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Interventional catheterization in surgically treated patients with congenital heart disease
B Friedli1, I Oberhänsli, B Faidutti
1Department of Paediatrics Faculty of Medicine Geneva, Switzerland.
Insights
Interventional catheterization offers alternatives and adjuncts to surgery for congenital heart defects. Catheter techniques effectively treat stenoses and close unwanted vessels, improving outcomes after cardiac surgery.
Area of Science:
- Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Interventional catheterization serves as an alternative to surgery for certain congenital heart defects.
- It is also used in conjunction with surgery for complex malformations like pulmonary atresia with VSD and aortopulmonary collaterals.
- Catheter-based interventions can correct post-surgical sequelae or residual lesions, potentially avoiding repeat surgeries.
Purpose of the Study:
- To review the role and efficacy of interventional catheterization in managing congenital heart defects.
- To discuss the application of balloon dilatation and stenting for various stenotic lesions.
- To evaluate the use of catheter techniques for closing unintended vessels and defects post-surgery.
Main Methods:
- Review of interventional catheterization procedures for congenital heart defects.
- Focus on balloon dilatation and stenting for pulmonary artery branch stenoses, venous obstructions, and recoarctations.
- Assessment of vessel closure techniques, particularly for aortopulmonary collaterals.
Main Results:
- Balloon dilatation is often effective for recoarctation.
- Stenting is frequently required for optimal results in pulmonary branch stenoses.
- Pulmonary vein stenting has yielded disappointing outcomes; closing aortopulmonary collaterals is a common post-surgical intervention.
Conclusions:
- Interventional catheterization is a valuable tool in the management of congenital heart defects, both as an alternative and in conjunction with surgery.
- Specific techniques like balloon dilatation and stenting show variable success rates depending on the target lesion.
- Further evaluation is needed for certain procedures, such as pulmonary vein stenting, while others, like collateral vessel closure, are well-established.
Abstract:
Interventional catheterization is an alternative to surgery for some congenital heart defects. For other malformations, the surgeon and the interventionist will join in an effort to obtain an optimal result: the typical example is pulmonary atresia with VSD and aortopulmonary collaterals. In other cases, the cardiologist may be called upon to intervene with catheter techniques to correct sequelae or residual lesions after surgical correction, avoiding redo surgery. Most often, the task consists of opening stenoses by balloon dilatation and/or stenting the main targets being pulmonary artery branch stenoses, venous obstructions after Mustard procedure, and recoarctations. Whereas simple balloon dilatation of recoarctation often brings good results, stents are often needed to obtain optimal results in pulmonary branch stenoses. Stenting of pulmonary veins has been disappointing. Closing unwanted vessels and defects is another task for the interventional cardiologist after cardiac surgery. Here, the most frequent procedure is closing aortopulmonary collaterals in pulmonary atresia and VSD after corrective surgery. Advantages and limitations of these procedures are discussed.