Radiation risk from pediatric cardiac catheterization: friendly fire on children with congenital heart disease.

Congenital heart disease (CHD) is the most prevalent and fatal of all birth defects, occurring in nearly 1 in 100 live births.1 Before the advent of cardiac surgery for congenital cardiac malformations, less than one fifth of children born with such lesions reached adulthood. The progress of surgical management and, more recently, interventional catheterization has allowed an increasing number of congenital heart defects to be corrected surgically so that an increasing number of patients reach adolescence and adult life, even those with complex defects.2,3 Article see p 1903 Indeed, grown-up patients with surgically repaired CHD are a large and growing population, estimated to be 1 million in United States in the year 2000 compared with an estimated 300 000 in 1980, and 1.4 million cases are anticipated in 2020.2 Numbers are likely to be similar in the European Union, although no hard figures are available.3 One worrisome social and medical problem in the management of patients with CHD is certainly the long-term effects of intensive medical exposure to ionizing radiation received during childhood, especially for interventional catheterization procedures.4–7 Pediatric cardiac catheterizations are undoubtedly an essential diagnostic and therapeutic tool for the diagnosis and the treatment of CHD; however, they also deliver one of the highest radiation doses to patients.4–7 Ionizing radiation exposure is a definite risk factor for cancer development. Children are especially vulnerable to the oncogenic effects of radiation. Tissues and organs that are growing and developing are more sensitive to radiation effects than those that are fully mature. Moreover, the oncogenic effects of radiation require a long latent period (decades) that varies with the type of malignancy. Thus, an infant or child patient has a longer lifetime risk for developing radiation-induced cancers than adult patients.8 In addition, catheterization procedures are also …