Transcatheter interventions in adult congenital heart disease

Abstract

Recent reports have suggested that the number of adults with congenital heart disease (CHD) has surpassed pediatric numbers and that approximately 1 in 150 adults has some form of CHD (Marelli et al., Circulation 115:163-172, 2007; Warnes et al., Circulation 118:2395-2451, 2008). Significant rates of intervention and re-intervention are required in this cohort of patients with one report demonstrating 20 % of young adults with CHD requiring cardiovascular surgery (Zomer et al., Circulation 124:2195-201, 2011). Increasingly, transcatheter alternatives to surgery exist in this population particularly in the field of transcatheter pulmonary valve replacement (tPVR), and recommendations for catheter intervention in adults with CHD have been published in the context of overall care of these patients (Warnes et al., Circulation 118:2395-2451, 2008). Case complexity will vary according to the underlying diagnosis ranging from more straightforward interventions such as atrial septal defect closure to complex stenting interventions for interatrial baffle leak in patients following atrial switch surgery for transposition of the great arteries. Many of the more complex patients may have had multiple previous interventions, and detailed review of previous data as well as sensible use of pre-procedural imaging techniques including cardiac CT and MRI is essential. This chapter will outline some of the procedural techniques and the diagnostic imaging tools used to optimize patient selection and procedural success. Outcome data where available will also be discussed in relation to the range of transcatheter interventions seen in this patient group.