State-Of-The-Art Cardiac Catheterization Laboratory

from Practice Update, Winter 2004

By Kak Chen Chan, MD, Director, Cardiac Catheterization Laboratory, The Children’s Hospital Associate Professor of Pediatrics, University of Colorado Health Sciences Center

The medical science of treating congenital and acquired heart disease in the young is one of the most rapidly advancing fields in medicine today. As part of The Children’s Hospital Heart Institute, the cardiac catheterization laboratory offers the most recent advances in technique and treatment. Historically, the cardiac catheterization laboratory has provided the cardiologists and cardiac surgeons with a means of diagnosing cardiac defects in young patients. However, with advancement in the newer modalities of non-invasive diagnostic techniques such as echocardiography and magnetic resonance imaging, there are diminished indications for cardiac catheterization as a diagnostic tool. Instead it is used in a more important role for treating young patients with heart defects. The concept of percutaneous non-surgical interventional cardiac catheterization treatment in the cardiac catheterization laboratory is increasingly gaining ground as the treatment of choice for many congenital heart defects. Since its inception and intro-duction in 1966 by Dr. William Rashkind, the technique of creating an atrial septal defect by using a balloon-tipped catheter, interventional cardiac catheter treatment of congenital heart defects has progressed to the current repertoire ranging from balloon and stent techniques to widen narrowed structures to closure of defects with implantable devices. Currently, transcatheter closure of a patent ductus arteriosus or an atrial septal defect is considered the treatment of choice. The cardiac catheterization laboratory at The Children’s Hospital also provides high-quality electro-physiology services to diagnose and treat young patients with heart rhythm abnormalities.

The cardiac catheterization laboratory at The Children’s Hospital in Denver consists of two dedicated rooms with digital biplane equipment. One of the rooms was recently commissioned in February 2003 with the latest state-of-the-art high resolution digital biplane angiography and archival system. The information obtained in the laboratory is stored digitally in a central archive and is available online and, with the imminent introduction of a web-based access system, will be available throughout the hospital.

Cardiac catheterization services are provided by a team of highly trained pediatric cardiologists, nurses, and technicians under the directorship of Kak-Chen Chan, MD. Interventional cardiologists, Dr. Chan is renowned in United States and internationally for their progressive and innovative procedures and techniques. Other contributing cardiologists are departmental chairman Dunbar Ivy, MD, specializing in pulmonary hypertension research, Michael Schaffer, MD, specializing in electrophysiology and ablation treatment of cardiac dysrhythmias, and Biagio Pietra, MD, specializing in transplant evaluations. The cardiac cath lab enjoys a close working relationship with pediatric interventional radiologist, Roger Harned, MD, who performs complex procedures, such as cerebral angiograms and transjugular liver biopsies in the laboratory. Mark Duster, MD, and Martin Runciman, MD, pediatric cardiologists from Colorado Springs , work closely with the cardiologists at Children’s to perform diagnostic, interventional, electro-physiology, and pacemaker/ICD implantation procedures.

The cardiac catheterization laboratory is an active participant in research in cardiovascular disease in young patients. Dr. Chan was one of two principle investigators in the U.S. multicenter trials for the various occluder devices, such as the CardioSeal Septal Occluder, StarFlex Septal Occluder, Amplatzer Septal Occluder, Amplatzer Ductal Occluder, Amplatzer Muscular VSD Occluder and the Helex Septal Occluder. The team is pioneering the concept of palliating hypoplastic left heart syndrome in the cardiac cath lab by stenting the ductus arteriosus and implanting an internal pulmonary arterial band. The cardiac cath lab is participating in another pioneering project with the echocardiographic department to assess pulmonary arterial hemodynamics using the new modality of color m-mode echocardiography.

The cardiac cath lab is complemented by a team of experienced, highly trained and specialized staff led by clinical director of The Heart Institute, Darcy Ripe, BSN, RN, and clinical coordinator, Rita Cassettari, BSN, RN. The team is comprised of registered nurses, registered cardiovascular interventional specialists, cardiovascular technologists, radiological technologists and clinical support personnel. They are a dedicated group of professionals who deliver high quality patient care and physician support everyday and provide 24/7 coverage for the lab.

As part of The Children’s Hospital Heart Institute, the cardiac catheterization laboratory offers the most comprehensive and child-specific treatment in the region and is building a national reputation for transcatheter occlusion of congenital heart defects and ablative treatment for cardiac dysrrhythmia. The cardiac catheterization laboratory performs 700 procedures a year, of which 60% are therapeutic catheter procedures.

 Current Services

• Diagnostic cardiac catheterization and angiography
• Comprehensive assessment of post heart transplant patients
• Intra-coronary ultrasound and assessment of coronary flow reserve
• Transcatheter closure of patent ductus arteriosus
• Transcatheter closure of atrial septal defect, transcatheter closure of muscular ventricular septal defect
• Transcatheter closure of superfluous or anomalous collateral arterial or venous channel
• Balloon pulmonary valvuloplasty
• Balloon aortic valvuloplasty
• Coarctation angioplasty
• Stent dilation of coarctation
• Stent dilation of pulmonary arterial stenosis
• Re-cannalization and stent dilation of obstructed venous channels
• Radio-frequency wire perforation of imperforate pulmonary valve
• Electrophysiology diagnosis and ablation treatment of cardiac dysrrhythmia
• Implantation of permanent pacemaker/ICD