Transcatheter management of cyanotic congenital heart defects: A review

Abstract

USASummary: In this review, the role of transcatheter methods in the management of cyanotic congenital heart defects is discussed. In patients with interventricular right-to-left shunting secondary to pulmonary outflow tract obstruction (most commonly tetralogy of Fallot), balloon dilatation may be an effective palliative procedure in a substantial proportion of patients, obviating the need for a palliative shunt. We would recommend this if the patient's size or cardiac anatomy makes that patient an unsuitable candidate for safe total surgical correction. Infundibular myectomy with atherectomy catheter in tetralogy of Fallot patients may become a useful adjunct in the management of these infants. Cyanotic children with interatrial right-toleft shunt secondary to severe valvar pulmonary stenosis respond to balloon pulmonary valvuloplasty in a manner similar to that seen with isolated pulmonary valve stenosis. In these patients, balloon valvuloplasty is the treatment of choice and may be corrective in most cases. In patients with a narrowed Blalock-Taussig shunt, balloon angioplasty may improve pulmonary oligemia and systemic arterial hypoxemia and may obviate the need for a second systemic-to-pulmonary artery shunt. Balloon angioplasty is recommended if the patient's cardiac defect is not amen- able to surgical correction at a low risk either because of the size of the patient or because of the complexity of the cyanotic heart defect. In patients with pulmonary valve atresia, initial opening of the atretic pulmonary valve by either laser or surgery with subsequent balloon dilatation is potentially beneficial in reducing the total number of surgical procedures that these children are likely to require. However, further clinical trials are needed prior to their general use.

Long-term outcome of the right ventricular outflow tract palliation procedure in children with cyanotic congenital heart disease: A case-series study

“…In surgical repairing procedures, resection of infundibulum and repair of RVOT with a long-term following of surgical prognosis is considered (9). Despite favorable outcome of operation, replacement of pulmonary valve due to pulmonary insufficiency may be essential (10).…”

Pulmonary atresia with intact ventricular septum

“…• The objective of any treatment plan is to achieve a four-chamber, biventricular heart, with completely separate pulmonary and systemic circulations; this plan has been reviewed time to time by this author [3,[13][14][15]. This aim may be achieved in the absence of 1) right ventricular-dependent coronary circulation, 2) severe right ventricular hypoplasia, and 3) infundibular atresia.…”

Management of Congenital Heart Disease: State of the Art—Part II—Cyanotic Heart Defects

“…If the predominant obstruction is at the pulmonary valve level, though uncommon, balloon pulmonary valvuloplasty [12,13] to increase the pulmonary blood flow may be performed; balloon pulmonary valvuloplasty apart from increasing pulmonary blood flow, promotes growth and development of the pulmonary artery (Figure 2) and left ventricle so that a total surgical corrective procedure could be performed safely at a later time [12,13,14,15,16].…”