{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T02:52:12Z","timestamp":1775616732954,"version":"3.50.1"},"reference-count":35,"publisher":"Georg Thieme Verlag KG","issue":"S 03","license":[{"start":{"date-parts":[[2025,1,13]],"date-time":"2025-01-13T00:00:00Z","timestamp":1736726400000},"content-version":"vor","delay-in-days":12,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Thorac Cardiovasc Surg"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003Interventional cardiac catheterizations have gained major importance in the treatment of congenital heart defects (CHDs). Since patients with CHDs frequently require lifelong medical care and sometimes subsequent invasive treatment, repeated radiation exposure during interventional procedures is a relevant issue concerning potential radiation-related risks. Therefore, a 9-year subanalysis on radiation data during interventional cardiac catheterizations from the German Registry for Cardiac Operations and Interventions in patients with CHDs was performed.<\/jats:p><jats:p>\n          Methods\u2003The German Registry for Cardiac Operations and Interventions in Patients with CHDs is a real-world, prospective all-comers database collecting clinical and procedural data on invasive treatment of CHDs. From January 2012 until December 2020, a total of 28,374 cardiac catheter interventions were recorded. For a homogeneous case mix and for obtaining comparable data, eight specified interventions were selected for detailed evaluation. The selected procedures were: atrial septal defect (ASD)\/patent foramen ovale (PFO) occlusion, patent ductus arteriosus (PDA) occlusion, ventricular septal defect (VSD) occlusion, coarctation of the aorta (CoA) balloon dilatation and stent implantation, aortic valvuloplasty, pulmonary valvuloplasty, and transcatheter pulmonary valve implantation (TPVI). Data on radiation exposure included total fluoroscopy time (TFT), dose area product (DAP), and DAP per body weight (DAP\/BW).<\/jats:p><jats:p>\n          Results\u2003The cohort accounted for 9,350 procedures, including 3,426 ASD\/PFO occlusions, 2,039 PDA occlusions, 599 aortic and 1,536 pulmonary valvuloplasties, 383 balloon dilatations and 496 stent implantations for CoA, 168 VSD occlusions, and 703 TPVI. Six hundred and ten ASD\/PFO procedures (17.8%) were performed without radiation. During the 9-year period, median annual TFT, DAP, and DAP\/BW showed a continuous decrease while radiation burden correlated with intervention complexity: For ASD\/PFO and PDA occlusion, aortic and pulmonary valvuloplasty as well as balloon dilatation of CoA the median DAP\/BW was &lt;20.0\u2009\u03bcGy*m2\/kg, while median values of 26.3\u2009\u03bcGy*m2\/kg and 31.6\u2009\u03bcGy*m2\/kg were noted for stent treatment of CoA and VSD closure, respectively. Radiation burden was highest in TPVI with a median TFT of 23.6\u2009minutes, median DAP of 4,491\u2009\u03bcGy*m2, and median DAP\/BW of 79.4\u2009\u03bcGy*m2\/kg.<\/jats:p><jats:p>\n          Conclusion\u2003A decrease in radiation exposure was found in eight cardiac interventions from January 2012 to December 2020. Comparison with international registries revealed a good quality of radiation protection. The data underline the requirement of surveillance of radiation burden, especially in this patient group.<\/jats:p>","DOI":"10.1055\/a-2514-7436","type":"journal-article","created":{"date-parts":[[2025,1,13]],"date-time":"2025-01-13T23:55:18Z","timestamp":1736812518000},"page":"e1-e10","source":"Crossref","is-referenced-by-count":1,"special_numbering":"S","title":["Radiation Exposure during Cardiac Interventions in Congenital Heart Defects: A Multicenter German Registry Analysis 2012\u20132020"],"prefix":"10.1055","volume":"73","author":[{"given":"Anja","family":"Tengler","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology and Pediatric Intensive Care, Ludwig Maximilian University of Munich, Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\u00f6rg","family":"Michel","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Pulmology and Pediatric Intensive Care, University Hospital Tuebingen, Tuebingen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudia","family":"Arenz","sequence":"additional","affiliation":[{"name":"German Pediatric Heart Center, University of Bonn, Bonn, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"UIrike","family":"Bauer","sequence":"additional","affiliation":[{"name":"National Register for Congenital Heart Defects, Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jens","family":"Beudt","sequence":"additional","affiliation":[{"name":"National