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Prof. Helmut Baumgartner,
View the Slides from this session in ESC Congress 365
In a session jointly organized by the International Society of Adult Congenital Heart Disease and the ESC Working Group on Grown-up Congenital Heart Disease innovative interventions in congenital heart disease were discussed on Sunday afternoon.
Dr. A. Eicken from Munich presented the current status and future developments of percutaneous pulmonary valve implantation. This intervention has already become well established for patients with a failing conduit between right ventricle and pulmonary artery where it is has replaced surgery as the first choice treatment in most centers. However, approximately 85% of congenital patients who require re-intervention for their right ventricular outflow tract do not have conduits but “native” outflow tracts. In general these are not suitable for current catheter technique since dimensions are too large. Innovative devices are currently under investigation that should overcome this limitation. One approach is to use devices that reduce the outflow tract size and allow implantation of currently available valves. The other approach currently being tested, is the use of new large self expanding stent valves. So far, the numbers of treated patients are still very small but first results are encouraging.
Dr. P. Khairy from Montreal addressed electrophysiologic devices. Considering the special challenges we are faced with in congenital heart disease, such as anomalous or obstructed and occluded venous access to the heart as well as shunt lesions with the risk of thromboembolic events the current development of leadless pacemakers may offer new opportunities for this patient group. Indications for ICDs and CRT are still less well established than in acquired heart disease and implantation is again often technically challenging. The advent of subcutaneous ICDs and of leadless electrodes that may be inserted in the right location of the systemic ventricle for CRT have brought major progress in this field.
Dr. Taylor from London highlighted the potential of interventional cardiovascular magnetic resonance (CMR). The hybrid CMR/catheterization laboratory offers new diagnostic possibilities by combining CMR flow information with invasive hemodynamics for pulmonary vascular restistance measurements. Offline acquired 3-D data sets can already be used for roadmaps in catheter interventions. In complex interventions such as catheter treatment of the right ventricular outflow tract CMR has become essential for planning the intervention and designing individual devices. Direct CMR guiding of interventions requires special wires and is still challenging. Nevertheless it has been shown to be feasible. What could be its actual role in clinical practice is still too early to tell.
Dr. Pepper from London introduced personalized external aortic root support (PEARS) as a new treatment option for Marfan patients. Based on the individual imaging data of each patient a personalized wrap is made that should prevent further dilatation and dissection of the ascending aorta. If proven, the lower surgical risk of this procedure may allow earlier intervention and may reduce the aortic complication rate in this patient group. The development of this techique is still in an early stage. Larger patient numbers and longer follow-ups are required to define the role of this intervention in the treatment of Marfan patients.
In summary, the rapid development of new interventional options has over the recent years revolutionized the treatment of congenital heart disease. New promising innovations are on the horizon that may allow us to further improve the outcome of this challenging patient group.
Innovative interventions in congenital heart disease, ESC and the International Society for Adult Congenital Heart Disease
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