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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Article info
Publication history
Published online: October 24, 2019
Accepted:
October 17,
2019
Received:
July 28,
2019
Footnotes
See page 1748 for disclosure information.
Identification
Copyright
© 2019 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
