Intravascular Ultrasound (IVUS) Provides the Filling for the Angiogram's Crust: Benefits of IVUS in Pediatric Interventional Cardiology.

BACKGROUND: Intravascular ultrasound (IVUS) is a catheter-based imaging modality that generates cross-sectional views of vessel walls and lumens. This technique is used in adult interventional and vascular surgeries to guide the management of coronary artery and peripheral arterial disease. IVUS has been described as superior to angiography in providing data about lesions of interest, including degree of vessel stenosis and stent apposition following intervention. IVUS use to guide transcatheter management of congenital heart disease is limited. OBJECTIVE: We reviewed our experience using IVUS as an adjunctive tool to diagnose lesions and assess intervention in pediatric patients during cardiac catheterization. METHODS AND RESULTS: A retrospective chart review of all pediatric patients who underwent IVUS during cardiac catheterization to evaluate the cross-sectional lumen of non-coronary vessel(s) at Rady Children's Hospital from January 2018 to December 2019 was performed. Median patient age was 637 days (range, 44-4328 days), with mean weight of 12.1 ± 9 kg. Twenty-six vessels were interrogated with IVUS (pulmonary venous stenosis [n = 8], coarctation [n = 5], branch pulmonary artery stenosis [n = 6], systemic shunts and conduits [n = 3], and other peripheral vasculature [n = 4]). IVUS added value in all cases (100%). We found that IVUS guided the intervention in 88% of procedures and defined the endpoint in 62% of transcatheter interventions. There were no IVUS-related complications. CONCLUSIONS: IVUS enhanced our diagnostic interpretation and identified occult lesions not visualized by angiography. IVUS was valuable in guiding and defining the endpoints of these interventions.