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- The Mission Hospital,Immon Kalyan Sarani, Sector IIC, Bidhannagar, Durgapur, West Bengal 713212
Home | Interventions in chd
Interventions in chd
ASD DEVICE CLOSURE
- ATRIAL SEPTAL DEFECTS(ASD):
- This defect is the next common heart defect, which is an abnormal communication between the upper two chambers of the heart. Small defects may close on its own by 2 - 4 years of age. Hence ideally they should be closed after 2 years of age or earlier if there are symptoms of heart failure.
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Ostium Secundum ASD is the most common type of ASD, most of these cases can be closed by device closures.
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Family History: A family history of CHD can increase the likelihood of developing the condition.
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Other types of ASDs like OP ASDs, SV ASDs, Coronary sinus ASDs are usually closed by surgical repair, however device closure can be done in selected cases
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Spontaneous closure occurs in 99% if the size is <3mm, in 80% if the size is between 3mm - 8mm, rarely closes if it is >8mm.
VSD device closure
- VENTRICULAR SEPTAL DEFECT(VSD):
- This the commonest acyanotic heart defect usually detected during the first vaccination check-up. It is an abnormal connection between the lower two chambers of the heart. Approximately 30%-40% of small to moderate sized perimembranous and muscular VSDs undergo spontaneous closure by 6 months of age.
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Larger defects need to be treated with anti-failure medications by a pediatric cardiologist and subsequently undergo surgical/device closure.
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Kids having moderate sized VSDs along with poor weight gain , recurrent respiratory tract infections can undergo device closure after assessment by a pediatric cardiologist.
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Larger VSDs and PDAs if left untreated can become Eisenmenger’s syndrome after 2 years of age.
PDA device closure
- PDA is an abnormal connection between the two great arteries i.e.- aorta and pulmonary artery. This is normally present in mother’s womb, but closes after birth. But in some cases it takes up to 3 months for complete closure.
- If your child is not gaining weight or having recurrent respiratory infections, it’s advisable to close the PDA by device closure
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Most of the preterm PDAs usually close on it’s own, few of them stuck in the NICU need PDA device closure.
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Weight of the patient is no bar for PDA device closure, even less than 1 kg babies can undergo this procedure safely.
PULMONARY STENOSIS(PS)
- PS can be 4 types:
- Valvular PS(most common)
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Supravalvular PS
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Infundibular PS
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Peripheral PS
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Balloon valvuloplasty (BPV) is the procedure of choice for Valvular PS
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Newborn with critical PS and cyanosis needs urgent intervention.
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Success rate 90%, chances of re-operation-10%
BALLOON AORTIC VALVULOPLASTY(BAV)
- 3 types:
- Valvular AS (most common)
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Sub-valvar AS
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Supra-valvar AS
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Critical valvular AS need urgent balloon aortic valvuloplasty(BAV)
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The valve is usually bicuspid, hence recurrence rate is 90%
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Later on these patients will require either surgical Ross procedure or prosthetic valve replacement.
BALLOON COARCTOPLASTY
- They are usually well baby after delivery, but develop poor feeding, decreased urination, breathlessness, sometimes cardiogenic shock in 6 days to 6 weeks time.
- They need urgent stabilisation in NICU
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Balloon coarctoplasty should be done in an urgent basis if there is associated left ventricular dysfunction
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Chance of re-intervention is 50%
BALLOON ATRIAL SEPTOSTOMY(BAS)
- BAS is a life saving procedure in case of a complex CHD like d-TGA
- It improves mixing of blood, thus relieves hypoxia, acidosis, heart failure and death in a sick kid
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Patient should be put on prostaglandin infusion as early as possible
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Arterial switch operation is advisable in all such cases within 1 month of age.
PDA STENTING
- PDA stenting is usually done within 2 months of age for complex cyanotic heart diseases like pulmonary atresia intact ventricular septum or any single ventricle physiology with pulmonary atresia.
- This is a life saving procedure, which later on will require surgical intervention
RVOT STENTING
- This is a palliative procedure to buy some time for definitive surgery in a later date.
- Usually done before 3 months of age for TOF and TOF like patients.
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Relatively less risky procedure than surgical procedure
RSOV DEVICE CLOSURE
- Sinus of Valsalva aneurysm (SVA) is a rare cardiac anomaly which has potential for spontaneous rupture into other cardiac chambers or the pericardial space
- It can either be repaired surgically or by device closure
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Now-a-days many cases are amenable for transcatheter device closure
PULMONARY AV FISTULA
- This is a rare cyanotic congenital or acquired heart disease, where the desaturated right arterial blood bypasses the lung bed and the deoxygenated blood goes to systemic circulation directly
- It is diagnosed by contrast echocardiography
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Gold standard for diagnosis is CT pulmonary angiogram
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These are usually closed by transcatheter coil closure or device cosure
AORTOPULMONARY WINDOW DEVICE
- Babies with an aortopulmonary window have a hole in between the aorta and pulmonary artery.
- Now-a-days AP windows can be closed by transcatheter method in selected patients
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Neonates with large AP window will require surgical closure
COIL EMBOLISATION OF MAPCA
- MAPCA- Major Aorto-Pulmonary Collaterals.
- Most commonly closed in complex cyanotic congenital heart diseases before heart surgeries.
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Sometimes to treat and prevent haemoptysis, these collaterals are being closed.
