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CRISP - Catheterization RISk Score for Pediatrics Nykanen et al. 2015 CRISP - Catheterization RISk Score for Pediatrics

Browse pre-cath diagnosis, procedure risk & physiologic categories

* Age
* Weight
* Inotropic Support
* Systemic illness / Organ failure
* Physiologic Category
(if multiple variables, choose highest)
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Category 1 Category 2 Category 3
Saturation >80% Saturation 65-79% Saturation <65%
Normal PVRI / No PVO PVRI 4-8 WU.m2 PVRI >8 WU.m2 / fixed PVO
  RVSP <1/2 Systemic (Biventricular heart) RVSP 1/2 - Systemic (Biventricular hearts) RVSP suprasystemic
Anemia - Elective Transfusion Active bleeding / Urgent transfusion  
Dynamic subpulmonary obstruction (no spells) Hypercyanotic spells
Severe systemic AVVR
Legend: AVVR=atrioventricular valve regurgitation, RVSP=Right ventricular (pulmonary) systolic pressure, PVO=Pulmonary vascular obstructive disease, PVRI=Pulmonary vascular resistance with flow indexed for body surface area, WU.m2=Indexed Wood Units
* Pre-Catheterization Diagnosis
(if multiple variables, choose highest)
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Category 1
Aneurysm, Other
Aneurysm, Pulmonary artery
Aneurysm, Ventricular, Right
Aortic valve, Other
Aortopulmonary window
Arrhythmia
Arrhythmia, Heart block, Acquired
Arrhythmia, Heart block, Congenital
Arrhythmia, Heart block, NOS
Arrhythmia, Pacemaker, Indication for replacement
ASD, Common atrium (single atrium)
ASD, Coronary sinus
ASD, NOS
ASD, Secundum
ASD, Sinus venosus
AVSD, Complete
AVSD, Intermediate (transitional)
AVSD, NOS
AVSD Partial (incomplete) (ASD, primum)
Cardiac tumor
Cor triatriatum
Coronary artery anomaly, Anomalous aortic origin
Coronary artery anomaly, Anomalous pulmonary origin (includes ALCAPA)
Double Chamber Right Ventricle
DORV, NOS
DORV, Remote VSD (uncommitted VSD)
DORV, TGA type
DORV, VSD type
Heart Transplant
Miscellaneous, Other
Mitral regurgitation
Normal heart
Partial anomalous pulmonary venous connection
Patent ductus arteriosus
Pectus excavatum or carinatum
Pericardial disease, Other
Pericardial effusion
Pericarditis
PFO
Pulmonary insufficiency
Pulmonary hypertension due to left to right shunt
Pulmonary stenosis, NOS
Pulmonary stenosis, Valvar
Pulmonary valve, Other
Sinus of Valsalva aneurysm
Systemic venous anomaly
Systemic venous obstruction
TGA, IVS
TGA, NOS
Total anomalous pulmonary venous connection, NOS
Total anomalous pulmonary venous connection, Type 1 (supracardiac)
Total anomalous pulmonary venous connection, Type 2 (cardiac)
Tricuspid regurgitation and tricuspid stenosis
Tricuspid regurgitation, non-Ebstein's related
Tricuspid valve, Other
Truncal valve insufficiency
Vascular ring
VSD, Multiple
VSD, NOS
VSD, Single

