Acute complications in the current era of therapeutic cardiac catheterization for congenital heart disease

The acute complications of therapeutic cardiac catheterization for congenit al heart disease as performed currently in a small unit were reviewed. In r ecent years, there has been a significant increase in the number of lesions thought amenable to catheter therapy. Only a few reports, however, have ad dressed the overall incidence of acute complications of therapeutic cardiac catheterization, all representing the experience of centres performing mod erate-to-large numbers of procedures. A retrospective review was Performed of 425 therapeutic catheter procedures performed at our institution between May 1993 and November 1997. Acute complications were retrieved from the da tabase. This included all adverse events that were clinically recognized at the time of or within 2 weeks after the procedure and which, to the best o f the authors' clinical judgement, were related to the catheterization and not part of the natural history of the child's illness. All patients were o bserved overnight following the procedure, and stayed in hospital if a comp lication developed. There were 49 acute complications (11.5%), of which 43 (10.1%) were deemed minor and 6 (1.4%) were considered major. The rate was low in patients with valvar pulmonary stenosis, including three neonates (3 /45, 6.7%), for those undergoing angioplasty of native co-arctation (1/15, 6.7%) and pulmonary arteries (2/27, 7.4%); and for coil embolization of sys temic to pulmonary collateral arteries (1/16, 6.3%). The rate was high in p atients with valvar aortic stenosis, including 12 neonates (9/37, 24.3%), a nd for angioplasty of re-coarctation (4/23, 21.7%). There were more overall complications in neonates (25.6%) than in older patients (10.1%) (p < 0.01 ). Two patients died (0.5%), but no patient required emergency surgical int ervention. In spite of the introduction of many new therapeutic modalities with greater intrinsic risk, and the fact that patients with more complex l esions and who are more acutely ill are being treated, the overall rate of complications remains relatively low. This probably reflects improvements i n pericatheterization medical management, in selection of patients, in proc edural techniques, and in the experience of operators.