Is cardiac catheterization a prerequisite in all patients undergoing bidirectional cavopulmonary anastomosis?

McMahon, Colin J.; Eidem, Benjamin W.; Bezold, Louis I.; Vargo, Thomas A.; Neish, Steven R.; Bricker, J. Timothy; Kovalchin, John P.; El‐Said, Howaida

doi:10.1016/s0894-7317(03)00592-3

Cited by 19 publications

(21 citation statements)

References 12 publications

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“…This is consistent with previous studies in which few patients were excluded from bidirectional Glenn on the basis of findings at cardiac catheterization. 9,10 It is also worth noting that the incidence of minor adverse events recorded in the catheterization group is higher in this study than in our previous retrospective study of a similar cohort. 9 This may be due to the meticulous prospective recording of all adverse events using predefined criteria in this trial versus retrospective data collection.…”

Section: Discussioncontrasting

confidence: 45%

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Cardiac Magnetic Resonance Versus Routine Cardiac Catheterization Before Bidirectional Glenn Anastomosis in Infants With Functional Single Ventricle

et al. 2007

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Background— Routine preoperative catheterization is standard practice in patients with single-ventricle physiology before bidirectional Glenn anastomosis. Because catheterization is invasive and exposes patients to ionizing radiation, cardiac magnetic resonance (CMR) may be a safe and effective alternative. Methods and Results— We conducted a prospective, randomized, single-center clinical trial comparing catheterization with CMR in patients considered for bidirectional Glenn operation from February 2003 to June 2006. End points were frequency of adverse events of the preoperative evaluation and a composite score of clinically successful surgery. Of 92 eligible patients, 82 were enrolled on the basis of screening echocardiogram, fulfillment of inclusion criteria, and informed consent. Patients were randomized to catheterization (n=41) or CMR (n=41). There were no baseline differences between groups. Four treatment crossovers occurred, 3 to catheterization and 1 to CMR. Catheter interventions were performed in 17 patients (41%). Catheterization resulted in more minor adverse events (78% versus 5%; P <0.001), longer preoperative hospital stays (median, 2 versus 1 day; P <0.001), and higher hospital charges ($34 477 versus $14 921; P <0.001). There was 1 major adverse event in the CMR group ( P =1.0). The operative course and frequency of postoperative complications were similar between the 2 groups. The proportion of patients who had a successful bidirectional Glenn operation was similar (71% versus 83%; P =0.3). At the 3-month follow-up, there were no differences in clinical status, oxygen saturation, or frequency of reinterventions. Conclusions— CMR is a safe, effective, and less costly alternative to routine catheterization in the evaluation of selected patients before bidirectional Glenn operation. Further studies are necessary to determine whether there are long-term benefits from transcatheter interventions in these patients.

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Section: Discussioncontrasting

confidence: 45%

“…8 Moreover, 2 retrospective studies have demonstrated that patients are rarely excluded from bidirectional Glenn operation on the basis of findings at cardiac catheterization. 9,10 Others have questioned the benefits of certain transcatheter interventions. 11,12 …”

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confidence: 99%

Cardiac Magnetic Resonance Versus Routine Cardiac Catheterization Before Bidirectional Glenn Anastomosis in Infants With Functional Single Ventricle

et al. 2007

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“…5 Success of the BCPC is dependent on preoperative anatomic and functional assessment. 6,7 Cardiac catheterization is used to delineate anatomy and to measure the pulmonary vascular resistance (PVR). 6,7 Echocardiography is used to assess valvar and right ventricular function.…”

mentioning

confidence: 99%

“…6,7 Cardiac catheterization is used to delineate anatomy and to measure the pulmonary vascular resistance (PVR). 6,7 Echocardiography is used to assess valvar and right ventricular function. Cardiac catheterization is associated with morbidity and occasional mortality in this group of patients 8 and leads to significant exposure to medical radiation.…”

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confidence: 99%

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Cardiac Magnetic Resonance Imaging After Stage I Norwood Operation for Hypoplastic Left Heart Syndrome

Muthurangu

Taylor²,

Hegde³

et al. 2005

Circulation

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Background-After the Norwood operation, a patient's suitability for proceeding to a bidirectional cavopulmonary connection (BCPC) is assessed by a combination of echocardiography and diagnostic cardiac catheterization. In this study, we describe the results of 37 patients who underwent cardiovascular magnetic resonance (MR) assessment before BCPC. Methods and Results-Cardiovascular MR and echocardiography were performed in 37 infants with hypoplastic left heart syndrome before BCPC, and the findings were compared with surgical findings. MR assessment of ventricular function and valvar regurgitation were compared with echocardiography. MR exhibited high sensitivity and specificity for identification of neoaortic (sensitivity 86%, specificity 97%) and left pulmonary artery (sensitivity 100%, specificity 94%) obstruction. Echocardiography exhibited poor sensitivity for identification of vascular stenosis. The mean right ventricular ejection fraction calculated from the MR data was 50Ϯ10%.

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Cardiac Catheterization Is Necessary Before Bidirectional Glenn and Fontan Procedures in Single Ventricle Physiology

Nakanishi

2005

Pediatr Cardiol

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There are significant mortality and morbidity in bidirectional Glenn (stage II) and Fontan (stage III) procedures for congenital heart diseases with single ventricle physiology. In order to minimize the mortality and morbidity, the presence or absence of hemodynamic and anatomical abnormalities, such as poor ventricular function, coarctation of the aorta, pulmonary artery distortion, high pulmonary resistance, and abnormal collateral vessels, should be evaluated. Echocardiography and magnetic resonance imaging (MRI) can visualize ventricular size and coarctation of the aorta but may fail to visualize pulmonary artery distortion. Furthermore, cardiac catheterization is needed to measure pulmonary resistance. If the pulmonary resistance is > 3 Wood units/m2 before stage II, the risk for the bidirectional Glenn operation may be high. Abnormal aortopulmonary collateral vessels may develop after the stage II procedure and echocardiography and MRI may not visualize these vessels. Coil embolization may be required to treat these vessels. In conclusion, cardiac catheterization is required to evaluate abnormalities, which may be treated by interventional catheterization, and to reduce mortality and morbidity of stage II and III procedures.

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Is cardiac catheterization a prerequisite in all patients undergoing bidirectional cavopulmonary anastomosis?

Cited by 19 publications

References 12 publications

Cardiac Magnetic Resonance Versus Routine Cardiac Catheterization Before Bidirectional Glenn Anastomosis in Infants With Functional Single Ventricle

Cardiac Magnetic Resonance Versus Routine Cardiac Catheterization Before Bidirectional Glenn Anastomosis in Infants With Functional Single Ventricle

Cardiac Magnetic Resonance Imaging After Stage I Norwood Operation for Hypoplastic Left Heart Syndrome

Cardiac Catheterization Is Necessary Before Bidirectional Glenn and Fontan Procedures in Single Ventricle Physiology

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