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Interventional cardiac catheterization
J Pihkala1, D Nykanen, R M Freedom
1Division of Cardiology, Hospital for Sick Children, University of Toronto School of Medicine, Ontario, Canada.
Insights
Transcatheter interventions, including dilations and closures, are vital for congenital heart disease. These minimally invasive procedures offer effective treatment options, often comparable to surgery, improving patient outcomes.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Pediatric Cardiology
Background:
- Transcatheter interventions have gained prominence in managing congenital heart lesions over the last decade.
- These procedures encompass both dilational techniques (septostomy, valvuloplasty, angioplasty, stenting) and closure methods (embolization, device closure).
Purpose of the Study:
- To review the current landscape and applications of transcatheter interventions in congenital heart disease.
- To highlight the efficacy and role of various interventional techniques in different patient populations and lesion types.
Main Methods:
- Review of established and investigational transcatheter techniques for congenital heart defects.
- Analysis of the application of balloon valvuloplasty, angioplasty, stenting, and embolization.
- Evaluation of device closure for septal defects and patent ductus arteriosus.
Main Results:
- Balloon valvuloplasty is the preferred treatment for simple valvar pulmonic stenosis and comparable to surgery for congenital aortic stenosis.
- Balloon angioplasty effectively treats a broad spectrum of aortic, pulmonary artery, and venous stenoses.
- Catheter-delivered coils and investigational devices show success in embolizing vascular connections and closing septal defects and patent ductus arteriosus.
Conclusions:
- Transcatheter interventions are crucial in treating congenital heart lesions, offering alternatives and adjuncts to surgery.
- Combining interventional catheterization with cardiac surgery optimizes outcomes for complex congenital heart disease.
- Well-planned catheterization strategies can reduce the lifetime procedural burden and improve long-term results for patients.
Abstract:
Over the past decade, transcatheter interventions have become increasingly important in the treatment of patients with congenital heart lesions. These procedures may be broadly grouped as dilations (e.g., septostomy, valvuloplasty, angioplasty, and endovascular stenting) or as closures (e.g., vascular embolization and device closure of defects). Balloon valvuloplasty has become the treatment of choice for patients in all age groups with simple valvar pulmonic stenosis and, although not curative, seems at least comparable to surgery for congenital aortic stenosis in newborns to young adults. Balloon angioplasty is successfully applied to a wide range of aortic, pulmonary artery, and venous stenoses. Stents are useful in dilating lesions of which the intrinsic elasticity results in vessel recoil after balloon dilation alone. Catheter-delivered coils are used to embolize a wide range of arterial, venous, and prosthetic vascular connections. Although some devices remain investigational, they have been successfully used for closure of many arterial ducts and atrial and ventricular septal defects. In the therapy for patients with complex CHD, best results may be achieved by combining cardiac surgery with interventional catheterization. The cooperation among interventional cardiologists and cardiac surgeons was highlighted in a report of an algorithm to manage patients with tetralogy of Fallot or pulmonary atresia with diminutive pulmonary arteries, involving balloon dilation, coil embolization of collaterals, and intraoperative stent placement. In this setting, well-planned catheterization procedures have an important role in reducing the overall number of procedures that patients may require over a lifetime, with improved outcomes.