Interventional catheterization in paediatric cardiology.

The primary role of interventional procedures in the management of some congenital heart diseases is established and their clinical utility broadens every day. Yesterday's relatively crude procedures have been replaced by safe and more effective techniques. Improvements and new developments in specifically designed paediatric equipment have played a significant role. In order to meet the cardiologist's drive to refine existing techniques and develop new ones, further investment into paediatric cardiac catheterization equipment is mandatory. More and more "heart operations' will be performed in cardiac catheterization laboratories in the future, and this will have clear implications on costs, as most non-surgical techniques are cheaper than surgery, and hospitalization is much shorter. New methods, tested within research protocols in specialized centres, combined with continuous critical evaluation of established techniques will ensure improved and sustained results. The primary consideration of practising paediatric cardiologists should not be whether it is possible to perform such techniques, but whether their clinical utility, morbidity and mortality justifies a non-surgical approach for their centre. Interventional catheterization, in other words has to "compete' with the results of surgery prior to new techniques being recommended for general use. Despite this "competition' it has been welcome to see a collaboration between paediatric cardiologists and paediatric cardiac surgeons in planning staged repairs of complex congenital heart disease. A typical example of this is the fenestrated Fontan procedure, in which the immediate post-operative course has dramatically improved due to the deliberate placement of a residual atrial shunt, which is then closed with an umbrella in the catheter laboratory. This type of cooperation is bound to increase further and is already contributing to a far better outcome for many of the complex congenital heart lesions.