Interventional cardiology

Abstract 

The concept that many serious defects can be effectively treated on a day-case basis without the need for incision has revolutionized our approach to many congenital heart defects. Interventional cardiology has undergone tremendous expansion and change over the past 20 years, many new techniques and devices having been introduced. Balloon valvuloplasty has become the treatment of choice for pulmonary valve stenosis at all ages and is also the treatment of choice for aortic valve stenosis in neonates, children and young adults. Endovascular stent implantation has been shown to be more effective than surgery for postoperative pulmonary artery stenosis and coarctation in older patients. The occlusion of intra- and extracardiac communications such as atrial septal defects, ventricular septal defects and patent ductus arteriosus with self-expanding preshaped devices matched to the defect has become routine. Electrical re-wiring of the heart with either a pacemaker or catheter ablation therapy provides curative treatment for many arrhythmias. Recent advances include the use of stents as a vehicle to implant pulmonary valves in failing surgical right ventricle-to-pulmonary artery conduits and the completion of Fontan circulations with covered stents to create intracardiac conduits. Although interventional cardiac catheterization has replaced surgery as the primary treatment for a number of congenital heart defects, it has also provided an additional and complementary treatment to surgery for many residual defects. Major ‘re-plumbing’ such as the arterial switch operation for transposition of the great arteries remains the province of the surgeon.

Keywords:  Interventional cardiology, Congenital heart disease, Occlusions, Stents