Cardiac catheterization, formerly only used for diagnostic purposes to aid in surgical management, has exploded over the last 15-20 years to include numerous methods of treatment without the need for surgery or in collaboration with surgical techniques. Rapidly advancing technology is allowing for the diagnosis of the most complex cardiac defects and therapeutic treatment of a variety of cardiac birth defects is now possible. Some of these defects include atrial septal defect, patent ductus arteriosus, ventricular septal defect, coarctation of the aorta, pulmonary stenosis, and aortic stenosis. Valves have been implanted in the pulmonary and tricuspid positions solely in the cardiac catheterization lab, avoiding the need for surgery altogether. IU School of Medicine interventional pediatric cardiologists at Riley Hospital have been at the forefront of those advancements. Recent advancements have allowed transcatheter closure of patent ductus arteriosus in tiny premature infants, who previously could only undergo surgery. These cardiologists have been among a small group of experts nationwide involved in clinical research trials for Amplatzer Septal and Duct Occluders and Nit-Occlude that treats atrial septal defects (ASD) and patent ductus arteriosus (PDA). Numerous clinical trials of newer medical devices are ongoing.
The cardiac cath labs are located within the Riley Hospital operating room area, across the hall from the Cardiac Surgery OR’s, which greatly facilitates collaboration of the interventional cardiologists and cardiac surgeons. One of the cath labs is designed as a hybrid cath lab suite, allowing both surgeons and cardiologists to work jointly in managing complex heart defects. Combined interventional and surgical techniques (hybrid procedures) have been performed at Riley Hospital for Children since 2004. Examples of such cases have included implantation of PDA stents, pulmonary valve perforation in pulmonary atresia, and ligation of unusual collateral vessels whereby angiographic localization provides immediate feedback before and after surgical intervention.
A team model of care shapes the treatment in the catheterization laboratory and recovery within the Riley Heart Center. Pediatric Interventional cardiologists and cath lab nursing personnel work closely with pediatric cardiac anesthesiologists for all procedures, and intensivists are involved whenever necessary. More than 500 pediatric cardiac catheterizations (diagnostic, interventional, biopsy and electrophysiologic) are performed by IU School of Medicine faculty each year.