Catheter intervention for adult patients with congenital heart disease

Adult congenital heart disease is one of the most important clinical issues not only for pediatric cardiologists but also adult cardiologists. After the introduction of catheter intervention for atrial septal defect in the pediatric population, therapeutic advantages of this less invasive procedure now focused on even geriatric patients. The most valuable clinical benefit of this procedure is the significant improvement in symptoms and daily activities, which result from the closure of left to right shunt without thoracotomy or cardiopulmonary bypass surgery. Although currently available therapeutic options for device closure for congenital heart disease in Japan are limited to atrial septal defect, patent ductus arteriosus, or some vascular abnormalities such as coronary arteriovenous fistula, various new techniques or devices such as ventricular septal defect device, pulmonary valve implantation, are going to be introduced in the near future. To perform safely and achieve good procedure success, real time imaging plays an important role in interventional procedures. Real time three-dimensional transesophageal echocardiography can provide high quality imaging for anatomical evaluation including defect size, surrounding rim morphology, and the relationship between device and septal rim. In adult patients, optimal management of comorbidities is an important issue, including cardiac function, arrhythmias, pulmonary function, and renal function. In particular, atrial arrhythmias are key issues for long-term outcome. Because the interventional procedures are not complication-free techniques, the establishment of a surgical back-up system is essential for achieving a safe procedure. Finally, the establishment of a team approach including pediatric and adult cardiologists, cardiac surgeons, and anesthesiologists is the most important factor for a good therapeutic outcome. Their roles include pre-interventional hemodynamic evaluation, good imaging technique for anatomical evaluation, management of comorbidities, and surgical back up.