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Interventional Catheterization Program

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Interventional Catheterization Program

Innovations

Innovations

The catheterization laboratory at Children's Hospital Boston has a long history of developing new ways of treating heart disease without surgery. We have developed and perfected catheterization procedures that can be used for treatment of unusual and complicated diseases as well as simple diseases.

Some of our innovations:

1996	The Webster-Jenkins basket catheter is developed by Kathy Jenkins, MD and James E. Lock, MD, to provide rapid diagnostic information in mapping multiple sites of cardiac arrhythmias.
1999	The FDA approves the use of CardioSEAL, a catheter-implanted device developed at Children's Hospital Boston to repair holes in the hearts of seriously ill heart patients.
2001	Surgeons at Children's Hospital Boston perform the world's first successful prenatal aortic valvuloplasty to prevent the progression of fetal aortic stenosis to hypoplastic left heart syndrome (HLHS) in a 19-week-old fetus. Children's cardiologists threaded a cardiac catheter through the fetus's aortic valve and inflated a balloon to widen the opening.
Ongoing	Children's Hospital Boston is part of a large multi-center study on the effectiveness of cutting balloons to treat resistant stenoses.

In addition, we are committed to a very careful measurement of the results of those procedures, and the outcomes of the children treated. Innovation, experience and commitment to outstanding results are the hallmarks of our cardiac catheterization laboratory.

Beginning more than 20 years ago, the team in the Children's catheterization laboratory began to develop and perfect a number of innovative catheterization procedures. Some of these procedures were designed to treat common problems, such as closure of holes in the heart and opening of narrowed valves. Many of these procedures are now widely available throughout the country and around the world. However, we have also focused on treating rare, life-threatening problems that require extremely developed technical skill and experience. Families come from around the country and the world in order to pursue second opinions and treatment from our experienced catheterization team.

Catheter-based therapies developed and performed by Children's faculty:

Catheter procedure	Cardiovascular Disease	Number of patients treated*
Valve dilation	Mitral stenosis in children	112
	Congenital mitral stenosis is very rare, and graded sequential valvuloplasty has substantially improved short and long term survival.
Balloon dilation	Stenotic pulmonary arteries	1455
	The mortality rate of this procedure has fallen 10-fold, from 2% to 0.2%. New techniques, including cutting balloons and high pressure balloons, have at the same time, increased success rates from 60% to more than 90%.
Stent placement	Coarctation of the aorta	164
	Serious aortic injury, although rarely reported, may occur in 1-2% of cases. Pre-stent assessment of aortic compliance and mobility has prevented catastrophic aortic ruptures at Children's Hospital Boston.
Defect closure	Ventricular septal defect	232
	Catheter closure of post-operative and multiple VSDs requires precise coordination between surgeons, interventional cardiologists and echocardiographers. With such coordination, procedural mortality is less than 1%.
Defect closure	Atrial septal defect or patent foramen ovale	908
	Atrial septal defect closure using one of several catheter-based devices can avoid the need for cardiopulmonary bypass, and may thereby optimize children's developmental outcome. Transcatheter device closure is offered as part of a team management approach for patients with a history of stroke or transient ischemic attack and an interatrial communication.
Defect closure	Leakage around prosthetic valve	45
	Proximity of leaks to moving valve parts and other cardiac structures makes it necessary to using different closure devices and strategies on a case-by-case basis.
Defect closure	Coronary artery fistula	48
	The absence of mortality and significant morbidity in a recent series from the Children's Hospital Boston, has prompted elective closure during childhood in most cases.

* Through 12/2004

On average, referring cardiologists request 300 second opinions regarding interventional catheterization from Children's cardiologists each year. While many of these cases never come to Boston, all are reviewed promptly and free of charge.

Whenever requested, a consultative visit is provided to the family as well. This practice, more than 20 years old, allows referring cardiologists and families to benefit from the extensive experience of our cardiac catheterization staff, and also improves our understanding of unusual forms of congenital and acquired heart disease.

Finally, the catheterization team are working with other members of the Cardiovascular Program to improve the available treatments for some very difficult and rare diseases. Specific examples include the use of combined catheter and medical treatment of pulmonary vein stenosis (more than 100 cases seen in the last 5 years), innovative catheter and surgical approaches to Shone's syndrome and other forms of small left hearts (more than 20 cases seen in the last 2 years), and replacement of pulmonary valves using only catheters in patients who have already had operations for Tetralogy of Fallot.


					Children's Hospital Boston is the primary pediatric teaching hospital of Harvard Medical School

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