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  • Review Article
  • Published:

Interventional cardiology in adults with congenital heart disease

Nature Reviews Cardiology volume 10, pages 662–678 (2013)Cite this article

Subjects

Key Points

  • The population of adults with congenital heart disease is increasing owing to the improved survival of paediatric patients with these conditions

  • Physicians with expertise in performing interventions in patients with congenital structural lesions are needed

  • Treatment of patients with congenital and acquired structural heart disease requires specialized catheterization laboratories, the integration of imaging modalities, and a collaborative multidisciplinary model for patient care and decision-making

  • With continued advancement in interventional technology and techniques, the use of minimally invasive and percutaneous interventions in this population of patients is expected to grow

Abstract

Interventional cardiac catheterization has become an integral component of the management of adults with congenital heart disease. The origins of this approach come from the paediatric interventional experience, although techniques and indications for interventional cardiac catheterization in adults are now being developed for use in the burgeoning field of adult congenital heart disease. Progress in the application and acceptance of interventional cardiac catheterization in this setting has been swift, and the pace is quickening. This Review provides a broad overview of some of the most common procedures used in the treatment of adults with congenital heart lesions, with an emphasis on new tools that have revolutionized the field. Specifically, we discuss interventions that can be broadly classified into the following groups: techniques for closing shunt lesions, valvular interventions, methods for achieving patency of vascular obstructions, and selected additional interventions applicable to some complex lesions. We emphasize the need for a thorough understanding of the anatomy of the lesion, its natural or unnatural history, and indications for intervention before the procedure takes place. Such procedures must be performed in centres where the operators are knowledgeable of the lesions being addressed, with full surgical, anaesthetic, nursing and imaging support.

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Figure 1: Percutaneous closure of ostium secundum defects in adult patients.
Figure 2: Percutaneous closure of ventricular septal defects in adult patients.
Figure 3: Percutaneous closure of the patent arterial duct in adult patients.
Figure 4: Balloon dilatation in adult patients with pulmonary valve stenosis.
Figure 5: Balloon dilatation in adult patients with aortic stenosis.
Figure 6: Percutaneous pulmonary valve implantation in adults with congenital heart disease.
Figure 7: Presentation and percutaneous treatment of aortic coarctation in adults with congenital heart disease: angiographic examples of arch coarctation.
Figure 8: Simple and complex presentations of pulmonary artery stenosis in adults with congenital heart disease.
Figure 9: Occlusion of venovenous collaterals in adult patients with a Fontan circulation.
Figure 10: Percutaneous repair of atrial baffle leaks or stenosis in adult patients with surgically repaired dextrotransposition of the great arteries.

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Authors and Affiliations

  1. Departments of Medicine and Pediatrics, Division of Cardiology, Cornell Centre for Adult Congenital Heart Disease, Weill Cornell Medical College, New York Presbyterian Hospital, 520 East 70th Street, Starr-4, New York, 10021, NY, USA

    Harsimran S. Singh

  2. Department of Medicine, Division of Cardiology, Toronto General Division, University Health Network, 200 Elizabeth Street, Toronto, M5G 2C4, ON, Canada

    Eric Horlick & Mark Osten

  3. Department of Pediatrics, Division of Cardiology, The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto School of Medicine, 555 University Avenue, Toronto, M5G 1X8, ON, Canada

    Lee N. Benson

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  1. Harsimran S. Singh
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Contributions

H. S. Singh researched the data for the article. H. S. Singh, E. Horlick, M. Osten and L. N. Benson contributed to discussion of the article content and writing the manuscript. H. S. Singh, E. Horlick and M. Osten undertook review and editing of the manuscript before submission.

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Correspondence to Lee N. Benson.

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Singh, H., Horlick, E., Osten, M. et al. Interventional cardiology in adults with congenital heart disease. Nat Rev Cardiol 10, 662–678 (2013). https://doi.org/10.1038/nrcardio.2013.127

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