Tetralogy of fallot cardiac catheterization: Difference between revisions
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{{Tetralogy of fallot}} | {{Tetralogy of fallot}} | ||
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{{CMG}}; '''Associate Editors-In-Chief:''' [[Priyamvada Singh| Priyamvada Singh, M.B.B.S.]] [mailto:psingh13579@gmail.com], [[User:KeriShafer|Keri Shafer, M.D.]] [mailto:kshafer@bidmc.harvard.edu]; '''Assistant Editor-In-Chief:''' [[Kristin Feeney|Kristin Feeney, B.S.]] [mailto:kfeeney@elon.edu] | |||
==Overview== | ==Overview== | ||
Cardiac catheterization can be performed if the anatomy cannot be evaluated on echocardiography. Although echocardiography is the imaging modality of choice, cardiac catheterization allows confirms the diagnosis and permits collection of additional anatomical and hemodynamic data, including the location and magnitude of right to left | [[Cardiac catheterization]] can be performed if the [[anatomy]] cannot be evaluated on [[echocardiography]]. Although echocardiography is the imaging modality of choice, [[cardiac catheterization]] allows confirms the diagnosis and permits collection of additional anatomical and hemodynamic data, including the location and magnitude of [[right-to-left shunt]]ing, the level and severity of right ventricular outflow obstruction, the anatomical features of the right ventricular outflow tract as well as the main [[pulmonary artery]] and its branches. Repair of residual defects following a repair of Tetralogy (leaking [[VSD]], or residual pulmonic narrowing) can also be undertaken percutaneously in experienced centers. | ||
== | ==2008 ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease (DO NOT EDIT)<ref name="pmid19038677">{{cite journal| author=Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA et al.| title=ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. | journal=J Am Coll Cardiol | year= 2008 | volume= 52 | issue= 23 | pages= e1-121 | pmid=19038677 | doi=10.1016/j.jacc.2008.10.001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19038677 }} </ref> == | ||
=== Diagnostic and Interventional Catheterization for Adults with Tetralogy of Fallot (DO NOT EDIT)<ref name="pmid19038677">{{cite journal| author=Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA et al.| title=ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. | journal=J Am Coll Cardiol | year= 2008 | volume= 52 | issue= 23 | pages= e1-121 | pmid=19038677 | doi=10.1016/j.jacc.2008.10.001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19038677 }} </ref> === | |||
{|class="wikitable" | {|class="wikitable" | ||
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| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | | colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | ||
|- | |- | ||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''Interventional catheterization in an ACHD center is indicated for patients with previously repaired tetralogy of Fallot with the following indications: | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' [[Catheterization]] of adults with tetralogy of Fallot should be performed in regional centers with expertise in ACHD. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | ||
|- | |||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' [[Coronary artery]] delineation should be performed before any intervention for the RVOT. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | |||
|- | |||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' Interventional [[catheterization]] in an ACHD center is indicated for patients with previously repaired tetralogy of Fallot with the following indications:<nowiki>"</nowiki> | |||
|- | |- | ||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''a.'''To eliminate residual native or palliative | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''a.''' To eliminate residual native or palliative systemic – [[pulmonary artery]] shunts. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''b.'''To manage coronary artery disease.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki> | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''b.''' To manage [[coronary artery disease]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki> | ||
|} | |} | ||
===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]= | {|class="wikitable" | ||
|- | |||
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]] | |||
|- | |||
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Interventional [[catheterization]] in an ACHD center is reasonable in patients with repaired tetralogy of Fallot to eliminate a residual [[ASD]] or [[VSD]] with a [[left-to-right shunt]] greater than 1.5:1 if it is in an appropriate anatomic location. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | |||
|} | |||
{|class="wikitable" | |||
|- | |||
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]] | |||
== | |- | ||
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' In adults with repaired tetralogy of Fallot, [[catheterization]] may be considered to better define potentially treatable causes of otherwise unexplained [[LV]] or [[RV dysfunction]], [[fluid retention]], [[chest pain]], or [[cyanosis]]. In these circumstances, transcatheter interventions may include:<nowiki>"</nowiki> | |||
|- | |||
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''a.''' Elimination of residual shunts or aortopulmonary collateral vessels. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | |||
|- | |||
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''b.''' Dilation (with or without [[stent]] implantation) of [[RVOT]] obstruction. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki> | |||
|- | |||
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''c.''' Elimination of additional muscular or patch-margin [[VSD]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | |||
|- | |||
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''d.''' Elimination of residual [[ASD]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki> | |||
|} | |||
= | |||
==References== | ==References== | ||
{{ | {{reflist|2}} | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Category:Congenital heart disease]] | [[Category:Congenital heart disease]] | ||
[[Category:Pediatrics]] | |||
[[Category:Disease]] | |||
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Latest revision as of 21:02, 25 January 2013
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Priyamvada Singh, M.B.B.S. [2], Keri Shafer, M.D. [3]; Assistant Editor-In-Chief: Kristin Feeney, B.S. [4]
Overview
Cardiac catheterization can be performed if the anatomy cannot be evaluated on echocardiography. Although echocardiography is the imaging modality of choice, cardiac catheterization allows confirms the diagnosis and permits collection of additional anatomical and hemodynamic data, including the location and magnitude of right-to-left shunting, the level and severity of right ventricular outflow obstruction, the anatomical features of the right ventricular outflow tract as well as the main pulmonary artery and its branches. Repair of residual defects following a repair of Tetralogy (leaking VSD, or residual pulmonic narrowing) can also be undertaken percutaneously in experienced centers.
2008 ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease (DO NOT EDIT)[1]
Diagnostic and Interventional Catheterization for Adults with Tetralogy of Fallot (DO NOT EDIT)[1]
| Class I |
| "1. Catheterization of adults with tetralogy of Fallot should be performed in regional centers with expertise in ACHD. (Level of Evidence: C)" |
| "2. Coronary artery delineation should be performed before any intervention for the RVOT. (Level of Evidence: C)" |
| "3. Interventional catheterization in an ACHD center is indicated for patients with previously repaired tetralogy of Fallot with the following indications:" |
| "a. To eliminate residual native or palliative systemic – pulmonary artery shunts. (Level of Evidence: B)" |
| "b. To manage coronary artery disease. (Level of Evidence: B)" |
| Class IIa |
| "1. Interventional catheterization in an ACHD center is reasonable in patients with repaired tetralogy of Fallot to eliminate a residual ASD or VSD with a left-to-right shunt greater than 1.5:1 if it is in an appropriate anatomic location. (Level of Evidence: C)" |
| Class IIb |
| "1. In adults with repaired tetralogy of Fallot, catheterization may be considered to better define potentially treatable causes of otherwise unexplained LV or RV dysfunction, fluid retention, chest pain, or cyanosis. In these circumstances, transcatheter interventions may include:" |
| "a. Elimination of residual shunts or aortopulmonary collateral vessels. (Level of Evidence: C)" |
| "b. Dilation (with or without stent implantation) of RVOT obstruction. (Level of Evidence: B)" |
| "c. Elimination of additional muscular or patch-margin VSD. (Level of Evidence: C)" |
| "d. Elimination of residual ASD. (Level of Evidence: B)" |
References
- ↑ 1.0 1.1 Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA; et al. (2008). "ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". J Am Coll Cardiol. 52 (23): e1–121. doi:10.1016/j.jacc.2008.10.001. PMID 19038677.