Tuesday, May 11, 2010

Kathryn’s Cardiac Catheterization and MRI

Katy’s cath and MRI is scheduled for Tuesday June 1st.

Pre Op May 28th. They informed us that they will be holding a bed for her, in case she needs to be admitted. I wish I could find the words to describe the feeling in the pit of my stomach, with the possibility of an admission. Also, I feel that the end result from this will be either bad news or no news. Bad news being that the catheterization proves what Dr. Marx fears and Kathryn is in congestive heart failure, and we are looking at a heart transplant in our near future. No news…we go back to the drawing board and try and figure out why our munchkin isn’t gaining any weight. As you can see there really is no good result of this upcoming visit at Children’s. A lot of you had some questions regarding what exactly the procedures entail. I am cutting and pasting below the info from the Children’s Hospital website. Have I mentioned how very thankful we are for that hospital and their FABULOUS and understanding, caring staff. Amazing.

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Cardiac catheterization is a specialized procedure in which a long, flexible tube (catheter) is inserted into a vein or artery and guided into the heart, allowing a close look at the structures inside. It may be performed for the following reasons:

  • To perform valvuloplasties or angioplasties by inflating balloons in obstructed valves or vessels.
  • To obtain cardiac tissue samples for biopsy.
  • To open the atrial septum to alleviate certain types of congenital heart defects that cause an infant to become cyanotic (blue color of the skin, lips and nailbeds due to an insufficient supply of oxygen in the blood).
  • To place devices that close small holes inside the heart (such as with atrial septal defect or ventricular septal defect), or intentionally block blood flow in a blood vessel (such as with patent ductus arteriosus).
  • To place wire devices, called stents, in narrowed blood vessels to keep them open.
  • To conduct an electrophysiologic study (EPS) or a radiofrequency catheter ablation (RFCA) procedure, which identifies the site of an arrhythmia's origin within the heart tissue (in many cases this procedure can eliminate the arrhythmia).

Cardiac catheterization can be performed on children of any age - even newborns immediately after birth.

How is cardiac catheterization performed?

The procedure is performed by a specially trained cardiologist. Your child's physician will discuss the risks and benefits of the procedure with you and will then obtain written permission (informed consent) from you in order to perform the procedure.

Your child is given a sedative to help him/her relax and sleep during the procedure. Once in the "cath lab," he/she will lie on a small table with a c-shaped x-ray machine surrounding it. Heart monitors and other equipment are nearby. A specially trained staff of nurses, technicians, and physicians will monitor your child and make sure he/she is comfortable during the procedure.

An injection of local anesthetic will be given under the skin where the catheter is going to be inserted. Next, a thin, flexible tube (catheter) is inserted into a blood vessel, most often in the groin area (the crease of the leg where it bends when sitting). The catheter is guided up the vein toward the heart. The cardiologist uses X-rays, called fluoroscopy, to help visualize the movement of the catheter. The catheter enters the right atrium -- the top right-hand chamber that receives oxygen-poor (blue) blood from the body. Eventually, the tube will be guided into the right ventricle, the pulmonary artery and perhaps the right and/or left pulmonary artery branches.

While inside the heart, several things are done to help evaluate the heart structures, as well as the pattern of blood flow inside the heart, including the following:

  • Blood samples are drawn from a number of blood vessels and heart chambers, which will allow for calculation of heart function and flow characteristics.
  • Blood pressure measurements are made inside a number of blood vessels and heart chambers.
  • A contrast fluid is injected into the catheter and, as it flows inside the heart, X-ray films are made of the path the fluid takes throughout the heart.
  • X-ray films are made as the catheterization proceeds, enabling your child's cardiologist to review the data after the procedure. If surgery is planned, the heart surgeon also may review the data.

What happens after the test?

When the catheterization is complete, the catheter will be withdrawn from the heart and the blood vessels. Several gauze pads and a large piece of medical tape will be placed on the site where the catheter was inserted to prevent bleeding. If blood vessels in the leg were used, your child will be told to keep the leg straight for a few hours after the procedure to minimize the chance of bleeding at the catheterization site.

Your child will be taken to a unit in the hospital where he/she will be monitored by nursing staff for several hours after the test. The length of time it takes for your child to wake up after the procedure will depend on the type of medicine given to your child for relaxation prior to the test, and on your child's reaction to the medication.

After the test, your child's nurse will monitor the pulse and skin temperature in the leg or arm that was used for the procedure.

Your child may be able to go home after a specified period of time, providing he/she does not need further treatment or monitoring. You will receive written instructions regarding care of the catheterization site, bathing, activity restrictions and any new medications your child may need to take at home.

Depending on the results of the cardiac catheterization test, additional tests or procedures may be scheduled to gather further diagnostic information.

Cardiovascular MRI

What is Magnetic Resonance Imaging (MRI)?

MRI is a way to take pictures of the body using a large magnet, radio waves and a computer. It is considered a "non-invasive" test because the machine takes pictures without touching the body. MRI does not use X-rays or any radioactive radiation.

When is it necessary?

MRI is done to evaluate the structure and function of the heart and blood vessels. Your cardiologist (heart doctor) requests this test to find out more about the structure and function of the heart and blood vessels. MRI may provide your cardiologist with information that cannot be obtained by other tests.

