Catheter intervention for congenital heart disease at risk of circulatory failure

Abstract

Percutaneous interventions complement other therapeutic modalities in the management of patients with heart failure secondary to congenital heart disease. The systemic left ventricle can fail when submitted to excessive afterload as seen with critical aortic stenosis or coarctation. Balloon dilation of the aortic valve is safe and effective in establishing adequate forward flow and improving myocardial function in neonates. A large left-to-right shunt caused by a ventricular septal defect or a patent ductus arteriosus can lead to left ventricular failure. In selected infants, device closure of these defects is a therapeutic option. The postoperative right ventricle burdened by chronic residual obstruction and volume overload is at risk of failure. Balloon dilation of the pulmonary valve, pulmonary artery angioplasty with or without stent implantation, and pulmonary conduit stenting are effective in minimizing afterload to the right ventricle. More recently, percutaneously implantable pulmonary valves have become an option, in selected patients, for full rehabilitation of dysfunctional pulmonary conduits. Patients with single ventricle physiology have a fragile physiology, justifying an aggressive catheter interventional approach to optimize hemodynamic characteristics. The hybrid approach to palliation of hypoplastic left heart syndrome has become a viable option in selected centres.