Interventional therapy is simply a non-invasive treatment method. The incision is only a small 0.5-0.8 cm skin incision, and a catheter is introduced through a puncture into a blood vessel, along which the catheter can enter the heart. After the necessary routine examination of the heart, further diagnosis and precise measurements of the condition, the device can be delivered to the area to be treated.
Interventional treatment does not require an open chest, extracorporeal circulation, opening of the heart, or any form of suturing, and children in older age groups do not require general anesthesia. These features have great advantages over surgical procedures. The rapid recovery of the patient after treatment (he can be discharged 2 days after treatment), the low number of post-treatment complications and the absence of skin scars are additional features of interventional therapy. The total risk of interventional treatment is less than surgery, and it is a typical minimally invasive treatment method that is gradually replacing surgery.
Favorable timing of congenital heart disease treatment
Congenital heart disease is a complex group of diseases that can produce serious complications if left untreated, such as pulmonary hypertension, heart failure, pneumonia, etc. The condition is often life-threatening in severe cases. The early stage of the disease simply affects the growth and development of the child and often has respiratory infections due to the reduced cardiac output. If not treated effectively in the early stages, significant heart damage can occur in the later stages, affecting the quality of life and leading to the patient’s death in severe cases. Childhood is the fastest growing and developing period in life, and if left untreated, it is bound to affect the growth of the child, and the consequences caused are irreparable. Therefore, modern medicine believes that early detection, early diagnosis and early treatment of congenital heart disease should be emphasized.
What patients should know when they visit the clinic
1. The interventional treatment of congenital heart disease requires the doctor to have a very detailed understanding of the condition. Before treatment, in order to make an accurate diagnosis of the condition, we have to conduct several examinations on your child. The purpose of this is to measure the patient’s data and to determine whether interventional therapy is appropriate.3 Before interventional therapy, we also perform routine cardiac catheterization and cardiovascular angiography. Our work procedures are serious and we also hope that parents will understand our work and cooperate with us.
2.After the treatment, the patient needs to be hospitalized for 2 days in the hospital for observation, mainly to observe whether there is bleeding, oozing blood and infection in the puncture area; to observe the immediate effect of the treatment; and the follow-up treatment after the intervention such as infusion and use of antibiotics. At the time of discharge from the hospital, we will apply a band-aid to the puncture site to protect the puncture. We ask patients not to participate in strenuous physical labor and activities for 1-2 weeks after discharge, to take care of rest and to take medications on time. Review at our center 3 months, 1 year and 2 years after treatment.
Introduction of interventional treatment methods for congenital heart disease
1.Atrial septal defect blocking surgery
In 1976, King and Mills performed the first successful closure of atrial septal defect (AtrialseptaldefectASD) via catheter with a double umbrella device, and in the 1980s, Rashkind developed a single-disc with hook closure device, and in 1989, Lock et al. further improved the Rashkind closure device into a clam-shell clip closure device, and in 1991, they also In 1990, Sideris invented the button-type patch closure method for ASD. The Amplatzer atrial septal occluder from AGA is widely used in clinical practice and has the most satisfactory efficacy, which is a double-disc device with a “waist” connecting the two discs. According to the diameter of the waist blocker is divided into 4-34mm total of 27 models. The indications are: 1, secondary foramen type atrial septal defect; 2, 1, 5 years of age or older, weight 10 kg or more; 3, oval foramen not closed and atrial septal tumor or with stroke and ever combined with cerebral embolism; 4, atrial septal traffic left after correction surgery of complex congenital heart disease, when hemodynamic adjustment is completed, can be considered closed; 5, residual shunt after surgical repair; mitral balloon valvuloplasty left after obvious atrial level shunts.
After clinical use in recent years, the clinical value of the Amplatzer blocker has come to the fore. Because it is designed on the principle of integration, the entire blocker is a mesh structure prepared of nickel-titanium alloy wire, which becomes double-disk-shaped after high pressure and high temperature setting. The waist part can play the role of tightly sealing the defect mouth, but also has to make the diameter of the sealer reduced. Clinical reports show that the success rate of this sealer is over 95% and no significant complications have been seen. This work has been performed in our center, and a patient with trisomy of Fallot was successfully treated with simultaneous balloon pulmonary valvuloplasty and atrial septal defect closure.
