{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T04:43:12Z","timestamp":1777869792182,"version":"3.51.4"},"reference-count":29,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:00Z","timestamp":1777507200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Extracorporeal membrane oxygenation (ECMO) is lifesaving in pediatric patients with respiratory and\/or cardiovascular failure. Cardiac catheterization is an important diagnostic and therapeutic tool in patients with congenital heart disease supported by ECMO, allowing the assessment of residual lesions, hemodynamically significant anatomical abnormalities, and unexplained indications for ongoing ECMO support. The timing and clinical contribution of cardiac catheterization in these patients are still debated. Objective: This study aimed to evaluate the indications, safety, and impact of cardiac catheterization on clinical management in pediatric patients receiving postoperative ECMO support. Methods: This single-center, retrospective study examined 39 pediatric patients under the age of 18 who underwent postoperative cardiac catheterization with ECMO support between January 2022 and December 2025. Demographic data, procedure characteristics, and clinical outcomes were analyzed. Results: Of the 190 patients under postoperative ECMO support, 39 underwent catheterization. The median age of the patients was 2.5 months (range, 6 days\u2013180 months) and median weight was 4.2 kg (range, 2.8\u201357 kg). The most frequent diagnoses were ventricular septal defect-pulmonary atresia (VSD-PA) in 20.5% (n = 8) and transposition of the great arteries (TGA) in 15.3% (n = 6). The indication for catheterization was to investigate the reason for ECMO placement in 26 patients (66.6%). Most patients underwent catheterization within the first 24 h after ECMO initiation. Patients who underwent catheterization represented a higher-risk subgroup, with a greater proportion of STAT 4-5 procedures (59% vs. 40%) compared with the overall ECMO cohort. Cardiac catheterization resulted in a change in clinical management in 25.6% of patients through catheter-based intervention or surgical revision. Survival in the catheterized subgroup was 12.8%, reflecting the high-risk nature of this population. Conclusions: Cardiac catheterization in pediatric patients on postoperative ECMO support can be performed with a low complication rate and can significantly alter clinical management. Cardiac catheterization should be considered an important diagnostic and therapeutic modality, particularly in the presence of suspected residual lesions or unexplained hemodynamic instability. Additionally, we recommend that cardiac catheterization be performed promptly within the first 24\u201348 h in this patient group on ECMO support.<\/jats:p>","DOI":"10.3390\/diagnostics16091367","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T14:35:53Z","timestamp":1777559753000},"page":"1367","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Early Cardiac Catheterization in Children with Congenital Heart Disease on Postoperative Extracorporeal Membrane Oxygenation: Safety, Outcomes, and Clinical Management"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4919-083X","authenticated-orcid":false,"given":"Burcu","family":"\u00c7evlik","sequence":"first","affiliation":[{"name":"Department of Pediatric Cardiology, Health Sciences University Basaksehir Cam and Sakura City Hospital, Istanbul 34480, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmet Saki","family":"O\u011fuz","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Health Sciences University Basaksehir Cam and Sakura City Hospital, Istanbul 34480, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3314-9090","authenticated-orcid":false,"given":"Ali Naz\u0131m","family":"G\u00fczelba\u011f","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Health Sciences University Basaksehir Cam and Sakura City Hospital, Istanbul 34480, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-5360-7044","authenticated-orcid":false,"given":"Demet","family":"Kangel","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Health Sciences University Basaksehir Cam and Sakura City Hospital, Istanbul 34480, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kahraman","family":"Yakut","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Health Sciences University Basaksehir Cam and Sakura City Hospital, Istanbul 34480, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4579-963X","authenticated-orcid":false,"given":"Muhammet Hamza Halil","family":"Toprak","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Health Sciences University Basaksehir Cam and Sakura City Hospital, Istanbul 