How to avoid and manage major complications during Congenital Cardiovascular Catheterizations

Although congenital cardiac catheterization has made significant progress in the recent years, complications or adverse events are still common. In the latest and so far largest prospective multicenter study, adverse events occurred in about 16% of the cases, ranging from 8% to 18%, depending on the participating center. That means that even when implementing the best practices and protocols to improve patient outcome, every interventional cardiolo gist who enters the catheterization suite should be prepared for complications. Obviously, not all complications are lives threatening and their potential deleterious effect on patients depends on the extent and severity of the adverse event. Based on the difference in the incidence and severity of com plications, congenital cardiac catheterization procedures were stratified according to the innate risk to the procedure. Most complications occur during interventional proce dures (22%), somewhat less during diagnostic cases (14%).Age and weight is an important predictor as well. There are cer tain hemodynamic measures that pose vulnerability and, therefore, could lead to complications. These hemodynamic characteristics are for patients with single ventricles: end-dia stolic pressure (EDP) > 18 mmHg, saturation <78%, mixed venous saturation <50%, main pulmonary artery (MPA) mean pressure > 17 mmHg, and for patients without single ventricles: EDP > 18 mmHg, saturation <95%, mixed venous saturation <60%, and MPA systolic pressure > 45 mmHg.2 Among the potential causes, multivariate analysis identified independent predictors of adverse events.There is a list of things that enhance the safety of catheter izations, and this list starts way before the procedure itself. Following these steps may help you to avoid some of the complications: 1- before cath: - Know your patient. - Think about your case the day before. - Day of the procedure: Discuss the cases with your head technician and nurse to assure that all anticipated equipment (for anesthesia, vascular access, arrhythmia control, pacemaker, ICD….), catheters, stents, devices, and imaging are available. - Go through the consent with the family in detail. Have a routine and say everything that could happen. - Just before the case: Review all previous studies again such as last CXR, ECG, echocardiogram, and angiograms.2- during cath: - be aware about complications of vascular access, catheter and wire manipulation, devices, interventional procedures and anesthesia and those management - continues control of patient’s heart rate and rhythm, blood pressure and oxygenation is mandatory.3- after cath: - Accurate homeostasis of the vascular access site and continues monitoring of the patient until complete recovery is crucial. - transfer of the complicated or critical cases or patients which underwent trans catheter interventions to intensive care unit and continues monitoring especially in first 24 hours is necessary.