Name: Pediatric Cardiac Catheterization | Dr. Ihab Khatib
Creator: Dr. Ihab Khatib

Pediatric Cardiac Catheterization

Cardiac catheterization makes it possible to diagnose and treat many heart defects through the blood vessels – without open-heart surgery, without a surgical scar, and usually with a quick return home. Dr. Ihab Khatib, head of pediatric cardiac catheterization at Rambam, explains the types of procedures and what parents should know.

What is cardiac catheterization?

During catheterization a thin, flexible tube (catheter) is inserted into a blood vessel – usually a vein or artery in the groin, sometimes in the neck – and guided to the heart using X-ray imaging and echocardiography. Through the catheter we can measure pressures and oxygen levels in every chamber of the heart, inject contrast for precise imaging, and even deliver tiny devices that repair the defect.

In children, the procedure is usually done under general anesthesia or deep sedation, so the child feels no pain and does not remember it. It takes between one and three hours, depending on complexity.

Procedures fall into three main types: diagnostic, interventional and complex.

Diagnostic catheterization

A diagnostic catheterization gathers precise information that cannot be obtained by echocardiography, MRI or CT. During the procedure we measure:

Pressures in each chamber and in the great vessels.
Oxygen saturation – to detect and quantify blood shunting between the right and left sides.
Pulmonary vascular resistance and its response to oxygen or medication.
Contrast imaging (angiography) of the heart chambers, pulmonary arteries and coronary arteries.

When is it needed? Before staged surgeries (such as the Glenn and Fontan operations), to evaluate pulmonary hypertension, after heart transplantation, and when imaging tests do not give a complete answer.

Illustration: catheter route from the leg vein through the right atrium and right ventricle to the pulmonary artery, with example normal pressures (mmHg) and oxygen saturations

Interventional catheterization

In an interventional catheterization the defect itself is repaired through the catheter. In many cases it replaces open-heart surgery, and the child goes home the next day.

Closing septal holes (ASD / VSD)

A device shaped like two folded "umbrellas" opens on both sides of the hole and closes it. Heart tissue grows over the device within a few months.

Closing a patent ductus (PDA)

A tiny plug or coil is placed in the vessel connecting the aorta and the pulmonary artery – even in very low-birth-weight premature babies.

Balloon valvuloplasty

A balloon is inflated inside a narrow pulmonary or aortic valve to open it. For pulmonary valve stenosis this is the treatment of choice.

Balloon and stent for narrowings

Widening a narrowed aorta (coarctation), pulmonary arteries or veins, and leaving a metal stent that keeps the vessel open.

Balloon atrial septostomy (Rashkind)

In newborns with defects such as transposition of the great arteries, a balloon enlarges the opening between the atria, allowing life-saving mixing of blood until surgery.

Complex catheterization

A complex catheterization combines several interventions, is performed in very small babies or in hearts that have already had surgery, and requires experience and careful planning – sometimes with 3D imaging (CT or MRI) of the heart. Examples:

Transcatheter pulmonary valve implantation – see below.
Stenting the ductus or the right ventricular outflow tract in newborns with reduced blood flow to the lungs, as an alternative to early shunt surgery.
Opening a blocked (atretic) valve with radiofrequency energy followed by balloon dilation.
Hybrid procedures together with cardiac surgeons in a dedicated operating room.
Treating multiple narrow pulmonary arteries and abnormal (collateral) vessels after heart surgery.
Catheterization in adults with congenital heart disease.

Example: transcatheter pulmonary valve implantation

Children born with defects such as tetralogy of Fallot, truncus arteriosus or pulmonary stenosis/atresia usually undergo corrective surgery at a young age. Over the years the pulmonary valve or the surgically placed conduit wears out – it leaks backwards, becomes narrow, or both. The right ventricle has to work harder, dilates and weakens, and fatigue, reduced exercise capacity and arrhythmias may appear.

In the past the only solution was another open-heart operation. Today, in most cases, a new valve can be implanted by catheterization: a biological valve mounted on a metal frame is crimped onto a balloon, inserted through a leg vein and implanted exactly in place of the old valve.

Advantages: no chest opening and no heart-lung machine, a one- or two-night hospital stay, and a return to routine within a few days.
Suitable usually for children weighing about 20–25 kg or more and for adults, depending on the size and shape of the right ventricular outflow tract.
Valve types: Melody, Edwards SAPIEN and self-expanding valves for large outflow tracts.
After implantation: aspirin for a period, good dental hygiene and regular cardiology follow-up to prevent valve infection (endocarditis).

Dr. Khatib completed a fellowship in transcatheter pulmonary valve implantation at Marie Lannelongue Hospital in Paris and is a co-investigator in the international EUROPULMS3 registry, which assessed outcomes of SAPIEN 3 valve implantation in the pulmonary position (European Heart Journal, 2024).

Step-by-step simulation

1. Access through a leg vein

Under general anesthesia a catheter is inserted into a vein in the groin and guided through the right atrium and ventricle to the pulmonary artery. Pressures are measured and images taken: the old valve leaks (red arrows) or is narrow.

Before, during and after the procedure

Before

A consultation with Dr. Khatib to explain the purpose of the procedure, expected benefits and risks.
Blood tests, and sometimes echocardiography, CT or MRI for planning.
Fasting according to the anesthesia team's instructions (usually a few hours).
Bring a favorite toy and explain things to your child simply and honestly.

During

General anesthesia or deep sedation – no pain.
Ultrasound-guided access to the groin vessels.
About one to three hours, sometimes longer for complex procedures.
Parents are updated as soon as it ends.

After

Lying flat for about 4–6 hours to prevent bleeding from the puncture site.
In most cases, discharge home the next day.
No baths, swimming or strenuous activity for about a week; back to kindergarten/school after 2–3 days.
Contact a doctor in case of bleeding, swelling, fever, or a cold, pale leg.

Are there risks? Pediatric cardiac catheterization is very safe in experienced centers. Possible risks – such as bleeding or bruising at the puncture site, temporary arrhythmias, device displacement or vessel injury – are rare, and the Pediatric Heart Institute team at Rambam is prepared to manage them. Before every procedure the specific risks for your child are explained during the consultation.

Frequently asked questions

Does cardiac catheterization hurt?

No. In children, catheterization is usually done under general anesthesia or deep sedation, so the child feels no pain and does not remember the procedure.

How long does a cardiac catheterization take?

Between one and three hours, depending on complexity; complex procedures sometimes take longer. Parents are updated as soon as it ends.

When does my child go home?

In most cases the next day. After the procedure the child lies flat for about 4–6 hours to prevent bleeding from the puncture site. After pulmonary valve implantation, usually within a day or two.

When can my child go back to kindergarten or school?

After 2–3 days. For about a week after the procedure, avoid baths, swimming and strenuous activity.

Can catheterization replace open-heart surgery?

In many cases, yes: closing holes (ASD, PDA and, in selected cases, VSD), widening narrowed valves and vessels, and implanting a pulmonary valve are all done through the blood vessels, without a surgical scar. Some complex defects still need surgery, sometimes combined with catheterization.

Is pediatric cardiac catheterization safe?

Yes. In experienced centers it is a very safe procedure. Complications such as bleeding at the puncture site, temporary arrhythmias or vessel injury are rare, and the specific risks for your child are explained during the consultation.

When should I call a doctor after catheterization?

In case of bleeding, swelling or fever, or if the leg is cold and pale.