Register for Congenital Heart Defects, Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Horke","sequence":"additional","affiliation":[{"name":"Division of surgery for Congenital Heart Defects, Department of Cardiac Surgery University of Hannover, Hannover, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gunter","family":"Kerst","sequence":"additional","affiliation":[{"name":"Clinic for Pediatric Cardiology and Congenital Heart Disease, Klinikum Stuttgart, Stuttgart, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0785-2591","authenticated-orcid":false,"given":"Andreas","family":"Beckmann","sequence":"additional","affiliation":[{"name":"Clinic for Cardiac Surgery and Pediatric Cardiac Surgery, Heart Center Duisburg, Duisburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7034-1132","authenticated-orcid":false,"given":"Michael","family":"Hofbeck","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Pulmology and Pediatric Intensive Care, University Hospital Tuebingen, Tuebingen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2025,3,4]]},"reference":[{"issue":"07","key":"ref1","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1016\/j.jcmg.2017.04.003","article-title":"Radiation safety in children with congenital and acquired heart disease: a scientific position statement on multimodality dose optimization from the Image Gently Alliance","volume":"10","author":"K D Hill","year":"2017","journal-title":"JACC Cardiovasc Imaging"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"370","DOI":"10.12688\/f1000research.13021.1","article-title":"Recent advances in cardiac catheterization for congenital heart disease","volume":"7","author":"S L Kang","year":"2018","journal-title":"F1000 Res"},{"issue":"05","key":"ref3","doi-asserted-by":"crossref","first-page":"870","DOI":"10.1007\/s00246-014-0869-7","article-title":"Patient radiation exposure in a modern, large-volume, pediatric cardiac catheterization laboratory","volume":"35","author":"A C Glatz","year":"2014","journal-title":"Pediatr Cardiol"},{"issue":"01","key":"ref4","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1161\/CIRCULATIONAHA.115.019137","article-title":"Exposure to low-dose ionizing radiation from cardiac procedures in patients with congenital heart disease: 15-year data from a population-based longitudinal cohort","volume":"133","author":"V Beaus\u00e9jour Ladouceur","year":"2016","journal-title":"Circulation"},{"issue":"02","key":"ref5","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1161\/CIRCULATIONAHA.113.005425","article-title":"Cumulative radiation exposure and cancer risk estimation in children with heart disease","volume":"130","author":"J N Johnson","year":"2014","journal-title":"Circulation"},{"issue":"19","key":"ref6","doi-asserted-by":"crossref","first-page":"1847","DOI":"10.1161\/CIRCULATIONAHA.109.904458","article-title":"Radiation risk from pediatric cardiac catheterization: friendly fire on children with congenital heart disease","volume":"120","author":"M G Andreassi","year":"2009","journal-title":"Circulation"},{"issue":"19","key":"ref7","doi-asserted-by":"crossref","first-page":"1730","DOI":"10.1161\/CIR.0000000000000048","article-title":"Approaches to enhancing radiation safety in cardiovascular imaging: a scientific statement from the American Heart Association","volume":"130","author":"R Fazel","year":"2014","journal-title":"Circulation"},{"issue":"04","key":"ref8","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1016\/j.radi.2017.02.001","article-title":"Radiation dose in paediatric cardiac catheterisation: A systematic literature review","volume":"23","author":"R Gould","year":"2017","journal-title":"Radiography (Lond)"},{"issue":"08","key":"ref9","first-page":"245","article-title":"Congenital heart disease and the risk of cancer: an update on the genetic etiology, radiation exposure damage, and future research strategies","volume":"9","author":"J Campolo","year":"2022","journal-title":"J Cardiovasc Dev Dis"},{"issue":"S 02","key":"ref10","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1007\/s00247-006-0194-2","article-title":"The ALARA concept in pediatric cardiac catheterization: techniques and tactics for managing radiation dose","volume":"36","author":"H Justino","year":"2006","journal-title":"Pediatr Radiol"},{"issue":"05","key":"ref11","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1136\/heartjnl-2016-309773","article-title":"Survival adjusted cancer risks attributable to radiation exposure from cardiac catheterisations in children","volume":"103","author":"R