Interventional Cardiology

Thanks to extensive research and major advancements in technology, complex congenital heart defects can now undergo invasive testing, evaluation and treatment with relatively low risk. Procedures that were once performed as major open heart surgeries can now be done with smaller incisions and faster recovery times.

For us that means delivering state-of-the-art care. For our patients it means the best care is just a heart beat away.

Choosing our Interventional Cardiology Program

Led by Deborah Schutte, M.D., the pediatric interventional cardiology team at Cook Children's specializes in diagnostic evaluation and transcatheter treatment of a wide variety of complex congenital heart lesions.

Our nationally ranked program is continually on the forefront of providing the most advanced diagnostic and interventional cardiac care in our cardiac catheterization lab with the latest in minimally invasive cardiac procedures, including the transcatheter pulmonary valve implantation procedure.

We continually seek out new technologies that can help to reduce the stress on our patients while improving their outcomes. The doctors and nurses at Cook Children's are also actively involved in cardiac research programs, work to find cures and ensure that our patients have access to the latest clinical trials.

The cardiac catheterization laboratory

The cardiac catheterization laboratory at Cook Children's provides both diagnostic testing and therapeutic interventions. Depending on your child's diagnosis, our pediatric heart specialists may be able to perform minimally invasive procedures on your child's heart. Procedures that were once performed as major open heart surgeries can now be done with lowered risk and faster recovery times.

An interventional catheterization may be performed at the same time as your child's diagnostic catheterization, depending on the severity and type of defect. Those procedures might include:

Arrhythmia ablation – This procedure is performed to correct certain types of irregular heartbeats or arrhythmias.
Pacemaker or defibrillator implantation – Procedure used to correct certain types of arrhythmias and prevent sudden cardiac death.
Balloon angioplasty – The doctor inserts a thin plastic tube (catheter) with a balloon at the tip into the artery or vein, typically in the leg. The balloon is put into place and inflated to open a narrowed blood vessel.
Balloon valvuloplasty – The doctor inserts a thin plastic tube (catheter) with a balloon at the tip into the artery or vein, typically in the leg. The balloon is put into place and inflated to open a narrowed heart valve.
Heart valve placement – The artificial valve is sewn onto a stent and compressed onto a balloon catheter. When in place, the balloon is inflated, opening up the stent. The balloon is deflated and removed. The stent remains open and the valve can function normally.
Septal closures – Certain types of holes within the heart wall can be repaired by placing a collapsed device in the catheter. When it reaches the area that needs repair the device opens and closes the hole.
Stent placement – A stent is a small wire mesh tube designed to support narrowed blood vessels. The stent is compressed onto a balloon catheter and dilated by inflating the balloon. When the balloon is deflated and removed, the stent remains open, enlarging the narrowed vessel
Vascular occlusion – A vascular occlusion is used to reduce or stop the blood flow in certain vessels. Sometimes a blood vessel doesn't function properly. A vessel may leak or cause pressure leading to an aneurysm (tear in the vessel). In the case of certain tumors, cutting of the blood supply that feeds the tumor can help to prevent its growth.

Occlusions are performed using small wire coils or a plug design. By releasing small wire coils at the point of occlusion, a clot is formed, blocking the flow of blood. Sometimes, several coils are needed to occlude the vessel. Tiny vascular plugs occlude vessels by expanding to block the blood vessel. In many cases, a single plug can block a blood vessel that would have required multiple coils. The plug may also provide a faster solution to stopping the blood flow through the vessel.

Transcatheter pulmonary valve implantation

Transcatheter pulmonary valve implantation can delay surgical intervention of the heart, resulting in fewer surgeries for your child and a faster recovery time. The interventional cardiology team at Cook Children's uses both the Melody® Transcatheter Pulmonary Valve and Edwards Sapien valve, depending on what the best fit is for the patient. This provides a new treatment option for children and adults with failed pulmonary valve conduits. Pulmonary valve conduits prevent adequate blood flow from the heart to the lungs. This procedure helps restore pulmonary valve conduit function including relief of narrowing (stenosis) and leaking (regurgitation).

Transcatheter pulmonary valve implementation therapy treats narrowed or leaking pulmonary valve conduits between the heart's right pumping chamber and the lungs without open-heart surgery. With this therapy, a thin, hollow tube (catheter) with a specially designed heart valve inside is inserted into a vein and pushed up to your child's heart. The heart valve is from a cow's vein that has been attached to a wireframe. When it's time for your child to get the new valve, it's placed onto a catheter and guided through your child's vein to their heart where the new valve will replace the old one. The new valve will then be able to help your child's heart pump blood correctly.