34480, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdullah","family":"Erdem","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Health Sciences University Basaksehir Cam and Sakura City Hospital, Istanbul 34480, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u0130brahim Cansaran","family":"Tan\u0131d\u0131r","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Health Sciences University Basaksehir Cam and Sakura City Hospital, Istanbul 34480, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ali Can","family":"Hatemi","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiovascular Surgery, Health Sciences University Basaksehir Cam and Sakura City Hospital, Istanbul 34480, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1762-3269","authenticated-orcid":false,"given":"Erkut","family":"\u00d6zt\u00fcrk","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Health Sciences University Basaksehir Cam and Sakura City Hospital, Istanbul 34480, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1397","DOI":"10.1080\/14767058.2016.1214706","article-title":"The use of neonatal extracorporeal life support in pediatric cardiac intensive care unit","volume":"30","author":"Cine","year":"2017","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1097\/MAT.0000000000002128","article-title":"Extracorporeal Life Support Organization Registry International Report 2022: 100,000 Survivors","volume":"70","author":"Tonna","year":"2024","journal-title":"ASAIO J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1106","DOI":"10.1038\/s41372-018-0129-4","article-title":"National trends in neonatal extracorporeal membrane oxygenation in the United States","volume":"38","author":"Bhatt","year":"2018","journal-title":"J. Perinatol."},{"key":"ref_4","first-page":"425","article-title":"Cardiac catheterization procedures in pediatric patients undergoing extracorporeal membrane oxygenation cardiac catheterization, ECMO","volume":"18","author":"Kasar","year":"2017","journal-title":"Anatol. J. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1230","DOI":"10.1016\/S0140-6736(21)01960-7","article-title":"Extracorporeal Life Support Organization. Extracorporeal membrane oxygenation for COVID-19: Evolving outcomes from the international Extracorporeal Life Support Organization Registry","volume":"398","author":"Barbaro","year":"2021","journal-title":"Lancet"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1681","DOI":"10.1016\/S0735-1097(02)02343-4","article-title":"Cardiac catheterization of patients supported by extracorporeal membrane oxygenation","volume":"40","author":"Booth","year":"2002","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1111\/joic.12368","article-title":"Early Cardiac Catheterization leads to shortened pediatric extracorporeal membrane oxygenation run duration","volume":"30","author":"Burke","year":"2017","journal-title":"J. Interv. Cardiol."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Rossetti, M., Capuano, P., Mamone, G., Abdulaziz, S., Ghisulal, P., Panarello, G., Martucci, G., Cho, S., and Lorusso, R. (2026). Diagnostic imaging challenges in pediatric patients on extracorporeal membrane oxygenation. Artif. Organs, 1\u201313.","DOI":"10.1111\/aor.70092"},{"key":"ref_9","first-page":"e67020","article-title":"Cardiac Catheterization Post Congenital Cardiac Surgery: Analysis of Risk Factors for Mortality and Literature Review","volume":"16","author":"Arfi","year":"2024","journal-title":"Cureus"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1016\/j.jtcvs.2013.03.021","article-title":"Residual lesions in postoperative pediatric cardiac surgery patients receiving extracorporeal membrane oxygenation support","volume":"147","author":"Agarwal","year":"2014","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1753","DOI":"10.1016\/j.athoracsur.2021.10.002","article-title":"The Society of Thoracic Surgeons Congenital Heart Surgery Database: 2021 Update on Outcomes and Research","volume":"112","author":"Kumar","year":"2021","journal-title":"Ann. Thorac. