Tokel Kürşat, Gümüş Ayten, Ayabakan Canan, Varan Birgül, Erdoğan İlkay
Departments of Pediatric Cardiology, Baskent University Ankara Hospital, Ankara, Turkey.
Departments of Pediatric Cardiology, Başkent University İstanbul Health and Training Hospital, İstanbul, Turkey.
Turk J Pediatr. 2018;60(6):675-683. doi: 10.24953/turkjped.2018.06.008.
Tokel K, Gümüş A, Ayabakan C, Varan B, Erdoğan İ. Complications of cardiac catheterization in children with congenital heart disease. Turk J Pediatr 2018; 60: 675-683. Catheterization procedures for congenital heart disease include a broad range of procedures with a large spectrum of potential adverse outcomes. We aimed to determine the incidence of various complications during pediatric cardiac catheterizations and to designate the relative risk factors for such complications. All pediatric patients undergoing cardiac catheterizations between January 2005-December 2010 were included. Data are collected prospectively by filling out computerized catheterization reports. Patient records were scanned for potential risk factors retrospectively. Groups were divided based on cardiac diagnosis; type of procedure. Adverse events were categorized into major or minor events. A total of 2662 cardiac catheterizations were performed during this period. The mean age of patients was 53.2±64.3 months. Diagnostic catheterizations were done for 1797 (67.5%) patients, and interventional procedures were done in 865 (32.5%) cases. Adverse events were observed in 688 patients (26%) during 941 procedures. Minor and major events were seen in 21.4% and 7.1% of the procedures respectively. Most frequent major complications were anesthesia related (6%), most frequent minor complications were vascular complications (45.2%). Complications were more frequent in younger patients (p=0.0001), during interventional procedures (p=0.0001). Thirteen patients died after a cardiac catheterization; they were younger and had longer procedures compared to those who survived (p=0.0001). Vascular complications were frequent among younger patients, with prolonged procedure time and vessel access (p < 0.0001). Cyanotic patients had more complications (p < 0.05; OR for major and minor complications: 3.5 and 2 respectively). Minor complications were 2.7 times more likely in ventricular outflow obstructions (p < 0.05). The complication rates of cardiac catheterization in children are low, but not negligible. Defining risk factors will help anticipate adverse events, which will guide in preparation for rescue procedures and improvement of patient safety systems in catheterization laboratories.
托凯尔·K、居穆什·A、阿亚巴坎·C、瓦兰·B、埃尔多安·I。先天性心脏病患儿心导管检查的并发症。《土耳其儿科学杂志》2018年；60:675 - 683。先天性心脏病的导管检查程序包括范围广泛的操作，具有一系列潜在的不良后果。我们旨在确定小儿心导管检查期间各种并发症的发生率，并确定此类并发症的相关危险因素。纳入了2005年1月至2010年12月期间所有接受心导管检查的小儿患者。通过填写计算机化的导管检查报告前瞻性收集数据。回顾性扫描患者记录以寻找潜在危险因素。根据心脏诊断、操作类型分组。不良事件分为重大或轻微事件。在此期间共进行了2662例心导管检查。患者的平均年龄为53.2±64.3个月。1797例（67.5%）患者进行了诊断性导管检查，865例（32.5%）进行了介入操作。在941例操作过程中，688例患者（26%）出现了不良事件。轻微和重大事件分别见于21.4%和7.1%的操作中。最常见的重大并发症与麻醉相关（6%），最常见的轻微并发症是血管并发症（45.2%）。并发症在较年轻患者中更常见（p = 0.0001），在介入操作期间更常见（p = 0.0001）。13例患者在心导管检查后死亡；与存活患者相比，他们更年轻且操作时间更长（p = 0.0001）。血管并发症在较年轻患者中常见，操作时间延长和血管入路相关（p < 0.0001）。青紫型患者并发症更多（p < 0.05；重大和轻微并发症的OR分别为3.5和2）。心室流出道梗阻患者出现轻微并发症的可能性高2.7倍（p < 0.05）。小儿心导管检查的并发症发生率较低，但并非可以忽略不计。确定危险因素将有助于预测不良事件，这将指导在导管检查实验室中为抢救程序做准备并改善患者安全系统。