Prior to the development of this therapy, children with failed pulmonary valves had to undergo high-risk open heart surgery that also required a hospital stay of one to two weeks. Today, thanks to this breakthrough medical technology, the hospital stay at Cook Children's is reduced to only one to two days.

Before your appointment

Most people are anxious about any kind of medical exam. Having your heart tested can even be scary. We will walk you through the process every step of the way so that you know what to expect, and we'll answer any questions you may have. Please don't hesitate to let us know if you have any concerns.

We recommend that you talk to your child before your appointment and explain, in an age appropriate manner, why they are having the procedure and how it will help them. Knowing this ahead of time can help to ease their fears.

Prior to your scheduled visit, you will receive a call confirming your appointment. At that time, we will go over your child's procedure based on his or her needs and the referring doctor's request. We will also go over eating and drinking instructions.

Since you will be admitted on the day of the procedure, we will need to do a pre-admission work-up on you the day before your procedure. You will receive a letter from Cook Children's Cath Lab prior to your procedure. The letter will note the dates and times of your pre-admission and your procedure. Your pre-admission visit may take 3-4 hours to complete. Your cardiologist MAY request the following tests to be performed during your pre-admission visit:

EKG
Echocardiogram
Holter monitor
Blood work
Exercise stress test

If you have have any questions, or need to change the date of your procedure, please let us know as soon as possible.

If your child becomes ill with fever, diarrhea or vomiting within 24 hours of your procedure, please call us and let us know at 682-885-2140. If you have a change of address, phone number, primary care physician or insurance, please let us know AS SOON AS POSSIBLE so we can make note of any changes in our medical records.

Most insurance companies require pre-admission authorization prior to your procedure. Our office will obtain precertification from your insurance company before you enter the hospital. If a referral is needed from your primary care provider (PCP), please notify him/her in advance of your procedure. If you need further assistance, please call 1-800-244-0830 or 682-885-7944 and ask for one of the Cath Lab Nurse Clinicians.

On the day of your appointment

Your child's stomach should be empty when they have test. In most cases, your child should not eat or drink after midnight on the night before the test. (They may have sips of water with their pills if taking medication). If your child's catheterization is in the afternoon, they can have a clear liquid breakfast – then nothing more. To help your child relax, a sedative will be given before the procedure. For your child's comfort, they will need to empty their bladder just before leaving for the test.

Please bring any medications that your child is currently taking with you to the hospital.

When you arrive for your scheduled catheterization, please report to Patient Registration on the 1st Floor of the hospital at your appointed time. It is very important that you arrive on time in order to complete any paperwork that may be needed. We also need time to prep your child for the test and, in some cases, additional testing may be required before the study begins.

The catheterization lab contains an array of special computer equipment, monitoring and recording devices. In addition to your child's cardiologist, a highly trained group of nurses and technicians will be in the lab during the test.

Your child will be under general anesthesia (asleep) during the test, which will probably take several hours. While your child is in the catheterization lab, they will lie on a bed. Several monitoring devices will be attached to their body. ECG electrodes – small adhesive patches that record the heart's activity – will be placed on your child's skin. To assure good contact, it may be necessary for your child's skin to be shaved and rubbed with alcohol. A blood pressure cuff will be placed on your child's arm and a small rubber cap will be placed on their finger to measure the amount of oxygen in your child's blood.

Before the test

Depending on your child's particular case, after you arrive but before beginning the actual study, your cardiologist MAY request the following tests to be performed on your child:

EKG
Echocardiogram
Holter monitor
Blood work
Exercise stress test

After any required tests are completed, the doctor and one of the Cardiology Case Managers will meet with you to obtain consent for the procedure and answer any additional questions.

After all paperwork is completed and any needed tests are done, your child will be dressed in a hospital gown. A sedative will be given prior to the test to relax your child. Most children will have a breathing tube placed for the duration of the procedure so that they will be asleep and not feel any pain. A numbing medicine will be given at the catheter insertion sites also. The procedure can last from 3-4 hours, but one of the Cardiology Case Managers will keep you informed throughout your child's procedure.

Cardiac catheterization is what is called an invasive procedure, meaning it involves going into the body through the skin. However, it is a minimally invasive procedure and is not considered "open" surgery since it's performed without making any large incisions.

