Interventional cardiology for congenital heart disease
Approximately 0.8: 1000 newborns are born with some form of dysplasia of the heart. Newborns with severe congenital heart disease are diagnosed immediately after birth and a large percentage will be diagnosed later in childhood or even in adulthood. The majority of the patients born with congenital heart disease will need some anatomic – corrective intervention to restore the structure and function of the heart back to normal.
Congenital Heart Disease Surgery began in 1938 with the first ligation of a patent duct.. Since then, huge advances taken place, while new methods of treating congenital heart disease without open heart surgery have been made available. This is possible by transcatheter interventions, such as implantation of devices and valves inside the heart through the arteries and veins of the body. Transcatheter interventions are widely accepted and performed instead of open heart surgery because of less patient suffering, while the effectiveness and safety for specific diseases, such as valvar and vascular stenosis, etc., are similar or even better than open heart surgery. Percutaneous procedures with cardiac catheterization are performed to dilate valves or vessels with balloons or stent implantation, intracardiac communications closures such as ASD, VSD, PDA with umbrella type devices as well as ablation of arrhythmias with radio-frequency.
In the past 2 decades, percutaneous implantation of heart valves, such as the pulmonary valve in patients with Tetralogy of Fallot or other congenital heart disease have also become a routine procedure. Hospitalization time and patient’s recovery time are rapid, about 1-2 days. In addition, hybrid interventions, which consist of catheterizations in conjunction with mini-surgical interventions, are being performed. These hybrid interventions are performed to avoid the use of extracorporeal circulation (cardiopulmonary bypass) in vulnerable infants, syndromic or extremely complex patients.
Interventional catheterization procedures are performed using fluoroscopy. The last advancement of cardiac catheterizations is their performance without any radiation, by using MRI guidance. In December 2009, the first solely-guided interventional catheterization was performed in Great Britain for the first time world-wide by Dr Tzifa and Professor Razavi. Until now, few centers in the world have acquired the technological infrastructure and the knowledge about performing cardiac catheterization under MRI guidance. At MITERA Children’s Hospital we perform hybrid cardiac catheterizations for pulmonary hypertension, without the use of ionizing radiation. One of its most important applications is during pregnancy, as the usage of ionizing radiation could be harmful to the fetus. The use of MRI guidance for performing cardiac catheterizations without radiation is a revolutionary method that plays an important role in patients where the use of ionizing radiation should be significantly reduced or completely contraindicated.
In conclusion, interventional cardiac catheterisations have in many cases replaced open heart surgery with the same efficiency and safety. They are performed in certain cases, according to international standards and guidelines, when the interventional method is proposed as the first-line treatment of choice, versus open heart surgery. Interventional cardiac catheterization procedures are performed by expert staff in highly specialized units and with cardiac surgical back up, when required.