Now there are several domestic manufacturers who have produced such occluders, and the cost of treatment has been greatly reduced.
2. Ventricular septal defect occlusion
In 1988, Lock et al. first used the Rashkind double-sided umbrella to close the ventricular septal defect (VentrcularseptaldefectVSD), and then developed to the Cardioseal double-sided umbrella after the Clamshell stage. In 1994, Sideris reported the use of a button patch to close VSDs, and in 1998, Amplatzer reported the success of its device to close myocardial VSDs. Currently, the most widely used and successful blocking device in China and abroad is still the Amplatzer blocking device. Its indications are (1) age older than 3 years, (2) myocardial and membranous VSDs with defect diameter less than 12 mm, (3) ruptured membranous septal aneurysm, and (4) no combined severe pulmonary hypertension.
Amplartzer blocker has been introduced in foreign countries for more than 5 years, and started to be used in clinical practice in China in June 02. The clinical success rate is more than 95%, as shown by the application in Beijing Fu Wai Hospital, Anzhen Hospital, Chaoyang Hospital and our center. In our center, a patient with ruptured ventricular septal membrane tumor was successfully blocked with this blocker, and the rupture was tightly blocked and the heart shape returned to normal at the 3-month postoperative follow-up.
3.Blocked arterial catheterization
Interventional treatment of patent ductus arteriosus (patentductusarteriousesPDA) was the first to be used in clinical practice and has become the treatment of choice for patent ductus arteriosus. The main methods include the Cook and PFM spring coil method and the Amplatzer single mushroom umbrella method. The Amplatzer mushroom umbrella method is currently the most widely used and simplest to operate in clinical practice. Any type of patent ductus arteriosus with a weight of 4 kg or more and non-resistant pulmonary hypertension is suitable for interventional treatment. The Amplatzer is a single mushroom umbrella made of nickel-titanium alloy wire that holds the blocker in place; the middle is filled with sponge to block blood flow and the surface is covered with a complete endocardium. More than 100 patients have been treated with this type of blocker in our center, with a success rate of 98%. The follow-up after treatment showed no change in the position of the blocker, significant recovery of the heart shape and increased strength. Interventional arterial catheter occlusion is safe, reliable, simple, low complications, and short recovery and hospitalization time, with an average procedure time of about 60 minutes and an average hospitalization time of 3-5 days. 1999 statistics from Denver Children’s Hospital in the United States showed that non-surgical cases have accounted for more than 90% of arterial catheter occlusion, and the number of related papers presented at international cardiology academic conferences in recent years has The number of papers presented at international cardiology conferences in recent years has also increased significantly. These indicate that interventional approaches to the treatment of patent ductus arteriosus are replacing surgical treatment methods and have become a distinct trend.
4. Percutaneous balloon pulmonary valvuloplasty
Pulmonary valve stenosis (pulmonaryvalveatenosisPVS) is a relatively high incidence of congenital heart disease, accounting for 8-10% (fourth) of patients with preexisting heart disease. percutaneous balloon pulmonary valvuloplasty was first reported by Kan in 1982 ( Percutenous balloonpulmonaryvalvuplastyPBPV) was first reported by Kan in 1982 and has become the treatment of choice for congenital pulmonary valve stenosis. The main indications are: (1) simple PVS or combined with secondary outflow tract stenosis, with a transvalvular pressure difference between the right ventricle and pulmonary valve = 35 mmHg, from neonates to adults, especially in neonates with severe pulmonary stenosis; (2) poor outcome in severe pulmonary valve dysplasia, but not contraindicated, and balloon dilatation can still be used in mild and moderate dysplasia PVS (3) PBPV is available for both supra-pulmonary and arcuate funnel stenosis; (4) restenosis after surgery; (5) severe pulmonary stenosis with right-to-left shunts at the atrial level; and (6) PBPV can be used as a palliative alternative to first-stage open-heart surgery for complex preconditioning with PVS. Our 15-year follow-up of nearly 200 patients has shown that the immediate and medium- to long-term outcomes of PBPV are reliable and stable, with no serious complications.
The following is a schematic diagram of the interventional occlusion of patent ductus arteriosus, atrial septal defect, and ventricular septal defect, respectively