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Percutaneous Structural Interventions in Adult Congenital Heart Disease: State-of-the-Art Review Cover

Percutaneous Structural Interventions in Adult Congenital Heart Disease: State-of-the-Art Review

Open Access
|May 2023

Figures & Tables

Table 1

List of interventional procedures for adult congenital heart disease.

  • Closure of patent ductus arteriosus

  • Closure of atrial septal defects (II ASD and patent foramen ovale)

  • Closure of acquired and native muscular or perimembranous ventricular septal defects

  • Embolization of unwanted vessels (coronary fistulas, pulmonary arteriovenous malformations, aortopulmonary collaterals, and venovenous collaterals)

  • Angioplasty and stenting for coarctation of the aorta

  • Angioplasty and stenting of right ventricular to pulmonary artery conduit

  • Angioplasty and stenting of pulmonary artery

  • Angioplasty and stenting of pulmonary veins

  • Angioplasty and stenting of Fontan conduit, and fenestrations

  • Fontan lymphatic interventions

  • Angioplasty and stenting of atrial switch baffle stenosis, and baffle leak closure

  • Transcatheter pulmonary valve interventions (balloon valvuloplasty, pulmonary valve replacement, valve-in-valve implantation)

  • Transcatheter tricuspid valve interventions (valve-in-valve, valve-in-ring, clipping, systemic versus subpulmonic atrioventricular valve)

  • Closure of paravalvular leaks

  • Recanalization of obstructed vessels or valves

  • Left sided interventions (eg, aortic and mitral valve)

Figure 1

Patent ductus arteriosus (PDA) closure. (A) Angiography demonstrating 5.5-mm calcified PDA. (B,C) Amplatzer 10-8 Occluder (Abbott) with aortic disc in descending aorta with aortography demonstrating no further shunting. (D) Stable position of PDA occluder device following release.

Figure 2

Patent foramen ovale (PFO) occlusion. (A) Amplatzer PFO Occluder with left disc deployed in left atrium. (B) Right disc deployed against right atrium. (C) Amplatzer PFO Occluder deployed. (D) Lateral view of Amplatzer PFO Occluder in place.

Figure 3

Three-dimensional reconstruction of computed tomography angiograms. (A) Coarctation of the aorta at aortic arch preintervention (triangle showing calcified coarctation). (B) Postintervention view with covered stent in place (arrow showing stent).

Figure 4

Aortic coarctation angioplasty. (A) Pre-stent angiography demonstrating coarctation of aortic arch. (B) Expansion of inner balloon during angioplasty with Cheatham platinum covered stent 24 mm × 3 cm. (C) Full deployed stent with significant waist due to calcified coarctation. (D) 24 × 4 Atlas Gold balloon (Becton, Dickinson and Company) used for post-dilation. (E) Post-stent digital subtraction angiography demonstrating patent stent with no residual stenosis, dissection, or extravasation.

Figure 5

Right ventricular outflow tract and valvuloplasty. (A,B) Hancock bioprosthetic valve (Medtronic) with previous Melody valve (Medtronic). (C) Valvuloplasty and deployment of Palmaz 3110 XL stent (Cordis) with NuMED balloon-in-balloon device (NUMED, INC). (D) Post-dilation using Atlas Gold balloon {Becton, Dickinson and Company).

Figure 6

Cardiac magnetic resonance imaging post scimitar repair showing the scimitar vein baffle draining into the left atrium through a surgically created atrial septal defect (ASD). (A) Left atrium; (B) surgical ASD. Arrow: scimitar vein baffle

Figure 7

Intervention for stenosis of reattached right pulmonary vein in scimitar syndrome. (A) Venography demonstrating stenotic right pulmonary vein. (B) Inflation of Medtronic drug-eluting balloon. (C) Post-intervention with Genesis Palmaz 29- × 10-mm stent (Cordis).

Figure 8

Fontan fenestration closure. (A) Left disc of 4-mm Amplatzer ventricular septal defect closure device deployed in common atrium (triangle). (B) Right disc now also deployed in Fontan (arrow). (C) Intracardiac echocardiography showing device deployment (arrow) across fenestration from common atrium (star) to Fontan (x).

Figure 9

Percutaneous pulmonary valve replacement. (A) Anterior-posterior view of Edwards Alterra pre-stent in right ventricular outflow tract. (B) Lateral view of Alterra. (C) AP view of Edwards SAPIEN 3 valve deployed in Alterra. (D) Lateral view of SAPIEN 3 valve in position.

Video 1

Parasternal right ventricular outflow view with color Doppler showing moderate to severe pulmonary regurgitation prior to Edwards SAPIEN 3 transcatheter pulmonary valve system with Alterra adaptive pre-stent; see also at https://youtu.be/QN5lkKBQzrM.

Video 2

Parasternal right ventricular outflow view with color Doppler showing successful placement of Edwards SAPIEN 3 transcatheter pulmonary valve system with Alterra adaptive pre-stent. Trivial paravalvular leak is noted; see also at https://youtu.be/4IdjE0wN6a0.

Video 3

Fluoroscopy showing the Alterra adaptive pre-stent delivery system in the right ventricular outflow tract with deployment of the distal portion of the Alterra; see also at https://youtube.com/shorts/O-MEnsP9ZFc.

Video 4

Fluoroscopy showing complete deployment of the self-expanding Alterra adaptive pre-stent in the right ventricular outflow tract; see also at https://youtube.com/shorts/Hb64ywc_rsU.

Video 5

Fluoroscopy showing the SAPIEN 3 transcatheter pulmonary valve being implanted within the Alterra adaptive pre-stent; see also at https://youtube.com/shorts/iTxb0ymN6Vw.

Figure 10

Bioprosthetic tricuspid valvuloplasty. (A) 26-mm Vida valvuloplasty balloon inflated showing 20.6 mm at waist. (B) 28-mm True balloon inflated for intentional value fracture (green markers showing landmarks created using 2D/3D registration from computed tomography angiography). (C) Post valve fracture measurement with improvement. (D) SAPIEN 3 Ultra 26-mm valve successfully deployed.

DOI: https://doi.org/10.14797/mdcvj.1219 | Journal eISSN: 1947-6108
Language: English
Page range: 78 - 90
Submitted on: Feb 16, 2023
Accepted on: Apr 12, 2023
Published on: May 16, 2023
Published by: Houston Methodist DeBakey Heart & Vascular Center
In partnership with: Paradigm Publishing Services

© 2023 Rody G. Bou Chaaya, Zhihao Zhu, Valeria E. Duarte, Chun Huie Lin, published by Houston Methodist DeBakey Heart & Vascular Center
This work is licensed under the Creative Commons Attribution-NonCommercial 4.0 License.