Referral Criteria of Patients to Pediatric Cardiologist

The tremendous development of cardiac surgery, transcatheter intervention, and intensive care management in pediatric cardiac ICU has a pivotal role in the growth of an infant to adulthood in spite of having a complex form of CHD. Fetal echocardiography has added another dimension to the evaluation process by enhancing and encouraging neonatal interventions – both catheter and surgical. The pharmacological and anesthetic advances have improved the surgical outlook for many young and malnourished infants. So it is important to diagnose CHD in earliest possible chance preferably in the neonatal period and to decide which intervention is appropriate for which patient and which time is best for the intervention

The timing of surgical intervention depends on the following factors:

1. Natural history of the lesion
2. The severity of the lesion
3. Available surgical center
4. Symptomatic status
5. Noninvasive evaluation – echocardiography in particular
6. Invasive: cardiac catheterization and angiography
7. MRI in selected cases

• Early Referral Criteria to Pediatric Cardiologist:

1. Simple correctable lesions which are hemodynamically severe like PDA, Coarctation and VSD may need an early referral for surgery. The baby may succumb to either CHF or pneumonia, otherwise.
2. Neonatal severe obstructions – PS, CoA or AS can cause severe cardiac dysfunction and CHF and will require early intervention.
3. Ductus dependent lesions on either the right side – pulmonary atresia or left side – HLHS, Severe complex Coarctation of Aorta are neonatal medical emergencies and will require some form of intervention.
4. Lesions which have tremendous pulmonary blood flow and the propensity of PVOD (Pulmonary Vascular Occlusive Disease) like a large VSD, AV Canal Defect, AP window, TAPVC, and TGA need be operated in infancy.
5. An adverse event like a cerebrovascular accident, brain abscess, spell, and infective endocarditis calls for early attention.

• General Criteria for Referral:

1. Patients having cyanosis since birth or early infancy.
2. Patients having a history of repeated respiratory tract infection with suspicion of CHD.
3. Patients with symptoms of heart failure.
4. Patients having an obvious murmur on auscultation.
5. Patients having radio-radial or radio-femoral delay with or without hypertension.
6. Patients having hypertension due to a cardiovascular cause.
7. Failure to thrive without any known cause.
8. Patients with any syndrome e.g Down syndrome, Turner syndrome, Congenital Rubella Syndrome.
9. Patients with other congenital malformations.
10. Siblings having known congenital heart disease.
11. Screening of cardiac functions of patients getting chemotherapy.
12. For Sub-acute Bacterial Endocarditis prophylaxis in CHD cases before any surgical or dental procedures.
13. Fetal Echocardiography of high-risk pregnancies.
14. For screening of high risk newborn.