W Harbron","year":"2017","journal-title":"Heart"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"7639754","DOI":"10.1155\/2019\/7639754","article-title":"Multicenter assessment of radiation exposure during pediatric cardiac catheterizations using a novel imaging system","volume":"2019","author":"L J Lamers","year":"2019","journal-title":"J Interv Cardiol"},{"issue":"02","key":"ref13","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1161\/CIRCINTERVENTIONS.110.959262","article-title":"Procedure-type risk categories for pediatric and congenital cardiac catheterization","volume":"4","author":"L Bergersen","year":"2011","journal-title":"Circ Cardiovasc Interv"},{"issue":"09","key":"ref14","doi-asserted-by":"crossref","first-page":"1060","DOI":"10.1016\/j.jcin.2014.04.013","article-title":"Radiation dose benchmarks during cardiac catheterization for congenital heart disease in the United States","volume":"7","author":"S J Ghelani","year":"2014","journal-title":"JACC Cardiovasc Interv"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1093\/rpd\/ncv039","article-title":"Follow-up of children exposed to ionising radiation from cardiac catheterisation: the Coccinelle study","volume":"165","author":"H Baysson","year":"2015","journal-title":"Radiat Prot Dosimetry"},{"issue":"02","key":"ref16","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1007\/s00246-018-2024-3","article-title":"Radiation risk categories in cardiac catheterization for congenital heart disease: a tool to aid in the evaluation of radiation outcomes","volume":"40","author":"B P Quinn","year":"2019","journal-title":"Pediatr Cardiol"},{"issue":"05","key":"ref17","doi-asserted-by":"crossref","first-page":"e008172","DOI":"10.1161\/CIRCINTERVENTIONS.119.008172","article-title":"Longitudinal improvements in radiation exposure in cardiac catheterization for congenital heart disease: a prospective multicenter C3PO-QI study","volume":"13","author":"B P Quinn","year":"2020","journal-title":"Circ Cardiovasc Interv"},{"issue":"06","key":"ref18","first-page":"1154","article-title":"Standardizing radiation exposure during cardiac catheterization in children with congenital heart disease: data from a multicenter Brazilian registry","volume":"115","author":"J L Manica","year":"2020","journal-title":"Arq Bras Cardiol"},{"issue":"07","key":"ref19","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1017\/S1047951123001427","article-title":"Combining Congenital heart surgical and interventional cardiology outcome data in a single database: The Development of a Patient-Centered Collaboration of the European Congenital Heart Surgeons Association (ECHSA) and the Association for European Paediatric and Congenital Cardiology (AEPC)","volume":"33","author":"J P Jacobs","year":"2023","journal-title":"Cardiol Young"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"e21","DOI":"10.1055\/s-0041-1722978","article-title":"German Registry for cardiac operations and interventions in patients with congenital heart disease: report 2020-Comprehensive Data from 6 Years of Experience","volume":"69","author":"A Beckmann","year":"2021","journal-title":"Thorac Cardiovasc Surg"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"e21","DOI":"10.1055\/s-0042-1757175","article-title":"German Registry for Cardiac Operations and Interventions in Patients with Congenital Heart Disease: Report 2021 and 9 Years' Longitudinal Observations on Fallot and Coarctation Patients","volume":"70","author":"S Dittrich","year":"2022","journal-title":"Thorac Cardiovasc Surg"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"e16","DOI":"10.1055\/a-2350-7374","article-title":"German Registry for cardiac operations and interventions in CHD: Annual Report 2022","volume":"72","author":"M Hofbeck","year":"2024","journal-title":"Thorac Cardiovasc Surg"},{"issue":"03","key":"ref23","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1007\/s10654-019-00500-x","article-title":"Guidelines and recommendations for ensuring Good Epidemiological Practice (GEP): a guideline developed by the German Society for Epidemiology","volume":"34","author":"W Hoffmann","year":"2019","journal-title":"Eur J Epidemiol"},{"issue":"10","key":"ref26","doi-asserted-by":"crossref","first-page":"1872","DOI":"10.1017\/S1047951117002244","article-title":"Nomenclature for congenital and paediatric cardiac disease: the International Paediatric and Congenital Cardiac Code (IPCCC) and the Eleventh Iteration of the International Classification of Diseases (ICD-11)","volume":"27","author":"R CG Franklin","year":"2017","journal-title":"Cardiol