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As the diagnostic role of cardiac catheterization has diminished over the years, its role as a mode of primary therapy has exponentially increased. In most large congenital cardiac centers today more than 70% of all children undergoing cardiac catheterization have an interventional therapy as part of the procedure. Interventional cardiac catheterization has become the standard of care for treating an increasing number of congenital heart lesions, while in others it remains investigational (Table 499-1). Common interventional procedures include balloon septostomy in neonates with d-transposition of the great arteries, balloon valvoplasty in valvar pulmonic or aortic stenosis, balloon angioplasty with or without stent repair of branch pulmonary artery stenosis or coarctation of the aorta, device closure of a patent ductus arteriosus, atrial septal defect, muscular ventricular septal defect, and embolization of abnormal venous or arterial vessels. Investigational interventional catheter based treatments include stented valve implant for pulmonary insufficiency, ductal stenting for first stage treatment of infants with hypoplastic left heart syndrome or pulmonary atresia, and fetal intervention for critical aortic or pulmonic stenosis to promote ventricular growth in utero.

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Table 499-1. Diseases Treated with Interventional Catheterization Procedures
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Interventional procedures are directed at avoiding, postponing, or complementing surgery with its attendant risks, scars, and lengthy hospitalization and recovery times. Occasionally there is no suitable surgical procedure. Most patients treated with interventional catheterization go home the same day as the procedure and can return to full activity within 5 days. The therapeutic procedures performed in pediatric populations are dilatations, valve implants, or closures. Dilatations are performed using balloons alone or in combination with stents, valve implants use specially designed valved stents, whereas closures are done with embolization coils or specially designed devices or plugs.

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An unrestrictive atrial septal defect may be necessary for patients with certain cardiac abnormalities. Adequate mixing through an ...

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