Outline of Transcatheter Procedures Described in the Text With Potential Concerns

Septal defect closure
 ASDTranscatheter closure possible in >80% cases0.2% incidence of erosion with certain devices
 VSDMuscular defects and aneurismal membranous defects5% incidence of heart block with membranous defects
 PDAStandard therapy. Evolving in very small infantsConcerns about device protrusion in smaller infants
 PulmonaryExcellent initial and longer-term outcomesPoorer response seen with very dysplastic valves
 AorticOutcomes similar to surgery in neonates and infantsProgressive aortic regurgitation leading to need for AVR
Angioplasty and stenting
 Pulmonary arteriesStenting likely to provide a more sustained relief of stenosisRestenosis (ballooning). Somatic outgrowth (stenting)
 Aortic archStenting effective therapy in older childrenAneurysm formation with ballooning
 RVOTProvides good palliation for symptomatic ToF patientsMay increase the need for transannular patch repair
 PDAUse of a native connection from the aorta to the pulmonary arteries to provide pulmonary blood flowSignificant variation in ductal morphology
Transcatheter valve replacement
 PulmonaryExcellent outcomes (conduits). Evolving—native RVOTEndocarditis rates with Melody valve
 TricuspidOption for valve in valve in congenital patientsNative valve replacement continues to prove a challenge
 MitralGrowth option with stented tissue valve in childrenLonger-term outcomes are lacking
 AorticEvolving need in patients with bicuspid aortic valve diseaseUnclear as to the optimal age to consider this a viable alternative to surgery
Hybrid procedures
 HLHSExcellent outcomes reported in experienced centersUnclear whether this should be reserved for higher-risk cohorts
 VSDGood outcomes in small cohortsLarge clinical experience lacking—limited numbers
 OthersPulmonary valve and pulmonary artery interventions are evolvingCollaboration with surgical team essential for optimal outcomes
  • ASD indicates atrial septal defect; AVR, aortic valve replacement; HLHS, hypoplastic left heart syndrome; PDA, patent ductus arteriosus; RVOT, right ventricular outflow tract; ToF, tetralogy of fallot; and VSD, ventricular septal defect.