Interventional Catheterization in Adult Congenital Heart Disease

Improved medical and surgical therapies for children with congenital heart disease have resulted in a growing population of patients reaching adulthood.1,2 Over this same time, the field of interventional cardiology has experienced significant growth, driven by technological improvements and better understanding of the mechanisms and intermediate-term results of individual procedures. Consequently, for adults with uncorrected or previously palliated congenital heart disease, percutaneous therapies have increasing acceptance as reasonable additions, alternatives, and treatments of choice when further surgical or medical intervention is contemplated (Table 1). Currently, interventional cardiology of adult congenital heart disease (ACHD) is a well-established field on its own and, programmatically, is a fundamental component of any center providing care for these patients.3 Although limited safety of interventional procedures for the ACHD population has been suggested in centers without ACHD global care programs,4 the wide variation in clinical presentation, novelty of cardiovascular pathologies (with similarity to as well as marked differences from both congenital and acquired conditions), and potential for concomitant multiple organ system pathology all contribute to situations atypical for standard adult or pediatric laboratories. These concerns, combined with a desire to centralize data collection to establish outcomes assessments for ACHD patients considered for interventional catheterization, lead to the recommendation that such procedures be performed in centers with ACHD expertise and established care programs.3 View this table:TABLE 1. Commonly Practiced Catheter-Based Interventions in ACHD: Indications and Level of Evidence In this article, we review the most commonly performed percutaneous procedures in ACHD, including valvuloplasty, angioplasty, and device closures. We also include discussions concerning complex ACHD patients (Table 2) as well as future directions. View this table:TABLE 2. Potential Interventions in Complex ACHD Patients Pulmonary Valve StenosisPulmonary valve stenosis (PS) is almost always congenital in origin and usually results from commissural fusion of thin and pliable leaflets. Less frequently, the pulmonary …