10. The joy of being a children's heart doctor

 I am often asked how I cope with seeing small babies and children having serious illnesses and having to undergo major procedures. I guess over a period of time one has to learn to distance one's emotions from one's profession. This is what allows me to do what I do well. The guileless smile of a young patient though never fails to move me and always brings a smile to my face. Whatever the stresses and frustrations of work may be it reminds me why I do what I do.

9. What to expect when admitted for cardiac catheterisation?

What to expect when admitted for cardiac catheterisation?

If you have been told that your child needs to have a cardiac catheterisation procedure here’s what you can expect. Firstly, the procedure is usually straight forward and low risk. So do not worry.

There are broadly two types of catheterisation procedures; diagnostic and therapeutic. Diagnostic cardiac catheterisation allows the doctor to come to a better understanding of what the problem is with the heart. It allows measurement of pressures in the various chambers of the heart and blood vessels. Also, a special dye (contrast) is injected and X-rays are performed to give further information about the heart problem. Although a fairly good understanding of the problem can be obtained with just echocardiography, diagnostic cardiac catheterisation is sometimes required prior to surgery in some patients to get finer details.             

                                         

Interventional cardiac catheterisation is carried out to close holes, unblock valves or blood vessels without surgery using a key-hole approach. This requires specialized skills and should be carried out only by well-trained individuals. The advantages of this approach are as follows

·         Minimally invasive

·         Less pain

·         Quicker recovery (usually overnight stay in hospital)

·         No scar

Usually the patient is admitted on the day of the procedure (in the morning) and advised to stay ‘nil by mouth’ (fasting) for at least 4 hours prior to the procedure. This is not just for solid foods but also for milk. Sips of water can be allowed until 2 hours prior to the procedure. Some basic blood tests have to be performed prior to the procedure to make sure that there are no signs of infection and that the kidneys are working normally. Once these test results are available and the patient has been fasting for at least 4 hours he/she can be taken for the procedure.

The procedure is carried out in the Catheterisation Laboratory or Cath Lab which is a room which contains all the equipment necessary to carry out the procedure safely. There are heart monitors, X-ray equipment and emergency equipment available in the Cath Lab. Usually for most catheterisation procedures there is no need to put the patient on a breathing machine. Some sleep medication is given through a drip and this is enough to keep the patient asleep and free of pain during the procedure. Sometimes in more complex procedures there might be a need to ventilate the patient (using a breathing machine). This is however only brief and can be stopped at the end of the procedure allowing the patient to breathe on his or her own.

After the procedure the patient has to lie still for around 4 hours. This can be difficult in small children and there needs to be good monitoring of the patient after the procedure. The patient can have sips of water initially (usually once they become awake) and care has to be taken to avoid vomiting which can sometimes happen post procedure. Once the patient has tolerated liquids he can take solid food. After a brief overnight stay in hospital the patient can be discharged the following morning after assessment.