Since entering the 21st century, congenital heart interventions have developed rapidly. At present, interventional treatment for congenital heart disease can be carried out for atrial septal defect, ventricular septal defect, patent ductus arteriosus, pulmonary valve stenosis, coronary artery fistula, pulmonary arteriovenous fistula, descending aortic constriction and so on. With the development of surgical techniques and interventional level, interventional techniques are introduced into surgery for the combined treatment of some complex congenital heart diseases, which is called “mosaic treatment”. This includes atrial septal balloon stoma and complex precordial body-pulmonary collateral vascular embolization, etc.
I. Indications for interventional occlusion of atrial septal defect (ASD)
1.Secondary foramen ovale defect, the following conditions must be present at the same time.
(1) defect diameter ≥5mm, ≤36mm;
(2) right atrial dilatation with an indication of increased right ventricular volume load;
(3) The distance from the edge of the defect to the coronary sinus, the upper and lower vena cava ports and the right superior pulmonary vein is ≥5 mm;
(4) The distance from the edge of the defect to the atrioventricular valve annulus is ≥7 mm;
(5) left-to-right shunt of atrial defect is not accompanied by severe pulmonary hypertension.
(2) Residual shunt after surgery for atrial defect secondary to foramen ovale.
3.Post-operative complex precordial disease (such as post-Fontan surgery), there is left-to-right shunt at the atrial level.
4, there are other combined malformations, if all can be interventional treatment, interventional treatment can be performed at the same time.
Cost: The total cost of domestic blocker is about 23,000, and the total cost of imported blocker is 35,000.
Interventional blocking indications of ventricular septal defect (VSD)
1.Diameter of ventricular septal defect: the diameter of membrane ventricular defect is 3-12mm, the diameter of muscle ventricular defect is ≤14mm, children should generally be ≤10mm;
2.Distance of the membrane ventricular defect from the right aortic coronary valve: >1.5mm for eccentric blockers and >2mm for symmetric blockers, while the right aortic coronary valve prolapse does not obscure the mouth of the defect and does not combine with pathological aortic regurgitation;
3.Distance of the defect from the tricuspid valve: eccentric blocker ≥2mm, symmetric blocker ≥1.5mm, no moderate tricuspid regurgitation;
4.Ventricular septal defect with surgical indications;
5, ventricular septal defect combined with other interventional cardiovascular malformations;
6, post-surgical residual leak;
7, mild to moderate pulmonary hypertension without right-to-left shunt;
8, malformation myocardial infarction septal perforation or traumatic septal perforation;
9, Age >3 years and weight >10kg.
Cost: The total cost is about 35,000.
III. Indications for interventional occlusion of patent ductus arteriosus (PDA)
1.Amplatzer method.
(1) Left-to-right shunt does not combine with PDA that requires surgery;
(2) PDA narrowest diameter ≥ 2mm, age usually ≥ 6 months, weight ≥ 4kg;
(3) residual shunt after PDA surgery.
2, controlled spring bolus method.
(1) left-to-right shunt does not combine the PDA that requires surgery;
(2) PDA narrowest diameter (Cook spring ring ≤ 2mm, Pfm spring ring ≤ 3mm), the rest of the same as the Amplatzer method.
Cost: The total cost is about 20,000.
4.Indications for interventional treatment of pulmonary valve stenosis
Pulmonary valve stenosis is a common congenital heart disease, in the past surgery was the only treatment method, with the promotion of interventional percutaneous puncture pulmonary valve balloon dilatation, it has now become the preferred treatment method for this disease. The indications are: typical pulmonary stenosis, when the cardiac output is normal, transcatheter examination of the pulmonary valve transvalvular pressure difference ≥ 50 mmHg; the best age 2-4 years, the rest of the age group can be performed.
5.When is surgery more appropriate for congenital heart disease?
Generally speaking, since cyanotic congenital heart disease has no possibility of self-healing and has a high mortality rate without surgery, it should be diagnosed as early as possible and treated early, or the timing of surgery should be determined by the specialist’s opinion. Small ventricular septal defects have the possibility of self-healing and can be observed, but large ventricular defects can easily progress to severe pulmonary hypertension and may lose the chance of surgery, so early surgery is needed, even for infants within 1 year of age is very mature and safe.
Atrial septal defects can be considered for surgery or interventional occlusion before school age because of the slower progression of the disease. The arteriovenous ductus arteriosus that cannot be occluded is usually a giant arteriovenous ductus arteriosus, and pulmonary hypertension will appear early, so it should be treated as soon as possible.
In conclusion, the number of precardiac diseases that can heal on their own is small, and most of them require surgical or interventional treatment, and we should listen to the opinions and suggestions of specialists when to operate.