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Canadian Journal of Cardiology

Percutaneous Valve Interventions in the Adult Congenital Heart Disease Population: Emerging Technologies and Indications

  • Matthias Greutmann
    Correspondence
    Corresponding author: Dr Matthias Greutmann, University Heart Centre, Department of Cardiology, University Hospital Zurich, Zurich, Raemistrasse 100, 8091 Zurich, Switzerland. Tel.: ++41 44 255 3883; fax: ++41 44 255 8701.
    Affiliations
    University Heart Centre, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
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  • Lee Benson
    Affiliations
    Toronto Congenital Cardiac Centre for Adults, University Health Network, Division of Cardiology, University of Toronto, Toronto, Ontario, Canada

    Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Ontario, Canada
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  • Candice K. Silversides
    Affiliations
    Toronto Congenital Cardiac Centre for Adults, Division of Cardiology, University of Toronto, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada
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Published:October 24, 2019DOI:https://doi.org/10.1016/j.cjca.2019.10.019

      Abstract

      Adult survivors with congenital heart disease are not cured and residual cardiac valve lesions are common and contribute substantially to long-term morbidity. Given the increased risk of reoperations in patients with previous cardiac surgery, percutaneous treatment options have been developed. Initially percutaneous therapies focused on right ventricular outflow tract lesions, but they have now expanded to include mitral and aortic valve interventions. Although some of these procedures, such as balloon valvuloplasty of pulmonary valve stenosis and percutaneous pulmonary valve replacement, have become standard of care, there are many new and evolving technologies that will likely become important treatment strategies over the coming decade. The key for success of these transcatheter valve procedures is the careful evaluation of the patient’s individual anatomy and physiology and a multidisciplinary assessment involving cardiologists specialized in adult congenital heart disease, specialized imagers, cardiac surgeons, and interventionalists. Because many of these percutaneous interventions are relatively new, long-term outcomes are not yet well defined, dictating the need for careful and structured long-term observational studies on outcomes of these novel procedures, which will allow refining the indications of a specific intervention and to improve its technical aspects. The aim of this article is to provide an overview of common valve lesions in the adult congenital heart disease population and to discuss treatment options and strategies with a specific focus on percutaneous options.

      Résumé

      Les patients atteints d’une cardiopathie congénitale qui survivent jusqu’à l’âge adulte ne sont pas guéris; ils présentent souvent des lésions valvulaires cardiaques résiduelles qui augmentent considérablement la morbidité à long terme. En raison du risque accru de réopération chez les patients ayant déjà subi une chirurgie cardiaque, des techniques de traitement percutané ont été mises au point. Initialement, les traitements percutanés visaient surtout les lésions des voies d’éjection du ventricule droit, mais leur portée s’est maintenant élargie et englobe des interventions touchant la valve mitrale et la valve aortique. Bien que certaines de ces interventions, comme la valvuloplastie par ballonnet en cas de sténose de la valve pulmonaire ou le remplacement valvulaire pulmonaire par voie percutanée, fassent maintenant partie des soins couramment utilisés, beaucoup de techniques nouvelles et en évolution occuperont vraisemblablement une place importante dans l’arsenal thérapeutique au cours de la prochaine décennie. La réussite de telles interventions valvulaires par cathétérisme interventionnel passe par l’évaluation minutieuse des caractéristiques anatomiques et physiologiques de chaque patient et par une examenétude de cas par une équipe multidisciplinaire formée de cardiologues spécialisés en cardiopathie congénitale chez l’adulte, de spécialistes en imagerie, de chirurgiens cardiaques et de cardiologues interventionnels. Comme beaucoup de ces interventions percutanées sont relativement nouvelles, on n’en connaît pas encore bien les résultats à long terme, d’où la nécessité de réaliser des études observationnelles rigoureuses et structurées de longue durée qui permettront de mieux cibler les indications d’une intervention particulière et d’en améliorer les aspects techniques. Le présent article a pour but de donner un aperçu des lésions valvulaires fréquemment observées dans la population d’adultes atteints de cardiopathie congénitale et de présenter les options et stratégies thérapeutiques, en mettant l’accent sur les interventions percutanées.
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