Interventional treatment of congenital heart disease

  Congenital heart disease has a high incidence and is a serious threat to the physical and mental health of children. With timely and proper treatment, most children can live a normal life. With the rapid development of minimally invasive treatment, interventional therapy has become the main treatment method for congenital heart disease. Compared with the traditional open-chest extracorporeal circulation treatment, the advantages of interventional treatment are: less trauma, precise efficacy, shorter hospitalization time, less complications and cheaper price. The pediatric department of our hospital has carried out interventional treatment of congenital heart disease and successfully completed many procedures with the youngest age of 6 months.  The main common congenital heart diseases in pediatric patients are: ventricular septal defect, atrial septal defect, patent ductus arteriosus, pulmonary valve stenosis, and tetralogy of Fallot. The following will introduce the indications for interventional treatment of these common congenital heart diseases: a. Percutaneous balloon pulmonary valvuloplasty: This procedure is the first interventional treatment that should be used in clinical practice. It has been proven that this method is safe, effective, simple and economical in the treatment of pulmonary stenosis and can be the preferred alternative to open-heart surgery. The main indications are typical pulmonary stenosis with transvalvular pressure difference ≥ 30 mmHg, the best treatment age is 2-4 years old, and the rest can be performed at all ages. The method can also be used for the palliative treatment of infants and children with frequent episodes of tetralogy of Fallot that cannot be controlled by medications.  Second, arterial ductus arteriosus occlusion: The arterial ductus arteriosus is a congenital anomalous passage between the aorta and the pulmonary artery. It usually closes within 4 weeks of birth and is less likely to close naturally after 6 months, and can cause congestive heart failure and infective endocarditis and death if left untreated. Early interventional occlusion should be performed. The age is usually ≥6 months, weight ≥4 kg, and no obstructive pulmonary hypertension.  Third, atrial septal defect blocking: atrial septal defect, except for large defects, generally no obvious symptoms, only found during physical examination, such as into adulthood, can cause severe pulmonary hypertension and arrhythmia, so advocate early detection and timely treatment in childhood, interventional blocking is mainly used for secondary atrial septal defect, requiring age ≥ 3 years, weight ≥ 5 kg, defect diameter ≥ 5 mm, the edge of the defect of at least 4 mm. The atrial septal diameter is larger than 14-16 mm, and there is no obstructive pulmonary hypertension. Ventricular septal defect blocking is a defect of the right and left ventricular septum that leads to abnormal traffic between the right and left ventricles, and children often suffer from pneumonia and heart failure. The membrane ventricular septal defect closure requires an age of ≥3 years, a body weight of ≥5 kg, a superior edge of the defect at least 1 mm from the aortic valve, at least 3 mm from the tricuspid diaphragm valve, and a septal defect size of no more than 14 mm, without obstructive pulmonary hypertension. Myocardial ventricular septal defects are indicated in patients aged ≥1 year, weighing ≥8 kg, and without obstructive pulmonary hypertension.  With the improvement of devices and techniques, interventional treatment is adapted to congenital heart disease at younger and younger ages, with more and more types of diseases and better results.