Percutaneous Catheter Techniques for Management of Congenital Heart Disease

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Citation
US Cardiology, 2006;3(2):116-20

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Surgical repair has been the cornerstone of treatment for congenital heart diseases (CHD). However, cardiac catheterization has evolved from being a diagnostic modality to a therapeutic one in the past four decades. Application of catheter-based therapy has become the standard of care for some congenital heart defects, thus obviating surgery. This review will discuss congenital heart defects that are amenable to percutaneous, non-surgical therapy under two broad headings, namely established procedures and evolving procedures. Within these headings, we also discuss instances of therapeutic cardiac catheterization complementing surgery and the evolving hybrid strategies that combine surgical and catheter techniques to achieve better results than either can achieve alone.

Established Procedures
Balloon Valvuloplasty (Pulmonary and Aortic Valves)

In current medical practice, balloon valvuloplasty is considered first-line management for pulmonary and aortic valve stenosis. Balloon pulmonary valvuloplasty (BPV) is performed for patients with mean Doppler pressure gradients exceeding 30mmHg. In this procedure, a low-profile, low-pressure balloon is inflated across the valve and stenosis relieved. It is effective in over 90% and has favorable long-lasting results.1 Valves with thin leaflets and minimal dysplasia, characterized by doming appearance in echocardiograms, respond better than severely dysplastic valves. Pulmonary valvular regurgitation induced by this procedure is usually tolerated well for several years. In contrast, balloon aortic valvuloplasty (BAV) carries a higher procedural risk and relatively lower success rate.2 Aortic valve regurgitation induced by balloon valvuloplasty may be relatively poorly tolerated. For these reasons, BAV is considered more palliative than BPV and BAV is usually not performed until mean Doppler pressure gradient exceeds 50mmHg or signs of left ventricular (LV) pressure overload occur on ECG.

Coarctation of Aorta
Native Coarctation

Balloon angioplasty of native coarctation of aorta remains controversial among pediatric cardiologists.3 Some believe that surgical repair should be the first-line management for all native coarctation of aorta in infants and young children unless significant comorbidities preclude surgical repair. Recoarctation rate and aneurysm formation after the balloon dilatation are concerns. Balloon angioplasty and primary stenting of coarctation of aorta are successfully carried out in young adulthood and beyond.

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References
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