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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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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 ...