < 0.001), absence of back bleed at the end of the procedure (P < 0.001), and increased duration of catheterization (P < 0.01). Use of larger sheath size in a given weight and body surface area of children increased incidence of arterial thrombosis. The administration of heparin 50 IU/kg was equally efficacious to heparin 100 IU/kg. Of the patients with arterial thrombosis, 23 responded with intravenous heparin and 12 needed streptokinase. There was no bleeding or haematoma. Thus our study shows that less attempt for arterial puncture, use of smaller sheath size, maintaining shortest procedure time and ensuring back bleed minimises incidence of arterial thrombosis post catheterization.

Reduced radiation during cardiac catheterization of infants using acquisition zoom technology

It has been estimated that for adults, each hour of fluoroscopic imaging exposure carries a lifetime risk of developing a fatal malignancy of 0.1% and a risk of a genetic defect of 20/million births.4 Chromosomal damage has been seen following catheterization in pediatric patients,5 although to date no increase in the incidence of malignancies in children who have undergone cardiac catheterization has been reported.6 As these patients age, close surveillance will enhance our knowledge of the precise effects of radiation exposure. In the meantime, AZ digital technology provides a method of reducing exposure to infants with a slight reduction in image quality. Future software advances in the technique should enhance the image quality and potentially broaden its application to older patients.