Transcatheter Interventions in Adult Congenital Heart Disease

Interventions for adult congenital heart disease

Advances in imaging diagnostics, surgical techniques and transcatheter interventions for paediatric patients with severe congenital heart disease (CHD) have substantially reduced mortality, thereby extending the lifespan of these individuals and increasing the number of adults with complex CHD. Transcatheter interventions have emerged as an alternative to traditional open-heart surgery to mitigate congenital defects. The evolution of techniques, the introduction of new devices and the growing experience of operators have enabled the treatment of patients with progressively more complex conditions. The general cardiology community might be less aware of contemporary interventions for adult CHD, their clinical indications and associated outcomes than interventional cardiologists and congenital heart specialists. In this Review, we provide a comprehensive evaluation of the available transcatheter interventions for adult patients with CHD.

Percutaneous management of late occluder dislodgement: A case report

Percutaneous closure of ASD is nowadays preferred and more widely performed over surgical closure. The GORE® CARDIOFORM ASD occluder (GCA) is the latest generation of occluder with promising results as it performed well with high successful implant rates (96%) and showed high efficacy in challenging clinical and anatomical situations. We present the case of a 65 female with a 2.5 cm ASD, left atrial hypertension, deficient retroaortic rim, mobile septum primum and hypertrophied septum secundum. She underwent uncomplicated closure with a 44-mm GCA. However, the patient presented to the emergency room five weeks post procedure and was found to be in atrial fibrillation with rapid ventricular response at a rate of 158 bpm. Further workup showed a dislodged GCA device despite appropriate device placement and size selection based on the published instructions for use. We elected to not remove the 44-mm GCA given that it had become adherent to the septum primum but instead used the stiffer Amplatzer septal occluder to stabilize the GCA and occlude the residual defect. Finally, we highly recommend taking device destabilizing factors into consideration when selecting device size.

[The adult with tetralogy of fallot: what the clinical cardiologist needs to know]

Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. After more than seven decades of the first palliative surgery, TOF prognosis has changed dramatically. The prevalence of TOF is approximately 3 per 10 000 births, representing 7 to 10% of congenital heart disease. With a higher survival into adulthood, the clinical cardiologist faces challenges in the management of this population, from severe pulmonary regurgitation to heart failure and ventricular arrhythmias. Its prevalence is approximately 3 per 10 000 live births, representing 7 to 10% of congenital heart disease. This review will describe the most relevant aspects of the care of adult patients with this disease.