Young"},{"issue":"07","key":"ref27","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1017\/S104795112100281X","article-title":"Nomenclature for Pediatric and Congenital Cardiac Care: Unification of Clinical and Administrative Nomenclature - The 2021 International Paediatric and Congenital Cardiac Code (IPCCC) and the Eleventh Revision of the International Classification of Diseases (ICD-11)","volume":"31","author":"J P Jacobs","year":"2021","journal-title":"Cardiol Young"},{"issue":"02","key":"ref28","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1002\/ccd.26911","article-title":"Radiation dose benchmarks in pediatric cardiac catheterization: a prospective multi-center C3PO-QI study","volume":"90","author":"P C Cevallos","year":"2017","journal-title":"Catheter Cardiovasc Interv"},{"issue":"04","key":"ref29","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1016\/j.jacc.2019.11.042","article-title":"Adverse events, radiation exposure, and reinterventions following transcatheter pulmonary valve replacement","volume":"75","author":"B H Goldstein","year":"2020","journal-title":"J Am Coll Cardiol"},{"issue":"01","key":"ref30","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1007\/s00246-020-02456-2","article-title":"Short- and long-term outcome after interventional vsd closure: a single-center experience in pediatric and adult patients","volume":"42","author":"M Bergmann","year":"2021","journal-title":"Pediatr Cardiol"},{"issue":"09","key":"ref31","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1007\/s00392-012-0445-1","article-title":"Interventional closure of atrial septal defects without fluoroscopy in adult and pediatric patients","volume":"101","author":"S Schubert","year":"2012","journal-title":"Clin Res Cardiol"},{"issue":"27","key":"ref32","doi-asserted-by":"crossref","first-page":"2255","DOI":"10.1093\/eurheartj\/ehz201","article-title":"Acute and midterm outcomes of the post-approval MELODY Registry: a multicentre registry of transcatheter pulmonary valve implantation","volume":"40","author":"J Nordmeyer","year":"2019","journal-title":"Eur Heart J"},{"issue":"01","key":"ref33","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.jacc.2021.10.031","article-title":"Reintervention and survival after transcatheter pulmonary valve replacement","volume":"79","author":"D B McElhinney","year":"2022","journal-title":"J Am Coll Cardiol"},{"issue":"09","key":"ref34","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1080\/17434440.2019.1653180","article-title":"Intermediate outcomes of transcatheter pulmonary valve replacement with the Edwards Sapien 3 valve - German experience","volume":"16","author":"A Lehner","year":"2019","journal-title":"Expert Rev Med Devices"},{"issue":"02","key":"ref35","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1002\/ccd.30916","article-title":"Five-year follow-up after percutaneous pulmonary valve implantation using the Venus P-valve system for patients with pulmonary regurgitation and an enlarged native right ventricular outflow tract","volume":"103","author":"Q Jin","year":"2024","journal-title":"Catheter Cardiovasc Interv"},{"issue":"03","key":"ref36","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/j.acvd.2017.05.011","article-title":"Reduction of radiation exposure in transcatheter atrial septal defect closure: how low must we go?","volume":"111","author":"F Sitefane","year":"2018","journal-title":"Arch Cardiovasc Dis"},{"issue":"01","key":"ref37","doi-asserted-by":"crossref","first-page":"e001267","DOI":"10.1136\/openhrt-2020-001267","article-title":"Catheter strategy to ease the procedure and reduce radiation exposure when requiring neck access","volume":"7","author":"R Kubicki","year":"2020","journal-title":"Open Heart"}],"container-title":["The Thoracic and Cardiovascular Surgeon"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2514-7436.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,4]],"date-time":"2025-03-04T23:46:10Z","timestamp":1741131970000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2514-7436"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1]]},"references-count":35,"journal-issue":{"issue":"S 03","published-online":{"date-parts":[[2025,3,4]]},"published-print":{"date-parts":[[2025,1]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2514-7436","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0171-6425","1439-1902"],"issn-type":[{"value":"0171-6425","type":"print"},{"value":"1439-1902","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,1,13]]},"published":{"date-parts":[[2025,1]]}}}