Category 2
Aneurysm, Ventricular, Left
Aortic aneurysm (including pseudoaneurysm)
Aortic arch hypoplasia
Aortic insufficiency
Aortic stenosis, Subvalvar
Aortic stenosis, Valvar
Aortic valve atresia
Atrial Isomerism, Left
Atrial Isomerism, Right
Cardiomyopathy
Chylothorax
Coarctation of aorta
Conduit failure
Congenitally corrected TGA
Coronary artery anomaly
Coronary artery anomaly, Fistula
DOLV
DORV TOF type
Ebstein's anomaly
Endocarditis
HLHS
Hypoplastic LV
Hypoplastic RV
Interrupted aortic arch
LV to aorta tunnel
MAPCA(s) (without PA-VSD)
Meconium aspiration
Mediastinitis
Mitral regurgitation and mitral stenosis
Mitral stenosis, NOS
Mitral stenosis, Subvalvar
Mitral stenosis, Subvalvar, Parachute
Mitral stenosis, Supravalvar mitral ring
Mitral stenosis, Valvar
Mitral valve, Other
Myocarditis
Peripheral vascular, Other
Persistent fetal circulation
Prosthetic valve failure
Pulmonary artery origin from ascending aorta (hemitruncus)
Pulmonary artery stenosis (hypoplasia), Main (trunk)
Pulmonary artery stenosis, Branch, Central (within the hilar bifurcation)
Pulmonary artery stenosis, Branch, Peripheral (at or beyond the hilar bifurcation)
Pulmonary artery stenosis, NOS
Pulmonary artery, Discontinuous
Pulmonary atresia
Pulmonary atresia, IVS
Pulmonary atresia, VSD (Including TOF with pulmonary atresia)
Pulmonary atresia, VSD-MAPCA (pseudotruncus)
Pulmonary arteriovenous fistula
Primary pulmonary hypertension
Pulmonary venous hypertension
Pulmonary hypertension secondary to pulmonary disease
Pulmonary insufficiency and pulmonary stenosis
Pulmonary stenosis, Subvalvar
Pulmonary venous stenosis
Single ventricle, DILV
Single ventricle, DIRV
Single ventricle, Heterotaxia syndrome
Single ventricle, Mitral atresia
Single ventricle, NOS
Single ventricle, Other
Single ventricle, Tricuspid atresia
Single ventricle, Unbalanced AVSD
TGA, IVS-LVOTO
TGA, VSD
TGA, VSD-LVOTO
TOF
TOF, AVSD
Total anomalous pulmonary venous connection, Type 3 (infracardiac)
Total anomalous pulmonary venous connection, Type 4 (mixed)
Tricuspid stenosis
Truncus arteriosus
Partial anomalous pulmonary venous connection, scimitar

Category 3
Aortic dissection
Aortic insufficiency and aortic stenosis
Aortic stenosis, Supravalvar
Cardiomyopathy, End-stage congenital heart disease
Coronary artery anomaly, Aneurysm
Lung disease, Malignant
Myocardial infarction
Pulmonary vascular disease
Pulmonary embolism
Pulmonary vascular obstructive disease (Eisenmenger’s)
Pulmonary vascular obstructive disease, NOS
TOF, Absent pulmonary valve
Tracheal stenosis

Legend
ALCAPA=Anomalous origin of the left coronary artery from the pulmonary artery, ASD=Atrial Septal Defect, AVSD=Atrioventricular Septal Defect, DOLV=Double outlet left ventricle, DIRV= - Double inlet right ventricle, DILV=Double inlet left ventricle, DORV=Double outlet right ventricle, HLHS=Hypoplastic left heart syndrome. IVS=intact ventricular septum, LV=Left ventricle, LVOTO=left ventricular outflow tract obstruction, MAPCA=major aortopulmonary collateral, NOS=Not otherwise Specified, PA-VSD=pulmonary atresia/ventricular septal defect, PFO=Patent Foramen Ovale, RV=Right ventricle, TGA=Transposition of the great vessels, TOF=Tetralogy of Fallot, VSD=Ventricular Septal Defect


