Rationalising the use of cardiac catheterisation before Glenn completion

Lorraine James*, Animesh Tandon, Alan Nugent, Sadia Malik, Claudio Ramaciotti, Gerald Greil, Luis Zabala, Joseph Forbess, Tarique Hussain

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Previous studies have shown that cardiac MRI can be used to evaluate the suitability for infants to undergo the Glenn operation after having undergone the Norwood procedure. We sought to analyse our institutional data retrospectively to identify whether such a policy would be advisable in the current era. We reviewed patients who underwent the Norwood procedure between 1 January, 2006 and 1 January, 2016. All patients undergoing evaluation for the Glenn procedure received clinical evaluation, echocardiography, and cardiac catheterisation. A total of 179 patients were identified; 154 patients (86%) survived to undergo cardiac catheterisation as part of evaluation for the Glenn, and all who were evaluated did not eventually receive the Glenn. Using said algorithm, if cardiac MRI or CT were to be used to rationalise the use of catheterisation, 26 of 154 patients would have required catheterisation after cross-sectional imaging identified vascular obstruction; 83 of 154 patients would have received cross-sectional imaging only; and 45 of 154 would have had catheterisation only. All cases that required intervention, excluding aortopulmonary collaterals, and all cases that were not suitable to progress would have been correctly identified using clinical and echocardiographic criteria in addition to cardiac cross-sectional imaging to rationalise the use of catheterisation. Thus, in cases with acceptable clinical, echocardiographic, and angiographic findings, the additional haemodynamic information from catheterisation is rarely of use for decision-making, and interventions can largely be predicted by angiographic imaging modalities.

Original languageEnglish (US)
Pages (from-to)719-724
Number of pages6
JournalCardiology in the Young
Volume28
Issue number5
DOIs
StatePublished - May 1 2018

Fingerprint

Cardiac Catheterization
Catheterization
Norwood Procedures
Blood Vessels
Echocardiography
Decision Making
Hemodynamics

Keywords

  • Catheterisation
  • Echocardiography and Scans
  • Glenn procedure
  • cardiac
  • cardiac CT
  • cardiac MRI
  • child

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Cardiology and Cardiovascular Medicine

Cite this

James, L., Tandon, A., Nugent, A., Malik, S., Ramaciotti, C., Greil, G., ... Hussain, T. (2018). Rationalising the use of cardiac catheterisation before Glenn completion. Cardiology in the Young, 28(5), 719-724. https://doi.org/10.1017/S1047951118000240
James, Lorraine ; Tandon, Animesh ; Nugent, Alan ; Malik, Sadia ; Ramaciotti, Claudio ; Greil, Gerald ; Zabala, Luis ; Forbess, Joseph ; Hussain, Tarique. / Rationalising the use of cardiac catheterisation before Glenn completion. In: Cardiology in the Young. 2018 ; Vol. 28, No. 5. pp. 719-724.
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James, L, Tandon, A, Nugent, A, Malik, S, Ramaciotti, C, Greil, G, Zabala, L, Forbess, J & Hussain, T 2018, 'Rationalising the use of cardiac catheterisation before Glenn completion', Cardiology in the Young, vol. 28, no. 5, pp. 719-724. https://doi.org/10.1017/S1047951118000240

Rationalising the use of cardiac catheterisation before Glenn completion. / James, Lorraine; Tandon, Animesh; Nugent, Alan; Malik, Sadia; Ramaciotti, Claudio; Greil, Gerald; Zabala, Luis; Forbess, Joseph; Hussain, Tarique.

In: Cardiology in the Young, Vol. 28, No. 5, 01.05.2018, p. 719-724.

Research output: Contribution to journalArticle

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AU - James, Lorraine

AU - Tandon, Animesh

AU - Nugent, Alan

AU - Malik, Sadia

AU - Ramaciotti, Claudio

AU - Greil, Gerald

AU - Zabala, Luis

AU - Forbess, Joseph

AU - Hussain, Tarique

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AB - Previous studies have shown that cardiac MRI can be used to evaluate the suitability for infants to undergo the Glenn operation after having undergone the Norwood procedure. We sought to analyse our institutional data retrospectively to identify whether such a policy would be advisable in the current era. We reviewed patients who underwent the Norwood procedure between 1 January, 2006 and 1 January, 2016. All patients undergoing evaluation for the Glenn procedure received clinical evaluation, echocardiography, and cardiac catheterisation. A total of 179 patients were identified; 154 patients (86%) survived to undergo cardiac catheterisation as part of evaluation for the Glenn, and all who were evaluated did not eventually receive the Glenn. Using said algorithm, if cardiac MRI or CT were to be used to rationalise the use of catheterisation, 26 of 154 patients would have required catheterisation after cross-sectional imaging identified vascular obstruction; 83 of 154 patients would have received cross-sectional imaging only; and 45 of 154 would have had catheterisation only. All cases that required intervention, excluding aortopulmonary collaterals, and all cases that were not suitable to progress would have been correctly identified using clinical and echocardiographic criteria in addition to cardiac cross-sectional imaging to rationalise the use of catheterisation. Thus, in cases with acceptable clinical, echocardiographic, and angiographic findings, the additional haemodynamic information from catheterisation is rarely of use for decision-making, and interventions can largely be predicted by angiographic imaging modalities.

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