The test

The test will be done using one or more catheters, depending on the areas of the heart that need to be tested. A catheter is a thin, insulated tube that contains tiny wires capable of sending and receiving electrical impulses.

Your child's groin, neck and/or arm may be cleaned so that one or more catheters can be inserted. The catheter insertion site may need to be shaved and will then be rubbed with an antiseptic solution. Sterile sheets will be placed over your child, leaving only a small area exposed. All of this is done to prevent infection.

The catheter will be inserted into a vein through a needle puncture. Guided by x-ray pictures, as well as a special 3 dimensional mapping system, your child's doctor will advance the catheter and position it in the heart. In some cases, it will be necessary to inject dye material so that pictures can be taken of structures of interest.

While inside the heart, several things are done to help evaluate the heart structures, as well as the pattern of blood flow:

Blood samples are drawn from a number of vessels and heart chambers, which will allow for calculation of heart function and flow characteristics.
Blood pressure measurements are taken.
A contrast fluid is injected into the catheter and, as it flows inside the heart, x-ray films are made of the path the fluid takes throughout the heart.

The cardiologist is able to detect abnormalities in the heart such as narrowed arteries, blood vessels or valves and can help your doctor decide which treatment may be best for your child's condition.

Depending on the results of the test, your child may have an interventional procedure at this time. In some cases, the results may indicate a need for additional types of tests or other treatments.

After the catheterization

When your child's catheterization is over, the catheters will be removed. To prevent bleeding, pressure will be applied for 10 to 20 minutes on the area where the catheters were inserted. Then a small bandage or a small pressure dressing will be applied. Your child will not need stitches.

Your child will be taken to the recovery room on a stretcher. They will then be able to drink some liquids. During the first two or three hours, your child's nurse will frequently check their blood pressure, pulse and catheter insertion sites. In some cases your child may stay overnight for observation. If your child is discharged after the procedure, he or she will need to stay in bed for four to six hours. This will help the catheter insertion sites begin to heal. Here are some tips that will speed healing of the insertion site:

Do not allow your child to bend the arm or leg the catheter was inserted in. Bending their leg at the hip may cause the site to bleed.
Call your child's nurse immediately if you notice bleeding or feel warmth, notice any swelling or if your child is experiencing pain at the insertion site.
When your child coughs or sneezes, they should put their hand over the site and apply pressure.

Before your appointment

Even if you've had a cardiac catheterization before, you may be anxious about having a minimally invasive exam or interventional procedure. We will walk you through the process every step of the way so that you know what to expect, and we'll answer any questions you may have. Please don't hesitate to let us know if you have any concerns.

The purpose of the heart catheterization is to evaluate the structure and function of your heart and/or major blood vessels connected to the heart. In some instances a catheterization is performed to repair a heart or blood vessel problem.

Prior to your scheduled visit, you will receive a call confirming your appointment. At that time, we will go over your procedure based on your cardiologist's request. We will also go over eating and drinking instructions.

EKG
Echocardiogram
Holter monitor
Blood work
Exercise stress test

If you have have any questions, or need to change the date of your procedure, please let us know as soon as possible.

If you become ill with fever, diarrhea or vomiting within 24 hours of your procedure, please call us and let us know at 682-885-2140. If you have a change of address, phone number, primary care physician or insurance, please let us know AS SOON AS POSSIBLE so we can make note of any changes in our medical records.

On the day of your appointment

Your stomach should be empty when you have the procedure. In most cases, you should not eat or drink after midnight on the night before the test. (You may have sips of water with your pills if taking medication). If your catheterization is in the afternoon, can usually have a clear liquid breakfast – then nothing more. To help you relax, a sedative will be given before the procedure.

Please bring any medications that you are currently taking with you to the hospital.

When you arrive for your scheduled catheterization, please report to Patient Registration on the 1st Floor of the hospital at your appointed time. It is very important that you arrive on time in order to complete any paperwork that may be needed. We also need time to prep you for the test and, in some cases, additional testing may be required before the study begins.

Before the test

After you arrive, you will change into a hospital gown. A sedative is usually given prior to the test to relax you. The procedure is performed under general anesthesia which necessitates you having a breathing tube placed for the length of the procedure. A numbing medicine will be given at the catheter insertion sites also.

Cardiac catheterization is what is called an invasive procedure, meaning it involves going into the body through the skin. However, it is a minimally invasive procedure and is not considered "open" surgery since it's performed without making any large incisions.

