Introduction

The importance of a well-performed cardiac catheterisation in adults with congenital heart disease (CHD) cannot be overstated. Despite the modern-day diagnostic benefits of echocardiography and cross-sectional imaging, diagnostic cardiac catheterisation remains the most accurate method of assessing intracardiac filling pressures, valve gradients, shunt lesions and, in many cases, anatomy. When properly performed, cardiac catheterisation serves as a tool to guide decisions for medical and invasive intervention, identify causes of occult symptoms when non-invasive image has failed to do so and aid in prognostication.

Given the anatomic variability and haemodynamic complexities of patients with CHD, cardiac catheterisation is often performed at CHD specialty centres by cardiologists with expertise in CHD, per the 2018 American Heart Association/American College of Cardiology (AHA/ACC) Guidelines for the Management of Adults with Congenital Heart Disease (Class I, Level C).1 However, as the population of adults with CHD continues to increase, many of these patients are being seen and cared for in the community.2 3 The purpose of this manuscript is to review some of the common tools and techniques employed by interventionalists who specialise in CHD to serve as a guide for any who may be called on to perform diagnostic cardiac catheterisations in the service of their patients.

The approach to catheterisation in patients with CHD differs from those with anatomically normal cardiovascular systems in a few key ways. Often, patients with CHD have undergone one or more surgical or transcatheter interventions altering their original anatomy and physiology. …