   
|
|
By John F. Keane, MD
When Michael Freed, MD, and I began our fellowship
training at Children's in 1970, there were two catheterization
laboratories in operation. One was in the sub-basement
(known as the "baby lab") next to the hyperbaric chamber
and had a biplane GE 35 mm cine capability, the first so
dedicated for use in children. The second laboratory was
located on the second floor, where Dr. Jim Lock's office
is now! This area was used for older patients and had a
biplane cutfilm angiography unit into which the table
and patients were moved from the fluoroscopy field.
At this time the angiographic pictures were not available
until the films were developed in the radiology department.
On Saturdays, cows with implanted ventricular assist devices
were catheterized in this adult laboratory. Some 500 patients,
adults and children, were catheterized that year; vessel entry
was all by cutdown (vein and artery), and premedication
consisted largely of Demerol compound with Valium for
additional sedation during the studies. Renovist, an ionic
agent, was the contrast material used and was associated
with considerable patient discomfort.
Essentially, all catheterizations were done for hemodynamic
and anatomical data, the only interventional procedure
being balloon atrial septostomy. All patients were hospitalized,
the laboratories were staffed by four technicians,
and running the pressure recording equipment was part
of the cardiology fellows' rotation. There were no nurses or
anesthesiologists assigned to the laboratories. Percutaneous
vessel entry and use of flow-directed balloon catheters
began about this time.
|
|
|
|
In 1984, Dr. Lock arrived and the catheterization laboratory mission, to quote W.B. Yeats, "changed utterly." The patient numbers increased rapidly and a variety of interventional procedures were introduced so that by 2002, of 1,609 catheterizations, 83% had some interventional aspect (see figure) and routine hemodynamic and anatomic studies became a rarity. Today, three catheterization laboratories are in operation, with one devoted exclusively to electrophysiology studies. The staff now includes six technicians, nine nurses, and eight cardiac anesthesiologists. All studies are done percutaneously. Conscious sedation is used for most hemodynamic and many interventional procedures, while general anesthesia is employed for most complex interventions. A five-bed recovery unit is part of the catheterization suite, and about 20% of the patients undergo their procedures as outpatients. Echocardiographic assistance, particularly transesophageal studies, has become part and parcel of many procedures, especially device placement. The catheterization laboratory, in essence, has become an operating room. Years ago, Dr. Fyler worried in his monograph that in earlier days some of us might have become members of the Cardiac Surgical Department since in some centers the surgical department employed the catheterizers. Today, perhaps, the opposite is a possibility. It should be noted that Dr. Norwood completed a catheterization laboratory rotation during his time here at Children's Hospital. |
|
|
As recorded by Donald Fyler, MD, in his History of
Cardiology at Children's Hospital Boston, the hospital's first
catheterization laboratory was in operation in 1950, with 50
patients catheterized that year. At the time, the studies were
confined to measurements of right heart saturations and
pressures, and a second procedure in the radiology department
was required for angiograms.
