BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
Authors: Athina Pappas; Seetha Shankaran; Nellie I Hansen; Edward F Bell; Barbara J Stoll; Abbot R Laptook; Michele C Walsh; Abhik Das; Rebecca Bara; Ellen C Hale; Nancy S Newman; Nansi S Boghossian; Jeffrey C Murray; C Michael Cotten; Ira Adams-Chapman; Shannon Hamrick; Rosemary D Higgins Journal: Pediatr Cardiol Date: 2012-05-30 Impact factor: 1.655
Authors: Walter Knirsch; Christian Kellenberger; Sven Dittrich; Peter Ewert; Martin Lewin; Reinald Motz; Jan Nürnberg; Oliver Kretschmar Journal: Pediatr Cardiol Date: 2012-09-09 Impact factor: 1.655
Authors: Michael L O'Byrne; Andrew C Glatz; Brian D Hanna; Russell T Shinohara; Matthew J Gillespie; Yoav Dori; Jonathan J Rome; Steven M Kawut Journal: J Am Coll Cardiol Date: 2015-09-15 Impact factor: 24.094
Authors: Eoghan E Laffan; Patrick J McNamara; Joao Amaral; Hilary Whyte; Johanne L'Herault; Michael Temple; Philip John; Bairbre L Connolly Journal: Pediatr Radiol Date: 2009-05-09