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[Therapeutic catheterization in adults with congenital cardiopathy]
1Servicio de Pediatría, Instituto Nacional de Cardiología Ignacio Chávez, INCICH, Juan Badiano No. 1, Col. Sección XVI, Tlalpan, 14080 México, D. F. zabal@cardiologia.org.mx
Insights
Therapeutic cardiac catheterization effectively treats common congenital heart diseases in adults. Key factors like valve anatomy and residual gradient influence long-term outcomes for pulmonary stenosis and aortic coarctation.
Area of Science:
- Cardiology
- Interventional Cardiology
- Adult Congenital Heart Disease
Context:
- Congenital heart diseases (CHDs) frequently persist into adulthood, necessitating specialized interventions.
- Therapeutic cardiac catheterization offers minimally invasive treatment options for adult CHD patients.
- This study focuses on four prevalent CHDs: valvular pulmonary stenosis, aortic coarctation, patent ductus arteriosus, and atrial septal defect.
Purpose:
- To evaluate the efficacy and outcomes of therapeutic cardiac catheterization in adult patients with four common congenital heart diseases.
- To identify key determinants of immediate and long-term success for each specific condition.
Summary:
- Valvular pulmonary stenosis (20 patients): Valve anatomy was the primary predictor of results.
- Aortic coarctation (54 patients): Residual gradient, influenced by anatomy and stent use, determined long-term success.
- Patent ductus arteriosus (17 patients): Complete occlusion was achieved using coils or Amplatzer duct occluder without complications.
- Atrial septal defect (39 patients): The Amplatzer septal occluder yielded good results.
Impact:
- Demonstrates the feasibility and effectiveness of catheter-based interventions for adult CHDs.
- Provides insights into patient selection and procedural optimization for improved long-term outcomes.
- Highlights the importance of considering specific anatomical factors and device choices for successful treatment.
Abstract:
We report our results with therapeutic cardiac catheterization in adult patients with four of the most frequent congenital heart diseases. 1) Valvular pulmonary stenosis. We treated 20 patients older than 15 years of age and we concluded that anatomy of the valve is the most important variable related to immediate and long-term results. 2) Aortic coarctation. In a group of 54 patients, 32 treated with angioplasty alone and 22 with stent, we concluded that the main determinant for a good long-term result is the residual gradient, which is related to the coarctation anatomy and the use of stent. 3) Patent ductus arteriosus. In 17 adult patients, the ductus was occluded with coils in 5 and with the Amplatzer duct occluder in 12 with complete occlusion of the ductus in all cases followed for a mean period of 18 months and without complications. 4) Atrial septal defect. We treated 39 adult patients using the Amplatzer septal occluder with good results.