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The indications of interventional therapy for congenital heart disease (CHD)

The indications of interventional therapy for congenital heart disease (CHD). Chinese Academy of Medical Sciences Peking Union Medical College Fu Wai Hospital Xu Zhongying, MD. Indications. Indications to obey general principles; Different CHD has different indication;

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The indications of interventional therapy for congenital heart disease (CHD)

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  1. The indications of interventional therapy for congenital heart disease (CHD) Chinese Academy of Medical Sciences Peking Union Medical College Fu Wai Hospital Xu Zhongying, MD

  2. Indications • Indications to obey general principles; • Different CHD has different indication; • The indications should be individual and concrete.

  3. Indications • Nearly all the PDA can be treated with interventional therapy, the indication is broad; • The majority of ASD can also be treated with interventional therapy; • But the indication of VSD is strict.

  4. Indications • Special case has the special therapeutic method; • Pay more attention and make adequate preparation for the high-risk cases; • It’s not a good idea to treat case which you have no confidence or there is not other remedial measures; • Learn to stop and give up at the right time.

  5. Interventional therapy of ASD • Choice of the occluders in children and adults; • Prevent the air embolism; • Anticoagulant strategy(during and after the interventional therapy).

  6. Interventional therapy of ASD • Keep vigilance over multiple atrial septal defect; • Avoid some special techniques in the procedure of catheterization as possible (release the ASD occluder devices in the pulmonary vein).

  7. Male, 19 years, received the first ASD interventional therapy before 6 months ago

  8. There is another ASD, TEE 18mm, • ASD occluder 26mm

  9. After the second interventional therapy

  10. Discover another ASD incidentally in the procedure of interventional therapy

  11. This ASD with severe PH was occluded in other hospital. Now the ASD occluder was compressed and deformed.

  12. Interventional therapy of PDA • Different murmur represents the different anatomical morphology and hemodynamic status; • Do not dependent on UCG completely, sometimes X-ray is more accurate than UCG.

  13. Interventional therapy of PDA • If it’s hard to transfer the transferring sheath from right ventricle to pulmonary artery, the sheath is probably blocked by the chorda tendineae; • Try to transfer the transferring sheath to the distal part of the descending aorta; • Release the occluder at the infundibulum of the PDA.

  14. Residual shunt of PDA after surgical ligation

  15. The residual shunt was occluded by using two PDA occluders

  16. The residual shunt was occluded by using two PDA occluders

  17. The residual shunt was occluded by using two PDA occluders

  18. A huge VSD

  19. This huge VSD was occluded by a PDA occluder

  20. Pre-occluded • Post-occluded

  21. III°AVB after interventional therapy of VSD • Male，14 year-old • EKG： Normal sinus rhythm. • X ray：C/T＝0.46 • TTE: a 2-3mm perimembranous VSD.

  22. Catheterization • Hemodynamic data：PAP 18/13(15)mmHg，LV 133/8(70)mmHg。 • Cardiography： 2-3mm D-LV • Instant complete closure with SearTM: 6mm symmetric occluder。

  23. Left Ventricular Angiogram Before After

  24. Shape of Occluder

  25. Before After

  26. UCG (Post-procedure )

  27. EKG (Post-procedure )

  28. sinus rhythm I°AVB RBBB Post-procedure Day1

  29. nodal tachycardia junctional escape rhythrn III°AVB LBBB Post- procedure Day2

  30. Post-procedure Day 2 • EKG： III°AVB, LBBB • Treatment： • Implantation of temporary pacemaker • Dexamethasone 5mg，tid • Vit C • Maintain electrolyte balance

  31. Temporary Pacing Rhythm

  32. Post- implantation Pacemaker Day 3 :LBBB

  33. Treatment • Surgery operation • Recovery of sinus rhythm

  34. EKG (Post- surgery )

  35. Before Post-intervention Post-surgery

  36. THANKS 谢 谢！

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