Trans-Catheter Treatment in Children and Adults with Congenital Heart Disease
Pp. 153-187 (35)
Gianfranco Butera, Zakhia Saliba, Luciane Piazza, Massimo Chessa, Diana Negura, Angelo Micheletti, Carmelo Arcidiacono and Mario Carminati
Thanks to significant advances in techniques and devices, trans-catheter
treatment of congenital heart disease has taken important steps forward over the last
decades. This paper summarizes the most relevant advances in percutaneous therapy of
congenital heart malformations, highlighting the available procedures in 3 main groups:
balloon dilatation and/or stenting of valves and vessels, device closure of intra-cardiac
or extra-cardiac communications and pulmonary valve implantation.
1- Percutaneous treatment of valve stenosis can now be effective in a high percentage of
cases either in newborns or in adult patients. Indeed, pulmonary or aortic valve dilation can
be performed using one or two balloons with very good early and long-term results.
Systemic or pulmonary vessel stenosis (either native or post-surgical) can be effectively
treated by balloon angioplasty or stent implantation. High-pressure or cutting balloons are
highly useful for native lesions, while the relief of post-surgical stenoses can be achieved
by stent implantation. To date, the only significant limitation to this latter approach is the
size of the patient in terms of potentiality of growth, although the use of bio-absorbable
stents could overcome this drawback, allowing the treatment of even newborns or small
infants. Native aortic coarctation can be effectively approached by balloon dilatation in
newborns and infants, while stent implantation is suggested in patients older than 8 years of
age. However, post-surgical re-coarctation can be successfully treated by balloon
angioplasty (preferably in low-weight patients) or stent implantation.
2- Percutaneous closure of atrial septal defect and patent foramen ovale is possible in
most patients using devices with different mechanism and physiology. This approach
makes it possible to tailor the device to the defect anatomy and size. Early and longterm
results of this technique are very satisfactory, with closure rate near to 100% and
very low complications rate. Device closure of muscular ventricular septal defects is
possible and safe also in low-weight infants, while the percutaneous approach to
membranous ventricular septal defect should be indicated in patients older than 6 years
due to high risk of heart block in younger patients. Patent ductus arteriosus can be
safely approached by percutaneous techniques at any age, although this treatment is
more challenging in patients weighting less than 5 kg. The most used device are
detachable coils or Amplatzer Duct Occluder devices, with very high success rate and
low complication rate.
3- The first percutaneous pulmonary valve replacement was performed almost 10 years
ago by Bohnoeffer et al. Nowadays, this approach is widely used in patients older than
5 years and/or weighting more than 20 kg with pulmonary conduit stenosis and/or
insufficiency. In these patients the Melody® valve can be effectively implanted with a
high rate of success and anticipated good effectiveness over a mid-term follow-up.
Congenital heart disease, catheterization, percutaneous intervention,
aortic coarctation, aortic valvuloplasty, atrial septal defect, Melody valve, patent
ductus arteriosus, pulmonary branch stenosis, pulmonary valvuloplasty,
ventricular septal defect.
Pediatric Cardiology, Policlinico San Donato, via R. Morandi n. 31 - 20097, San Donato Milanese (Milan) Italy