الفهرس 
CONGENITAL HEART DISEASEOnly 14 pages are availabe for public view
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Abstract
C
hildren with congenital heart disease (CHD) remain at high risk for long-term neurodevelopmental disabilities. Acute neurologic complications, such as seizures, transient ischemic attack, intracranial hemorrhage, and ischemic stroke might occur in the setting of cardiac surgery and cardiac catheterization. Cardiac catheterization is important in the diagnosis and assessment of hemodynamic function in children with congenital heart disease. The incidence of neurologic complication (occurring within 48 hours) in interventional cardiac catheterization is significantly higher than diagnostic.
The Aim of this study was to evaluate the effect of cardiac catheterization on transcranial Doppler sonography in children with congenital heart disease.
This is a prospective study 40 children were enrolled; at Children’s hospital, Ain Shams University over 6 months. TCD parameters, clinical data, neurologic examination were done before and after cardiac catheterization.
In the present study, 33 patients (82.5%) had interventional catheter and 7 (17.5%) had diagnostic catheter. A history of previous cardiac catheterization were found in 11 (27.5%) of 40 patients; 4 (36.4%) had previous failed catheterization, 3 (27.3%) had previous diagnostic catheterization, while PDA stenting, PDA coil closure, balloon dilatation of LPA & RPA and balloon valvuloplasty were the least performed types with 1case (9.1%) for each.
Diagnostic group showed higher systolic and diastolic blood pressure despite insignificant difference as regard centiles. Also showed lower oxygen saturation at enrolment and during catheterization with higher percentage of cyanosis and signs of heart failure which reflects the severity of cardiac anomaly in this group. Hematocrit and hemoglobin value were higher in diagnostic group compared to interventional group as a compensation to the persistent low arterial oxygenation.
Middle cerebral artery TCD parameters of the patients in the diagnostic group showed lower peak systolic PS and time average mean of the maximal velocities (TAMX), also called mean velocity, before catheterization and lower PS, end diastolic ED and TAMX post catheterization. All patients showed lower TAMX post catheterization.
CONCLUSION
T
ranscranial Doppler sonography is a noninvasive physiologic monitor of cerebral hemodynamics that can be performed at the bedside in the PICU. In our experience derangements in cerebral hemodynamics were recorded. However, the practical implications of these findings remain uncertain. Future research using transcranial Doppler sonography in the PICU may elucidate underlying cerebrovascular pathophysiology, identify markers of increased risk of further neurologic injury, influence the choice of additional testing and treatment, and ultimately impact patient outcomes.
RECOMMENDATIONS
• It’s preferred to minimize the duration of catheterization and the manipulation of catheter intracardiac as possible for fear of embolization.
• The study should be repeated on a larger scale and longer duration for follow up.