Open heart surgery is absolutely essential for the treatment of many types of congenital heart defects. However, there are an increasing number of defects that can be treated with special catheters or tiny devices that can be folded into catheters. If a defect can be treated effectively with a catheter technique, the procedure is much easier on the patient.
Most catheter treatment procedures are done with the patient sedated or under mild anesthesia. The only incision is a 1/8-inch insertion point over the blood vessels (usually in the legs). These do not even require a stitch. In most cases, patients are able to leave the hospital the same day as the procedure or sometimes, after an overnight observation period. Patients can return to school or to work within 1 to 2 days after a catheter treatment procedure in most cases. Because of the greatly shortened hospital stay and reduced need for complicated equipment in the operating room and intensive care unit, the costs of catheter procedures are usually significantly less than the cost of treatment of the same defect by surgical techniques.
Common catheterization procedures
The most common types of interventional catheterization procedures are those performed to:
- Create septal defects
- Open stenotic valves
- Open stenotic vessels
- Close abnormal vessels
- Close certain septal defects
Creating septal defects
Certain types of congenital heart defects require that there be a large communication between the two atria (upper chambers of the heart). These heart conditions include transposition of the great vessels and some patients with mitral or aortic stenosis or atresia. The communication can be created by either rapidly pulling a round balloon through the defect to tear the septum or by placing a long valvuloplasty balloon in the septum and inflating it to a large size. These procedures are usually temporary procedures to allow the patient to recover or survive until the time of surgery.
Opening stenotic valves
Both the aortic and pulmonary valves can be treated in many patients with aortic or pulmonic stenosis. The basic technique is to advance a special catheter through the small opening in the valve. A long balloon on the catheter is then rapidly inflated and deflated. The procedure works by pulling apart the fused leaflets of the stenotic valve.
Pulmonary balloon valvuloplasty is almost universally considered the treatment of choice for isolated pulmonary stenosis. Balloon aortic valvuloplasty is a technically more difficult procedure to perform and carries a higher risk than pulmonary valvuloplasty so that only experienced centers utilize this technique.
The results with balloon valvuloplasty at The Cleveland Clinic Foundation have been excellent and this is usually the first procedure done on patients who do not have significant leakage of the aortic valve.
Opening stenotic vessels
Children with congenital heart disease frequently have narrowed vessels in the pulmonary arteries or may have coarctation of the aorta which is a narrowing or stenosis of the aorta.
Balloon angioplasty is the procedure wherein a special balloon catheter is advanced to the stenotic area. The balloon is rapidly inflated and deflated.
The procedure works by stretching the stenotic area enough that small tears are created in the inner two layers of the vessel wall. If the vessel is not dilated enough, then the stenotic area will simply stretch and return to it's original size. If the area is dilated too far, there is the possibility of rupture or creating a thin enough area in the vessel that an aneurysm forms later.
In older patients, stents can be used to overcome the elastic recoil of the vessel and usually provide a better result. Angioplasty procedures may need to be repeated and if stents are placed in growing children, they will need to be further dilated as the child grows larger.
Closing abnormal vessels
The most common abnormal vessel that need to be closed is the patent ductus arteriosus (PDA). If this vessel is large, then the patient may have signs of heart failure and will have a significantly shortened life.
If the PDA is small, the patient may have no symptoms, but may be at risk for an infection called endocarditis which is fatal if not treated with high doses of intravenous antibiotics for 4 to 6 weeks. Closing the PDA eliminates both of these problems. PDAs are most often closed with a device called a coil. This is a long, slinky-like device with long cloth fibers imbedded in it. Coils can be straightened and pushed through a small catheter. When they come out of the catheter, they form loops of a predetermined size. If these loops are very carefully placed in the PDA, then they will cause clumping of blood cells in the material and will form a plug to close the vessel. In over 90 percent of patients, PDAs can be closed with the catheter treatment. Surgery or a specially designed PDA closure device can be used to close larger PDAs.
Closing septal defects
Several devices have been devised to fold up into catheters and open like umbrellas to close atrial septal defects and certain types of other septal defects. These devices have proven to be effective in most ASD patients. We use the one device that has received FDA approval (Amplatzer ASD device) and also use some newer devices that may have some advantages but are still investigational. The ASD devices are usually placed with the aide of transesophageal echocardiography or intracardiac echocardiography. Most patients can leave the hospital later on the day of their procedure. Investigational devices to close a hole between the ventricles (VSD) may be used in some patients who are at high risk for surgery.
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Thanks for this info! Hospital for Ballon valve surgery in Turkey
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