expandable or self-expanding stents are now clinically approved for use in treatment of stenotic and regurgitant lesions in both the left and right ventricular outflow tracts (RVOTs).18–22 Transcatheter techniques for repair of the left- and right-sided atrioventricular valves, based on surgical principles such as the creation of dual orifices and annuloplasty, are also being actively deployed and investigated in the clinical setting.23,24 The final frontier in interventional techniques could well be the transcatheter treatment of complex congenitally malformed hearts, replacing surgical interventions such as the Norwood procedure or completion of Fontan circulation.25–28 Short of this, recent efforts have pushed early neonatal palliations to the catheterization laboratory, including the use of patent ductus arteriosus (PDA) and RVOT stent placement—as opposed to surgical arteriopulmonary shunt placement—in lesions with inadequate pulmonary blood flow.29–30 Principles of Catheterization The field of interventional catheterization is rapidly expanding as newer techniques and devices appear on the market Any description of a standard procedure is therefore unlikely to stand the test of time and will soon be outdated Moreover, given substantial differences in resources and regulatory environments across countries (and continents) and institutional and even individual practitioner biases, we cannot possibly cover all specific approaches to procedures within this chapter Instead, we intend to describe a series of approaches to interventional procedures, admittedly with a North American bias, given the current working location of the authors However, the basic tenets of interventional catheterization are likely to remain constant and have already stood the test of time over the past few decades Subtle variations in available technology or strategies should not negate the value found in the advice housed within Ultimately, the success of an interventional catheterization procedure is dependent not only on the performance of the procedure but also on good planning prior to the procedure, coupled with anticipation and preparation for unexpected events Preprocedural Nursing Considerations A thorough chart review should be conducted within 30 days of the procedure The patient's current health condition should be assessed for infectious processes that could postpone an elective procedure Consideration should be given to mitigating existing comorbidities prior to the procedure, to decrease risk For example, patients with chronic renal insufficiency may receive prophylactic renal protection with hydration and N-acetylcysteine prior to contrast administration, in an effort to preserve kidney function.31 Patients with diabetes may need to adjust insulin dosing to avoid hypoglycemia, or hold oral hypoglycemic agents to prevent lactic acidosis.32 Discussion of specific care concerns with the patient's existing specialists should take place well in advance of the procedure, to customize a periprocedural care plan In addition, medication review is necessary to modify key therapeutics such as chronic anticoagulants or antiplatelet agents, which may need to be held or reduced in dose several days prior to procedure Consideration of bridge anticoagulation therapy (e.g., low-molecular-weight heparin) may be necessary for patients with a high risk for thrombus, such as those with prosthetic heart valves Use of an anticoagulant agent with a short half-life maintains anticoagulation for days prior to the procedure but decreases the risk of periprocedure bleeding with discontinuation hours prior to the procedure.33 Finally, inquire about any allergies that may require either treatment prior to the procedure (e.g., contrast allergy) or development of an alternate periprocedural medication plan (e.g., penicillin allergy) Before the procedure, a provider must complete a history and physical The exam could take place the day prior to, or day of, the scheduled procedure Discuss changes or increases in symptoms since referral with the interventional cardiologist Red flags such as decrease in feeding, desaturations, or increased work of breathing could warrant expediting the procedure or, occasionally, delaying the procedure Providers must be familiar with procedures to serve as a resource to patients and families The provider sets expectations for care immediately after a procedure (e.g., supine positioning to prevent bleeding, monitoring equipment, and possibly a urinary catheter), which can facilitate a smooth postprocedure experience for patients and families The developmental level of the patient is necessary to keep in mind during this counseling encounter It is necessary to provide guidance in terms that both patients and families can understand Use of a child life specialist should be considered when both appropriate and available Preprocedural Planning Consent should ideally be obtained either during outpatient consultation or in a dedicated preprocedural clinic that provides parents the opportunity to discuss relevant issues, prior to the “stress” of the procedure The consent should be obtained by a person suitably qualified, with sufficient knowledge to explain the procedural details and its risks or, ideally, by the interventional cardiologist It is unreasonable to expect to receive a blanket consent, covering all procedures, although detailed consent for specific anticipated events might be obtained The patient and the family should have sufficient time and information to make a fully informed decision Because it is difficult to approach parents during catheterization for consent to additional procedures, treatment of life-threatening complications or events that may lead to significant deterioration in the health of the patient must be performed as deemed necessary.34