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Interventional cardiology
  1. KEVIN P WALSH
  1. Heart Clinic
  2. Royal Liverpool Children’s Hospital
  3. Alder Hey, Eaton Road
  4. Liverpool L12 2AP

    https://doi.org/10.1136/adc.76.1.6

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      Over the last 15 years the treatment of congenital heart defects has changed from being primarily surgical to a combination of interventional cardiology and surgery. Although interventional cardiology has replaced surgery for a number of defects, it has also provided an additional and complementary treatment to surgery for many conditions.

      The cardiovascular system can be viewed as a pump with attached blood vessels. Major ‘replumbing’ such as the arterial switch operation for transposition of the great arteries remains the province of the surgeon, while dilations and occlusions are increasingly performed in the cardiac catheterisation laboratory. The heart also has an electrical system that may be disturbed by pacemaker failure, conduction defects, or unwanted electrical circuits and interventional electrophysiology is now an important part of interventional cardiology.

      Dilations

      Dilations are among the commonest interventional cardiology procedures and stenoses of all structures and blood vessels have been subjected to dilation. Balloon atrial septostomy was introduced by Rashkind and Miller over 30 years ago1 and remains in use in its original form to improve mixing in patients with transposition physiology and for patients who require venting of an atrium whose outflow is restricted. Atrial septostomy in older patients, whose atrial septum can be much tougher, can be accomplished by first cutting the atrial septum with a blade.2 The development of plastic cigar shaped balloon dilation catheters by Gruntzig et al,3 initially for peripheral and coronary arteries, represented the turning point for interventional cardiology. Larger diameter balloons were made for the larger central vessels and cardiac valves in children. These large diameter balloon dilation catheters (valvuloplasty catheters) were first used to treat pulmonary valve stenosis4 and balloon dilation is now the treatment of choice for pulmonary stenosis in all age groups. The aim of the procedure is to ablate the …

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