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* Procedure Risk Category
(if multiple variables, choose highest)
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Category 1
Atrial septostomy , balloon
Atrial septostomy static balloon dilation
Balloon angioplasty / native RVOT
Balloon angioplasty / proximal LPA or RPA / dilation < 8 ATM
Balloon angioplasty / RV to PA conduit
Balloon angioplasty / RVOT s/p surgery (no conduit)
Biopsy diagnostic >= 10 kg
Biopsy post transplant
Coil occlusion / device / systemic arterial collaterals
Coil occlusion / LSVC
Coil occlusion / PDA
Coil occlusion / veno-veno collaterals
Device closure / ASD
Device closure / fenestration
Device closure / PDA
Device closure / PFO
Device closure / venous collateral
Hemodynamic catheterization
Interventional techniques / snare foreign body
Interventional techniques / trans-septal puncture
Invasive procedure / central line placement
Invasive procedure / chest tube
Invasive procedure / pericardiocentesis
Other intended hemodynamic alteration / oxygen-nitric trial or inotropes
Other procedures: biopsy, bronchoscopy, drains, echo, TEE
Stent placement / systemic vein
Stent redilation / aorta
Stent redilation / intracardiac / atria
Stent redilation / proximal LPA or RPA
Stent redilation / RV to PA conduit
Stent redilation / systemic artery not aorta
Stent redilation / systemic vein
Ultrasound / IVUS
Valvuloplasty / pulmonary valve >= 1 month age

Category 2
Any catheterization within 72 hours of surgery
Atrial septostomy dilation and stent / diagnosis not single ventricle
Balloon angioplasty / aorta
Balloon angioplasty / lobar segment LPA or RPA / dilation < 8 ATM and < 4 vessels
Balloon angioplasty / proximal LPA or RPA / dilation >= 8 ATM or CB
Balloon angioplasty / systemic artery (not aorta)
Balloon angioplasty / systemic shunt
Balloon angioplasty / systemic vein
Biopsy < 10 kg (not transplant)
Coil / coronary fistula
Coil occlusion / systemic shunt
Device closure / baffle leak
Interventional techniques / atherectomy catheter
Interventional techniques / recanalization of occluded peripheral vessels
Interventional techniques/ recanalization of jailed vessel in stent
Stent placement / aorta
Stent placement / intracardiac / atria
Stent placement / lobar segment LPA or RPA
Stent placement / native RVOT
Stent placement / proximal LPA or RPA
Stent placement / RV to PA conduit
Stent placement / RVOT s/p surgery (no conduit)
Stent placement / systemic artery (not aorta)
Stent redilation / lobar segment LPA or RPA
Stent redilation / pulmonary vein
Valvuloplasty / aorta >= 1 month age
Valvuloplasty pulmonary valve < 1 month age
Valvuloplasty tricuspid

Category 3
Atrial septostomy dilation and stent
Balloon angioplasty / lobar segment LPA or RPA / dilation >= 8 ATM or CB and < 4 vessels
Balloon angioplasty / lobar segment LPA or RPA and >= 4 vessels
Balloon angioplasty or stent / pulmonary vein
Device closure / perivalvar leak
Device closure / VSD
Interventional techniques / atretic valve perforation
Stent placement / intracardiac / ventricular
Stent placement / systemic shunt or ductus arteriosus
Stent redilation / intracardiac / ventricular /ductus arteriosus
Valvuloplasty aorta < 1 month age
Valvuloplasty mitral < 1 year age
Valvuloplasty mitral >= 1 year age

Legend
SD=Atrial Septal Defect, ATM=Atmospheres, CB=Cutting balloon, IVUS=Intravascular ultrasound kg=kilograms, LPA=Left pulmonary artery, LSVC=Left superior vena cava, PDA=Patent ductus arteriosus, PA=Pulmonary artery, RPA=Right pulmonary artery, RV= Right Ventricle, RVOT=Right ventricular outflow tract, TEE=transesophageal echocardiogram, VSD=Ventricular septal defect


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* Procedure Type

Nykanen DG, Forbes TJ, Du W, et al. CRISP: Catheterization RISk score for Pediatrics: A Report from the Congenital Cardiac Interventional Study Consortium (CCISC). Catheter Cardiovasc Interv. 2016;87(2):302-9. PMID: 26527119

[With permission and review by Dr. David Nykanen.]

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