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Coil dislodgement and embolization to a distal blood vessel are the most common complications. In general, the errant coil can be retrieved in the cath lab without much difficulty and a new coil of a larger size placed to occlude the vessel. It is usual to obtain four to five specimens to improve the diagnostic gain, as the histopathological changes can be patchy. Complications of endomyocardial biopsy include cardiac perforation and tricuspid valve damage.

 

Rashkind balloon atrial septostomy, static balloon septoplasty, Brockenbrough transseptal needle puncture, and radiofrequency-assisted perforation of the pulmonary valve or the atrial septum are all less commonly used than the procedures described above, but routinely are undertaken in high-volume cath labs. These studies often are used to make a Dx of the mechanism of arrhythmia, assess the hemodynamic impact of the arrhythmia, assess efficacy of pharmacologic therapy, and map the location of abnormal conduction pathways or automatic foci.

 

This procedure was first described in pediatric surgery in, but has rapidly become a preferred therapeutic option for supraventricular tachycardia in this population. Pacemaker placement has become more common as data have accumulated regarding the risk of sudden death in patients with congenital complete heart block, as well as increased survival with postop heart block.

 

These patients are often challenging for the anesthesiologist due to their abnormal cardiac anatomy and physiology. Many of them have undergone repeated catheterizations and have had multiple anesthetics. General anesthesia may be a safer option for neonates and younger children because of patient anxiety, longer duration of procedure, and clinical state of the patient.

 

Patients with moderate to severe pulmonary hypertension present extra challenges and care for these patients differs among institutions.

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