Recent advances in cardiac catheterization for congenital heart disease

Abstract

The field of pediatric and adult congenital cardiac catheterization has evolved rapidly in recent years. This review will focus on some of the newer endovascular technological and management strategies now being applied in the pediatric interventional laboratory. Emerging imaging techniques such as three-dimensional (3D) rotational angiography, multi-modal image fusion, 3D printing, and holographic imaging have the potential to enhance our understanding of complex congenital heart lesions for diagnostic or interventional purposes. While fluoroscopy and standard angiography remain procedural cornerstones, improved equipment design has allowed for effective radiation exposure reduction strategies. Innovations in device design and implantation techniques have enabled the application of percutaneous therapies in a wider range of patients, especially those with prohibitive surgical risk. For example, there is growing experience in transcatheter duct occlusion in symptomatic low-weight or premature infants and stent implantation into the right ventricular outflow tract or arterial duct in cyanotic neonates with duct-dependent pulmonary circulations. The application of percutaneous pulmonary valve implantation has been extended to a broader patient population with dysfunctional ‘native’ right ventricular outflow tracts and has spurred the development of novel techniques and devices to solve associated anatomic challenges. Finally, hybrid strategies, combining cardiosurgical and interventional approaches, have enhanced our capabilities to provide care for those with the most complex of lesions while optimizing efficacy and safety.

Stenting of Right Ventricular Out Flow Tract: Analysis of 32 Cases from Catheterization Laboratory of a Paediatric Cardiac Centre

“…There was no procedure related mortality. [6][7] . This procedure not only allowed somatic and pulmonary growth but also help to get rid from comorbidities 8-9. In our institution, RVOT stenting is offered to get benefit for interim period with good quality of life and positive growth curve until they can manage cost of definitive surgery.…”

“…3Aortogram to look for close proximity of RVOT to coronary arteries (4) Placement of exchange wire to branch pulmonary artery. (5) Placement of long sheath or guide catheter over the wire (6) Placement of stent with side arms injection for checking position of stent. The premounted stent over a balloon was inflated manually with indeflator up to the prescribed nominal pressure i.e.…”

Interventional Treatment of Cardiac Emergencies in Children with Congenital Heart Diseases

“…44,45 The major complications related to this procedure are perforation of the RVOT and hemopericardium, damage of the tricuspid valve apparatus, stent dislodgement into the right ventricle, stent embolization into the aortic arch followed by moderate to severe aortic valve regurgitation, or stent thrombosis. [44][45][46][47][48][49][50][51][52][53]…”

3D printing applications for percutaneous structural interventions in congenital heart disease

“…3D models have been shown to be especially useful in devising percutaneous interventions for treatment of CHD. In recent years, there has been a remarkable evolution of catheterization techniques and technologies, including the development of numerous minimally invasive techniques to treat patients with CHD [3,6] . Catheter-based interventions have become the standard of care for a variety of procedures involving valve pathology, septal defects, and vascular abnormalities [6] .…”

“…In recent years, there has been a remarkable evolution of catheterization techniques and technologies, including the development of numerous minimally invasive techniques to treat patients with CHD [3,6] . Catheter-based interventions have become the standard of care for a variety of procedures involving valve pathology, septal defects, and vascular abnormalities [6] . 3D models have the potential to provide additional anatomic insight and can be used to mimic device or stent implantations prior to the procedure.…”