The procedure

During the catheterization, which will probably take several hours, you'll lie on a bed and several monitoring devices will be attached to your body. ECG electrodes – small adhesive patches that record the heart's activity – will be placed on your skin. To assure good contact, it may be necessary for your skin to be shaved and rubbed with alcohol. A blood pressure cuff will be placed on your arm and a small rubber cap will be placed on your finger to measure the amount of oxygen in your blood.

Your groin, neck and/or arm may be cleaned so that one or more catheters can be inserted. The catheter insertion site may need to be shaved and will then be rubbed with an antiseptic solution. Sterile sheets will be placed over your body, leaving only a small area exposed. All of this is done to prevent infection.

The catheter will be inserted into a vein through a needle puncture. Guided by x-ray pictures, as well as a special 3 dimensional mapping system, your cardiologist will advance the catheter and position it in the heart. In some cases, it will be necessary to inject dye material so that pictures can be taken of structures of interest.

While inside the heart, several things are done to help evaluate the heart structures, as well as the pattern of blood flow:

Blood samples are drawn from a number of vessels and heart chambers, which will allow for calculation of heart function and flow characteristics.
Blood pressure measurements are taken.
A contrast fluid is injected into the catheter and, as it flows inside the heart, x-ray films are made of the path the fluid takes throughout the heart.

Depending on the results of the test, your may have an interventional procedure at this time. In some cases, the results may indicate a need for additional types of tests or other treatments.

The procedure can take several hours, but one of the Cardiology Case Managers will keep your family informed throughout your procedure.

After the catheterization

When your catheterization is over, the catheters will be removed. To prevent bleeding, pressure will be applied for 10 to 20 minutes on the area where the catheters were inserted. Then a small bandage or a small pressure dressing will be applied. You will not need stitches.

You will be taken to the recovery room on a stretcher. During the first two or three hours, your nurse will frequently check your blood pressure, pulse and catheter insertion sites. In some cases you may need to stay overnight for observation. If you're discharged after the procedure, you'll need to stay in bed for four to six hours. This will help the catheter insertion sites begin to heal. Here are some tips that will speed healing of the insertion site:

Do not bend the arm or leg the catheter was inserted in as this may cause the site to bleed.
Call your nurse immediately if you notice bleeding or feel warmth, notice any swelling or if you're experiencing pain at the insertion site.
When you cough or sneeze you should put your hand over the site and apply pressure.

Typically, the transcatheter pulmonary valve procedure takes 1-2 hours, but usually requires an overnight stay in the medical center. Your child will be under general anesthesia (asleep) during the procedure.

Before the procedure

Depending on your child's particular case, after you arrive but before beginning the actual procedure, your cardiologist MAY request the following tests to be performed on your child:

EKG
Echocardiogram
Holter monitor
Blood work
Exercise stress test

After any required tests are completed, the doctor and one of the Cardiology Case Managers will meet with you to obtain consent for the procedure and answer any additional questions.

During the procedure

A sedative will be given prior to the procedure to relax your child. Most children will have a breathing tube placed for the duration of the procedure so that they will be asleep and not feel any pain. A numbing medicine will be given at the catheter insertion sites also. One of our Cardiology Case Managers will keep you informed throughout your child's procedure:

The catheter is inserted into the patient's femoral vein through a small access site.
The catheter holding the transcatheter pulmonary valve is placed in the vein and guided into the patient's heart.
Once the transcatheter pulmonary valve is in the right position, the balloons are inflated.
The transcatheter pulmonary valve expands into place and blood will flow between the patient's right ventricle and lungs.
The catheter is removed.
Fluoroscopy confirms that the transcatheter pulmonary valve is functioning properly.
The access site is closed.

After the transcatheter pulmonary valve implantation

When your child's catheterization is over, the catheters will be removed. To prevent bleeding, pressure will be applied for 10 to 20 minutes on the area where the catheters were inserted. Then a Band-Aid or a small pressure dressing will be applied. Your child will not need stitches.

Your child will be taken to the recovery room on a stretcher. Once your child is able to drink some liquids, they will be moved to a room in the medical center, which is typically a 1-2 night stay.

Before you leave the hospital, you will be given instructions for follow-up care to ensure the best possible results.

For more information – and additional details on the procedure, as well as patient handbooks to assist children, teens, adults and parents in understanding the entire process, please visit the transcatheter pulmonary valve implantation patient information pages here.