Congenital Heart Disease: What does the diagnostic check-up contain?
The pediatric cardiologist must get a detailed medical and family history and make a full clinical examination. He/she should then decide which of the following diagnostic methods the child should be submitted on.
• Echocardiogram (triplex)
• Chest X-ray
• Continuous 24hour ECG Recording (Holter)
It includes a 24-hour continuous rhythm recording while the patient continues with his daily activities. With this method, it is possible to diagnose tachycardia, or to investigate bradycardia and fainting episodes. Also, severe bradycardia or long pauses may be checked in patients who may need a pacemaker.
• Exercise test
It is performed on a treadmill or on a bicycle. The patient’s response to exercise, oxygen consumption, ECG changes during exercise and the patient’s haemodynamic response are monitored in detail.
• Cardiac MRI
Cardiac MRI is one of the newer imaging techniques; it is non-invasive and the patients are not exposed to radiation, which is very important for children, as they are at greater risk from the long-term cumulative effects of ionizing radiation. It offers high definition images and can give information about both anatomy and function of the heart and the cardiac vessels. MRI has become the most important pre-operative investigation for complex patients with congenital heart disease, as well as a routine follow-up tool for patients with tetralogy of Fallot, valvar regurgitations and vascular aneurysms.
• Cardiac Catheterisation: Diagnostic catheterisation
When the above tests do not provide all the necessary diagnostic information, a diagnostic catheterization may need to be performed. A small catheter is introduced through the vein or artery at the inguinal area or the neck and is advanced until it reaches the heart. With the use of contrast, the cavities and vessels of the heart are outlined in detail. In addition, haemodynamic recording of intracardiac and endovascular pressures and blood samples are taken to determine oxygen saturation and pressure in various sites.
Diagnostic cardiac catheterisation in children and adults with congenital heart disease needs to be performed by specialised doctors and nurses and it takes place in specialised and appropriately equipped pediatric and congenital cardiology centers.
• Cardiac Catheterization: Interventional catheterisation
An important development of the last 30 to 40 years involves the treatment of congenital heart disease with the help of cardiac catheterisation. Advanced methods of transcatheter diagnosis and treatment avoid surgery, decrease hospitalisation time and ensure the same results as with surgery, but with less risk, less discomfort for the patient and without leaving a permanent scar.
The interventional (transcatheter) method is suitable and preferrable over surgery for certain entities of congenital heart disease, such as stenosed cardiac valves and vessels, which are opened up with the use of special catheters, balloons and stents (valvuloplasty, angioplasty). The technique is also greatly employed for closure of cardiac defects and communications with devices (such as atrial septal defects, ventricular septal defects, patent ductus arteriosus), embolisation of pathological vessels and paravalvular leaks etc.
Dr Tzifa has performed > 2000 transcatheter interventions for children and adults with congenital heart disease, among which rare procedures, such as patent ductus arteriosus stent implantation to avoid a surgical shunt procedure, paravalvular leak closure, Fontan fenestration stenting etc.
Dr Tzifa, along with Professor Razavi at King’s College Lοndon, performed the world first interventional cardiac catheterisations solely under MRI guidance. The combined X-Ray and MRI catheterization procedures are also available at Mitera Hospital under the supervision of Dr Tzifa (XMR procedures), for the measurement of pulmonary vascular resistance and reversibility, in cases with pulmonary hypertension.