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Transcatheter intervention in the neonate with congenital heart disease
1Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, USA.
Insights
Interventional cardiology offers safe and effective transcatheter treatments for congenital heart defects (CHD) in infants. These procedures, including balloon valvotomy and angioplasty, are crucial for managing complex cardiac conditions with low risks.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Interventional cardiology has become a vital subspecialty in managing congenital heart disease (CHD) over the last 30 years.
- Transcatheter interventions are routinely performed in neonates for palliation, therapy, or as alternatives to surgery.
Purpose of the Study:
- To review the role and scope of transcatheter interventions in the management of infants with CHD.
- To highlight the variety of procedures and patient populations benefiting from these minimally invasive techniques.
Main Methods:
- Review of common transcatheter interventions for neonatal CHD.
- Description of patient selection criteria for various procedures.
- Summary of procedural outcomes and safety profiles.
Main Results:
- Procedures include atrial septostomy, balloon valvotomy, angioplasty/stenting of vessels, and closure of abnormal vessels.
- Indications span complex defects like transposition of the great arteries, valvar stenoses, coarctation of the aorta, and others.
- These interventions demonstrate high success rates with low morbidity and mortality (<1%) when performed by experienced specialists.
Conclusions:
- Transcatheter interventions are a safe and highly effective cornerstone in the modern management of neonatal congenital heart disease.
- These minimally invasive techniques offer significant therapeutic benefits for a wide range of complex cardiac anomalies in infants.
Abstract:
Over the past 30 years, interventional cardiology has developed as a distinct subspecialty, playing a major role in the management of infants with CHD. In the neonatal period, a wide variety of transcatheter interventions are performed routinely, either as palliation or therapy, as adjunct to surgery, or in place of surgical intervention. Among these are creation or enlargement of ASDs to allow atrial mixing; balloon valvotomy to treat congenital valvar stenoses; balloon angioplasty or stenting of stenotic vessels (pulmonary arteries, coarctation of aorta, or systemic or pulmonary veins) or postoperative anastomoses; closure of [figure: see text] unwanted vessels (congenital fistulae or collaterals); and other miscellaneous interventions. A wide variety of patients are candidates for these procedures, including those with transposition of the great arteries or other defects with transposition physiology, left atrial outlet obstruction and hypertension, severe valvar pulmonary or aortic stenosis, hypoplastic stenotic pulmonary arteries with severe symptomatology, severe coarctation of aorta and high surgical risks, large aortopulmonary collaterals or other hemodynamically significant unwanted vessels, acute thrombosis of certain surgical anastomoses, and many more. In experienced hands, these procedures are highly successful and safe, with a low morbidity and mortality (less than 1%).