Pediatric catheterization (puncture between the atria in the catheter)
The perforation between the atria (the aperture in the wall between the atria) represents about 13% of all congenital defects in the heart, knowing that the birth defects rate is 1% of newborns. Open heart surgery is the most basic method used by doctors to close such holes for many years. The risk of these operations has increased with the advent of open heart surgery these days, but there is a significant percentage of complications and health problems due to the opening of the chest bone during surgery and the conversion of blood to the artificial circulatory system Showed that 7% of the patients had an opening between the atria varying in size even after the operation.
Thinking of locking catheter holes without the need for operations in 1976 when King and Mills first performed the first successful catheterization catheter, although the first device was large and difficult to use and was made up only for adults, then attempts were made by cardiologists to lock Holes using new devices so that they are smaller and easier to use.
There are several devices designed for the same purpose used in several countries in varying rates such as:
Amplatzer and Occlutech
Amplatzr and Oculotec have developed in the past decade to become the most effective devices for locking the holes between the atria.
One of the characteristics of the two devices that distinguish it from others is the small size of the catheter used in the installation and thus considered appropriate for use in smaller children, and the devices contain two discs such as self-opening umbrella, and can be pulled from the body through the catheter out of the body in the case Incompatibility of the size of the device to the hole.
First :
The medical team performs the diagnostic catheter at the beginning to ensure the presence of the hole and place and take measurements. Any other defects may also be excluded.
Second:
An ultrasound study of the heart via the TRANSESOPHAGEAL ECHO has a clearer picture of what is taken from the outside of the chest through its wall, an important requirement for determining the measurements of the hole and its location. These rays also allow to follow the steps of installation and after installation.
Third: Test the size of the device
Fourth: Install and launch the device.
Fifth: Ensure the lock of the hole:
The device takes the final position after it is launched, and by ultrasound imaging and its technique through the esophagus it is sure to lock the aperture completely.
Medical studies conducted on this device showed that the success rate is up to 90% (the rate of locking the hole completely), and the incidence of complications is very small.
A therapeutic catheter may be installed and the lock device installed when the child reaches the fifth year of age before entering the school. This is the time for this therapeutic catheter before the child is involved in school activities. There are some cases call for a catheterization at a younger age and this is decided by pediatric cardiologists specialized in this type of therapeutic catheter as needed.
The development of the devices in recent years and their suitability for the size of children makes this technique dispense with many open heart surgery for children, especially females (for cosmetic reasons related to the opening of the rib cage).
Dr.. Awni Al Madani