[Catheter therapy of congenital cardiovascular defects]

The authors analyze the experience gained in catheter operations performed at their Department over the recent 28 years. A total of 500 balloon (Rashkind) and 35 knife (Park) atrioseptostomies were performed in critical patients with different "blue" congenital diseases over this period. An immediate hemodynamic effect at the operation table was attained in 95% of patients. Transluminal balloon valvuloplasty (TLBVP) was performed in 372 patients with valvular stenosis of the pulmonary artery. The results of this operation depend on the patient's age, anatomy of the defect, and correct choice of the diameter of balloon catheter. This intervention is particularly effective in patients aged under 1. In patients with combined valvular and infundibular stenosis the results of TLBVP depend on the severity of stenosis and age of patient. An attempt at TLBVP of congenital aortal stenosis was undertaken in 67 patients. Valvuloplasty was carried out in 57 patients. The operation was effective in 13 (62%) out of 21 patients aged under 1. The mortality in this group was 5.5%. Balloon valvuloplasty of the pulmonary artery was carried out in 71 patients with cyanotic congenital heart diseases. The intervention helped eliminate the critical state, rise the systolic pressure in the pulmonary artery, improve blood saturation with oxygen, and evade the operation for creation of a systemic-pulmonary anastomosis. Isolated and postoperative stenoses of pulmonary arteries were removed in 65 patients. Six Johnson and Johnson stents were effectively implanted to 3 patients with rigid postoperative stenoses; in 32 patients transluminal balloon angioplasty (TLBAP) for coarctation and recoarctation of the aorta brought about a satisfactory immediate hemodynamic effect. TLBAP of Blalock-Taussig's stenosed anastomosis were performed in 60 patients with various cyanotic congenital heart diseases. Its results were good in 39 (65%) patients, satisfactory in 19 (31.7%), and unsatisfactory in only 2 (3%) cases. Of the novel endocardial interventions, dilatation of the conduit following Rastrelli's operation, creation of a defect of the atrial septum after Fontain's operation, and embolization of the coronary-cardiac fistulas and of patent ductus arteriosus were carried out. This review demonstrates wide use of endocardial surgery methods in the treatment of some congenital heart diseases; in many cases such treatment may be an alternative to surgical interventions.