Clinical Study Of Interventional Cardiology In The Treatment Of Complex Congenital Heart Disease

Part 1 Clinical application of embolization of aortopulmonary collateral arteries in the treatment of complex congenital heart disease Objective To evaluate the usefulness of coil embolization of aortopulmonary collateral arteries in cyanotic complex congenital heart disease.Methods Embolization was performed in 47 patients from November 1992 to November 2007 including 42 patients in whom the vessels were occluded before surgical intervention and 5 patients after surgery due to hemoptysis,intractable heart failure or lung injury. The patients consisted of 29 cases of tetralogy of Follot,13 cases of pulmonary atresia with ventricular defect,2 cases of transposition of great arteries,1 cases of double outlet of right ventricle and 2 cases of partial abnormal pulmonary venous connection.Results Ninety one collateral arteries were identified by cardiac catheterization.Seventy six collateral vessels were successfully occlude and a total of 198 coils were used.Occlusion was complete in 65(85.5%) vessels and subtotal in 11(14.5%) vessels.Six patients died after surgery including 2 patients who received embolization of collateral arteries after surgery intervention.Conclusions We conclude that transcatheter coil embolization is useful in the treatment of abnormal systemic-to-pulmonary vessels in patients with cyanotic complex congenital heart diseases.For the patients who present with intractable congestive heart failure and lung injury after surgery the presence of aortopulmonary arteries should be considered and catheterization and embolization of these vessels should be performed as early as possible.It is necessary to distinguish sole pulmonary blood supply from dual pulmonary blood supply to avoid postoperative pulmonary infarction.Part 2 Balloon Atrial Septostomy in Complex Congenital Heart DiseaseObjective To evaluate the significance of balloon atrial septostomy(BAS) for neonates or infants who were born with transposition of great arteries(TGA) or other congenital heart diseases.Methods There were 11 patients with congenital heart disease received atrial septostomy in our center,10 of them was performed via the x-ray fluoroscopy in the catheterization room and one by the guidance with Doppler eehocardiography.Their preoperative and postoperative data of arterial oxygen saturation,mean pressure gradient between the right and left atriums and clinical symptoms were collected and compared.Results BAS was successfully performed in all the 11 patients.One neonate died after BAS.It was demonstrated that the diameters of atrial septal defect were increased from(3.1±0.6) mm to(9.5±1.6) mm(P＜0.01).The mean pressure gradient between atriums decreased from(7.8±1.8)mmHg to(2.4±1.4)mmHg(P＜0.01). Metabolic acidosis and clinical hypoxic signs improved immediately after the procedures.Conclusions We concludethatthere is great value of balloon atrial septostomy to save the lives of neonates or infants born with TGA and other congenital heart diseases,and to ensure the optimal timing and preoperative conditions for arterial switch and other surgical procedure.Part 3 Transcatheter closure of extracardiac Fontan fenestration by using Amplazter duct or septal occluderObjective The purpose of this study was to describe our experience concerning the transcatheter closure of patent fenestration after total cavopulmonary connection(TCPC) with an extracardiac conduit.Methods Three patients(ages 7,14 and 8 years) with various forms of functionally univentricular heart lesions received a total cavopulmonary connection with an extracardiac conduit as a final reconstructive procedure.All patients underwent diagnostic catheterization,which revealed normal pressures in the superior vena cava and pulmonary artery without obstruction at the site of the anastomosis.Angiography of the extracardiac conduit confirmed the communication between the conduit and the atrium in all three patients.Transcatheter occlusion of the fenestration was accomplished using a 8/6mm Amplatzer duct occluder in one patient,and 5 mm or 10 mm Amplatzer septal occluder in the other two patients.Residual shunting following occlusion was assessed using angiography and echocardiography.Results Immediate full occlusion of fenestration was obtained in all patients.Mean central venous pressure was not significantly increased and oxygen saturation significantly increased.No procedural or intra-hospital complications occurred.No complications or device failures were seen during the 3 to 6 month follow up period.Conclusion The Amplatzer septal or duct occluder device is safe,and effectively occludes the Fontan fenestration. Part 4 Clinical Application of Interventional Cardiology in the Treatment of Other Congenital Heart DiseaseObjective To evaluate the effectiveness of interventional cardiology in other complex congenital heart diseases.Methods There are seven patients in this group,five males and two females with ages from 8 days to 17 years old.A 8-day-old male infant was born with severe pulmonary valve stenosis(PS),atrial septal defect and patent ductus arteriosus and presented frequent anoxic spell.Concerning the too small age and low weight,the risk of surgical operation would be high.Percutaneous balloon pulmonary valvuloplasty(PBPV) was performed firstly and 5 months later surgical correction of the cardiovascular defects was successfully and with good postoperative or follow-up period.Other 6 patients who received interventional cardiology treatment are summarized as follows:PS was diagnosed in two patients with tetralogy of Fallot(TOF) after surgical correction and PBPV was performed.One patient with TOF demonstrated stenosis of the right pulmonary artery origin postopertively and received angioplasty.Embolization treatment was successfully performed in 3 patients.One was suffered from fistula between right internal mammary artery and right innominate vein,the other two patients were diagnosed with pulmonary arteriovenous fistula and systemic venous collateral channel,respectively.Both patients had received bidirectional Glenn shunt before.Results In the PBPV and pulmonary angioplasty group,all the four patients were successfully treated by means of interventional cardiology and the gradient pressure decreased postoperatively.The other three patients who received embolization treatment demonstrated therapeutic effect as well. Conclusions Interventional cardiology is effective and feasible in some complex congenital heart disease before or after surgical repair.It may simplify the surgical procedure,reduce the difficulty of operation and deal with the complications associated with surgery.Interventional technique combined with surgery will be used more frequently in complex congenital heart disease.