Description of the examination

  • The MRI machine sits in a large room and looks like a tunnel. The patient lies down on a table that slides into the tunnel.
  • One parent, spouse or friend may remain in the MRI room during the exam. No one who is pregnant can get an MRI or stay in the room for safety reasons. Another adult may stay with your child if you are a pregnant woman.
  • A technologist operates the MRI machine from outside the room behind a glass window. He or she talks and listens to you/your child through an intercom. The technologist will help you if you need anything during the exam.
  • An MRI examination of the heart usually lasts 45-90 minutes.
  • The MRI machine makes loud banging and clicking noises during most of the exam. We will give your child earplugs to soften the noise.
  • During the exam you may be asked to hold your breath for brief periods (10-20 seconds). This helps create clearer pictures. We will check with you before the test begins whether you feel comfortable holding your breath.
  • Most patients receive a contrast dye, called gadolinium, during the exam to help obtain a better picture of blood vessels. The medicine is given through an intravenous line (IV) placed before the examination. A cream that numbs the skin may be applied before the IV is placed (patients will need to arrive one hour prior to the exam time to allow time for the cream to numb the skin).

Sedation or anesthesia

To obtain clear pictures, the patient needs to remain still in the MRI scanner during the test. Young children and some older patients who are unable to lie still or are too afraid of the machine need to be asleep during the examination. In most young children with heart problems, general anesthesia, supervised by a specialist in cardiac anesthesia, is the safest method to maintain sleep inside the MRI machine. General anesthesia causes deep sleep and requires placement of a breathing tube. Patients who are scheduled for general anesthesia have an appointment at the Cardiology Pre-Op Clinic a few days before the MRI. During the visit your child will have a physical check-up, and you will have a chance to meet the anesthesiologist and ask questions.

Some patients may experience anxiety inside the tunnel (claustrophobia). Most of the time this feeling disappears after they get used to the tunnel. If you feel that you might have claustrophobia, please let your doctor know so he/she can prescribe a medication that relieves anxiety (such as Valium or a similar medication). In general, this option may be considered in adolescents and adults and should be discussed well in advance with your cardiologist. Please remember that you cannot drive after receiving Valium or a similar medication.

Eating and drinking instructions

All patients receiving anesthesia: Do not give your child any solid foods or full liquids according to the following guidelines in the six hours before the scan. For example, if the MRI is scheduled for 10 a.m., stop giving solid foods and full liquids at 4 a.m. Examples of solid foods are cereals, bread and candy. Examples of full liquids are milk, formula and orange juice. You may give your child clear liquids up to three hours before the time of the MRI. For example, if the MRI is scheduled for 10 a.m., stop giving clear liquids at 7 a.m. Examples of clear liquids are water, ginger ale, tea without milk and broth. If you are nursing and your child is six months old or younger, you may give your child breast milk up to three hours before the MRI is scheduled.

Patients who do not receive anesthesia or sedation: No food or drink one hour before the scheduled exam.

Preparation

  • Dress your child in comfortable clothing that does not have metal zippers, buttons or snaps. Do not put on Hanes' brand underwear; barrettes; hairpins; jewelry, other than 14k gold; or a watch. These items can affect the way the magnet works.
  • For children, it is helpful to explain in an age-appropriate way why the MRI is needed and what to expect. Let your child know that you will be nearby during the scan. Bring a favorite storybook or toy for the waiting time. Bring a special blanket or small stuffed animal for your child to hold during the MRI.

Arrival

Please make your travel plans carefully to ensure that you arrive on time. Keep in mind that traffic around the medical area is very congested. If you are late, the MRI may have to be rescheduled or delayed. Every effort will be made to keep MRI exams on time, but sometimes an emergency may delay the schedule.

If you have to reschedule the examination, please contact our scheduling office 617-355-2797 as soon as possible. Please keep in mind that many patients like you are waiting to get their MRI test, and if you miss the appointment or do not let us know at least several days in advance we cannot use the machine for another patient.

  • If your child is scheduled for anesthesia, please arrive no later than one hour before the exam time.
  • If your child is not scheduled for sedation or anesthesia, please arrive no later than 30 minutes before the exam time.

The MRI suite is located on the second floor of the Main building, in the Department of Radiology. After arriving at the hospital, proceed to the Radiology Inpatient Registration Desk located on the 2nd floor of the Main building.

Before the exam begins

  • After you fill out a screening form, a nurse will explain the exam, answer your questions and let you or your child know if you need to change into a hospital gown.
  • A nurse or technologist will then put ECG leads (stickers) on you/your child's chest or back.
  • All patients who need gadolinium (contrast dye), anesthesia or a drug test require an intravenous line (IV). A cream that numbs the skin may be applied before the IV is placed (patients need to arrive one hour prior to the exam time to allow time for the cream to take effect).

After the exam

  • Children who receive anesthesia will go to the catheterization lab recovery room to recover. When your child is fully awake and can drink, he or she will be ready to go home. This takes about one to two hours.
  • Patients who receive anesthesia, sedation or Valium (or a similar medication) must have a responsible adult with them when they leave the hospital. Any patient who receives sedation will not be allowed to drive home. If a ride has not been arranged, the procedure will be rescheduled.

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