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1093\/ejcts\/ezt319","article-title":"Results of rapid-response extracorporeal cardiopulmonary resuscitation in children with refractory cardiac arrest following cardiac surgery","volume":"45","author":"Alsoufi","year":"2014","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1693","DOI":"10.1161\/CIRCULATIONAHA.106.680678","article-title":"Extracorporeal membrane oxygenation to aid cardiopulmonary resuscitation in infants and children","volume":"116","author":"Thiagarajan","year":"2007","journal-title":"Circulation"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1216","DOI":"10.1097\/00003246-199209000-00007","article-title":"Use of extracorporeal life support in patients with congenital heart disease","volume":"20","author":"Delius","year":"1992","journal-title":"Crit. Care Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"E325","DOI":"10.1532\/hsf.2471","article-title":"Delayed sternal closure in congenital heart surgery: A risk-benefit analysis","volume":"22","author":"Elassal","year":"2019","journal-title":"Heart Surg. Forum"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1053\/j.pcsu.2010.02.004","article-title":"The IMPACT registry: IMproving Pediatric and Adult Congenital Treatments","volume":"13","author":"Martin","year":"2010","journal-title":"Semin. Thorac. Cardiovasc. Surg. Pediatr. Card. Surg. Annu."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1007\/s00246-016-1518-0","article-title":"Cardiac Catheterization in Pediatric Patients Supported by Extracorporeal Membrane Oxygenation: A 15-Year Experience","volume":"38","author":"Boscamp","year":"2017","journal-title":"Pediatr. Cardiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1017\/S1047951100003267","article-title":"Cardiac catheterization in children on extracorporeal membrane oxygenation","volume":"6","author":"Ettedgui","year":"1996","journal-title":"Cardiol. Young"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"155","DOI":"10.2174\/1573403X12666160301120955","article-title":"Diagnostic Cardiac Catheterization in the Pediatric Population","volume":"12","author":"Moustafa","year":"2016","journal-title":"Curr. Cardiol. Rev."},{"key":"ref_20","first-page":"361","article-title":"Cardiac Catheterization in Critically Ill Pediatric Patients Supported with Extracorporeal Membrane Oxygenation: A 12-Year Experience from a Latin American Center","volume":"107","year":"2026","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1186\/s43044-020-00117-6","article-title":"Cardiac catheterization addressing early post-operative complications in congenital heart surgery-a single-center experience","volume":"72","author":"Bahaidarah","year":"2020","journal-title":"Egypt. Heart J."},{"key":"ref_22","first-page":"102570","article-title":"Cardiac Catheterization and Interventions in Pediatric Patients on ECMO: Analysis of the IMPACT Registry","volume":"4","author":"McLean","year":"2025","journal-title":"J. Soc. Cardiovasc. Angiogr. Interv."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1007\/s00246-014-1057-5","article-title":"Outcomes of pediatric patients undergoing cardiac catheterization while on extracorporeal membrane oxygenation","volume":"36","author":"Callahan","year":"2015","journal-title":"Pediatr. Cardiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1177\/2150135113505297","article-title":"Cardiac catheter procedures during extracorporeal life support: A risk-benefit analysis","volume":"5","author":"Panda","year":"2014","journal-title":"World J. Pediatr. Congenit. Heart Surg."},{"key":"ref_25","first-page":"898","article-title":"Impacts of early cardiac catheterization for children with congenital heart disease supported by extracorporeal membrane oxygenation","volume":"7","author":"Kato","year":"2016","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_26","first-page":"389","article-title":"Adverse event rates in congenital cardiac catheterization\u2014A multi-center experience","volume":"75","author":"Bergersen","year":"2010","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1114","DOI":"10.1016\/j.jtcvs.2005.11.035","article-title":"Extracorporeal life support after staged palliation of a functional single ventricle: Subsequent morbidity and survival","volume":"131","author":"Hoskote","year":"2006","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_28","first-page":"592","article-title":"Early catheterization after initiation of extracorporeal membrane oxygenation support in children is associated with improved survival","volume":"88","author":"Abraham","year":"2016","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_29","first-page":"62","article-title":"Utility of cardiac catheterization in pediatric cardiac patients on ECMO","volume":"46","author":"DesJardins","year":"1999","journal-title":"Catheter. Cardiovasc. Interv."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/9\/1367\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T14:42:09Z","timestamp":1777560129000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/9\/1367"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,30]]},"references-count":29,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["diagnostics16091367"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16091367","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,30]]}}}