Complications of cardiac catheterization of neonates, infants, and children. A three-year study.

In order to assess the influence of recent modifications in cardiac catheterization technique and patient management, a prospective study of all complications in a series of 1160 cardiac catheterizations of neonates, infants, and children was performed. Thirty-four major and 136 minor complications were recorded. Fatal complications were rare in all age groups (0.26%); however, postcatheterization deaths not attributable to the procedure were common in critically ill neonates with nonremediable lesions. Arrhythmias and arterial complications accounted for 78% of all complications. Although the incidence of arrhythmias was high (8.3% of all cases), particularly in infants, almost all responded to simple therapeutic measures. Five arrhythmias resulted in clinical deterioration and two contributed to death. The incidence of arterial complications varied considerably with the method of arterial entry. Percutaneous catheterization by the sheath method was associated with fewer complications than with the Seldinger technique, arteriotomy, or insertion of a teflon cannula into an exposed artery. Complications were particularly common after brachial arteriotomy in patients with coarctation of the aorta (16.1%). Complications of contrast media and perforation of the heart were infrequent, each occurring once. Although the total number of major complications was only moderately less frequent than in patients of comparable age in the Cooperative Study on Cardiac Catheterization,' there was a considerable reduction in the most severe complications and deaths. The changes in catheterization technique and patient management that contributed to decreased mortality and morbidity are discussed.