Pediatric interventional cardiology: the cardiologist's role and relationship with pediatric cardiothoracic surgery

Abstract

The advances in pediatric interventional cardiac catheterization have changed the therapeutic strategy for many patients with CHD. The procedure of choice for valvar stenosis, recoarctation, collateral vessel occlusion, and branch PA stenosis has moved from the operating room to the catheterization laboratory. Effective and safe transcatheter interventions now exist for closure of ASDs, VSDs, and PDAs and are considered viable alternatives to surgical closure. Other interventional catheterization procedures are currently being investigated to complement the surgical management of patients with complex anatomy, including covered stents for repair of aortic aneurysms, covered stents to complete the Fontan circulation in patients after a modified Glenn shunt, multiple stent designs for all vascular stenoses, percutaneous PA band, and transcatheter resurrection of the pulmonary valve in patients with severe pulmonary regurgitation. The rapid advances in the technology used in the catheterization laboratory will serve to improve the care we provide for our patients and extend the range of interventions performed outside of the operating room. Pediatric cardiologists and congenital heart surgeons must understand each other's interventional techniques and how they can be used in a coordinated fashion. This may involve staged therapy with transcatheter intervention before surgery, transcatheter interventions in the operating room, or modifications of surgical techniques to facilitate future interventional catheterization completion of a staged repair of complex disease. This interaction is essential for the optimal management of our patients with both straightforward lesions and complex anatomy.