Catheter-based therapies in congenital heart disease: a focus on neonatal innovations

Technological advancements and therapeutic innovations have facilitated revolutionary changes in transcatheter management of patients with congenital heart disease (CHD). In this review, we highlight the evolution of existing and newer transcatheter therapies for management of neonates with CHD.

Ductus arteriosus stenting (DAS) for patients with ductal-dependent pulmonary blood flow has broadly emerged as an alternative to surgical aortopulmonary shunt placement as evidence of therapeutic equivalency, if not superiority, has been demonstrated. The development of pulmonary flow restrictors (PFR) by modification of a commercial device has facilitated percutaneous limitation of pulmonary blood flow in an important subset of higher-risk single- and two-ventricle patients. Lastly, there are challenges to the deployment of stent angioplasty in young children, given the competing demands for a low-profile stent that is later dilatable to adult size. Given limitations to the current repurposing of existing commercial devices designed for other uses, purpose-built device development is underway in an effort to maximize safety, efficacy, and usability.

Over the past decade, there has been substantial growth in the transcatheter management of infants with CHD. With continued technological advancements and multicenter collaborative efforts, it is anticipated that reparative and palliative transcatheter therapies will be increasingly applicable to young patients with CHD.