Recent advances in pediatric interventional cardiology

Abstract

During the last 10 years, there have been major technological achievements in pediatric interventional cardiology. In addition, there have been several advances in cardiac imaging, especially in 3-dimensional imaging of echocardiography, computed tomography, magnetic resonance imaging, and cineangiography. Therefore, more types of congenital heart diseases can be treated in the cardiac catheter laboratory today than ever before. Furthermore, lesions previously considered resistant to interventional therapies can now be managed with high success rates. The hybrid approach has enabled the overcoming of limitations inherent to percutaneous access, expanding the application of endovascular therapies as adjunct to surgical interventions to improve patient outcomes and minimize invasiveness. Percutaneous pulmonary valve implantation has become a successful alternative therapy. However, most of the current recommendations about pediatric cardiac interventions (including class I recommendations) refer to off-label use of devices, because it is difficult to study the safety and efficacy of catheterization and transcatheter therapy in pediatric cardiac patients. This difficulty arises from the challenge of identifying a control population and the relatively small number of pediatric patients with congenital heart disease. Nevertheless, the pediatric interventional cardiology community has continued to develop less invasive solutions for congenital heart defects to minimize the need for open heart surgery and optimize overall outcomes. In this review, various interventional procedures in patients with congenital heart disease are explored.

Keywords: Catheterization; Congenital heart disease; Intervention.

Fig. 1. Left ventriculogram taken after deployment of the Amplatzer ductal occluder in the perimembranous ventricular septal defect before releasing it. The image shows a well-positioned device and small residual leakage through it. AO, aorta; ADO, Amplatzer ductal occluder; LV, left ventricle.

Fig. 2. Available valves for percutaneous pulmonary valve implantation.

Fig. 3. Severe narrowing of the proximal right pulmonary artery is evident on live fluoroscopy with VesselNavigator (fusion imaging with computed tomography and fluoroscopy) (A), which offers a good 3-dimensional roadmap image for stenting without additional angiography (B). MPA, main pulmonary artery; RPA, right pulmonary artery; LPA, left pulmonary artery.