Cardiac Two-Dimensional Echocardiogram (2D ECHO)

Two-Dimensional Echocardiogram which is also known as cardiac ultrasound is one of the most widely used diagnostic tests for heart disease. It provides information about the structure of the heart as well as direction and velocity of blood flow. This allows the paediatric cardiologist to assess patients' heart structure and function. It uses sound waves to produce such images and no radiation is required. Echocardiogram machines are small and portable and can be used in all patient areas from the operating theatre to the outpatient clinic.

Cardiac MRI (Magnetic Resonance Imaging) and CT (Computed Tomography)

These are other diagnostic methods used to assess heart structure and function. Both allow physicians to look beyond the immediate structure of the heart into the blood vessels originating from them. CT and MRI may be able to provide superior images of the heart compared to echocardiograms particularly in adults and larger children. They also provide information on the function of the heart. However they are not used as frequently as echocardiogram as they are not as convenient to perform. Children may need to be sedated for these procedures. A routine MRI scan takes close to an hour and the child will have to lie very still for the procedure. Sometimes this means needing to undergo general anaesthesia (GA) for the procedure to be done. A CT scan is quick to perform but there is radiation exposure involved. If any of these procedures are required, your paediatric cardiologist will explain the need for them and the cardiac nurse will assist in the logistical arrangements.

Cardiac Catheterization

Cardiac catheterization is a procedure whereby a hollow tube(catheter) is inserted through a blood vessel(usually from the thigh or neck) into the heart in order to obtain information on heart structure and function.

The pressures within heart chambers and tubes as well as the oxygen content at various locations can be measured. It is usually done under general anaesthesia (GA) in a room known as the catheterization laboratory (cath lab).

Patient are usually admitted a day prior the procedure. Blood investigation and diagnostic investigation may be necessary before cardiac catheterization. The anaesthetist will review patient in the ward and the paediatric cardiologist will explain the nature and the risk of the procedure to parents and formal written consent will be obtained. The patient is fasted 4-6 hours before the procedure.

During the catheterizaton procedure, the cardiologist uses X-rays imaging or fluoroscopy to help visualize and guide the catheter to the desired locations within the blood vessels and chambers of the heart.

After the procedure, the catheters are removed and trained nurses in the cath lab will press on the groin area for about 10 minutes to prevent excessive bruising of the area where the catheter has been inserted. A pressure bandage is applied to stop bleeding. No stitches are required. The child is transferred back to ward when he or she is awake and stable.

In the ward, nurses will continue monitoring the child's vital signs and leg pulses. They will also look out for bleeding in the groin area where the puncture has been made. Generally bed rest for 6 hours is advised although in younger children, parents may carry their children if they are very fretful. If the child is fully alert with no nausea or vomiting, food or drink may be consumed.

Depending on the procedure performed, the child may be discharged on the same day or on the day after. Sometimes echocardiography is performed before discharge. You will be advised on medication and outpatient follow ups during the time of discharge.