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[1000 cardiac catheterizations in congenital heart disease]
Insights
Percutaneous therapeutic cardiac catheterization is vital for congenital heart disease. This study of 1000 procedures shows increasing use and safety, with low complication rates for various interventions.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pediatric Cardiology
Context:
- Percutaneous therapeutic cardiac catheterization has grown significantly in treating congenital heart disease over 15 years.
- This experience encompasses 1000 procedures performed between 1993-1997.
- A substantial portion of procedures (55%) were in children aged 1-12 years, with 20% in infants and 11.3% in adults with congenital defects.
Purpose:
- To report on the experience with 1000 percutaneous therapeutic cardiac catheterizations for congenital heart disease.
- To analyze the types of procedures performed, patient demographics, and complication rates.
- To discuss the current role and future development of transcatheter interventions in this patient population.
Summary:
- The study details 1000 cardiac catheterizations from 1993-1997, with a notable increase in therapeutic interventions (from 33% to 63%).
- 425 therapeutic procedures included valvular dilations, vessel angioplasties, closure procedures, and electrophysiological interventions, with 31.3% utilizing novel techniques.
- Complication rates were low (8.5% minor, 0.6% major), with most being manageable and self-limiting.
Impact:
- This experience highlights the safety and efficacy of percutaneous therapeutic cardiac catheterization in congenital heart disease.
- The findings support the consolidation of transcatheter methods, emphasizing the need for technological advancement for complex lesions.
- Longer follow-up studies are crucial to further establish the long-term role of these minimally invasive techniques.
Abstract:
Over the past 15 years, percutaneous therapeutic cardiac catheterization has become increasingly important in the treatment of congenital heart disease. We describe our experience in 1000 such catheterizations between 1993-1997. 55% were in 1-12-year-olds; only 20% were in patients younger than 1 year old and 11.3% were in adults with congenital heart defects. In about 50% it was at least a second cardiac catheterization. Overall, there were 425 therapeutic cardiac catheterizations, increasing from 33% in the first 200 procedures, to 63% in the last 200. We performed 30 different types of therapeutic catheterizations: 23.3% were valvular dilations, 21.4% vessel angioplasties, 36.9% closure procedures, 9.2% electrophysiological procedures, and 9.2% miscellaneous. In 31.3% of therapeutic catheterizations we used 12 new procedures. Minor complications occurred in 8.5% and major in 0.6%; most complications were successfully treated or were self-limited and there was no residual damage. In this report the current role of each type of major catheterization is discussed on the basis of our experience. Further development of technology for lesions not amenable to currently available transcatheter methods, and longer follow-up for current techniques will consolidate the role of therapeutic cardiac catheterization in congenital heart disease.