Interventional catheter therapy in adults with congenital heart disease

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Abstract

Many techniques commonly employed in the pediatric interventional catheterization laboratory have also gained successful application in the treatment of the adult patient with congenital heart disease. This article will review a variety of these interventional techniques and their results in the adult patient population.

Introduction

There is an ever-growing population of adult patients with congenital heart disease. Many of these patients are benefiting from transcatheter interventional techniques that have become routine in the care of the pediatric patient with congenital heart disease. This review will provide an overview of historically pediatric interventional techniques as applied to the adult patient with both operated and unoperated congenital heart disease.

Section snippets

Balloon pulmonary valvuloplasty

Congenital valvar pulmonary stenosis is a relatively common disorder diagnosed in the pediatric population, occurring in 5–10% of children with congenital heart disease. In neonates, infants and children, percutaneous balloon pulmonary valvuloplasty is the therapeutic procedure of choice, when intervention is indicated [1].

Use of this percutaneous technique has naturally extended to larger populations of adolescents and adults with isolated valvar pulmonary stenosis. In general, relief of

Balloon angioplasty

Balloon angioplasty remains an important interventional technique for the treatment of both native and post-operative stenosis in the patient with congenital heart disease. Improvements in catheter design have enabled introduction of higher pressure, lower profile balloons resulting theoretically in less vascular injury and greater success. Despite the gaining popularity of primary intravascular stent deployment in the adult patient, primary balloon angioplasty remains an accepted

Percutaneous balloon mounted stent deployment

Primary placement of endovascular stents is an attractive option in the adult patient with postoperative or native stenoses. Stent placement offers the primary advantage of providing a more rigid resistance to vessel recoil without the need for over-dilation of the stenotic vessel as is necessary with angioplasty. The large delivery systems required for stent delivery pose little problem in the adult patient as compared to the pediatric patient. These benefits must be weighed against the risk

Atrial septal defect

Atrial septal defects represent one of the most common congenital heart defects detected in adults [34]. Over time the increased volume load on the right heart can lead to right ventricular failure, arrhythmias, and Eisenmenger's syndrome with irreversible pulmonary hypertension. Surgical repair of atrial septal defects in adults has been shown to improve clinical status and long-term outcome [35], [36]. Surgery is not without significant complications which include postpericardiotomy syndrome,

Patent ductus arteriosus

Patent ductus arteriosus (PDA) is a relatively uncommon isolated cardiovascular anomaly in the adult patient. However, the persistence of this unrecognized defect into adulthood places the patient at risk for known complications including endocarditis, pulmonary hypertension, congestive heart failure and premature death [56], [57], [58]. For these reasons, closure of the PDA in those patients without irreversible pulmonary vascular disease or other medical risk factors is typically recommended.

Summary

Advances in transcatheter intervention have continued to benefit the adult with undiagnosed, palliated or ‘repaired’ congenital heart disease. As this diverse patient population expands in number and complexity, so do the challenges presented to the interventional cardiologist in providing them with optimal and sometimes definitive transcatheter treatment options. In an increasing number of situations, the role of such percutaneous techniques assumes a central role, in conjunction with or in

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