Percutaneous Relief of Vascular Obstruction: Potpourri

23.1

Key Points

• 1.

  Cardiovascular obstructions in adult congenital heart disease (CHD) often involve branch pulmonary artery stenosis and postsurgical baffles, homografts, and conduits.

• 2.

  Stenting various cardiovascular obstructions in adult CHD requires a good understanding of available stents and balloons of all sizes and all of their unique characteristics.

• 3.

  Intravascular stenting should accommodate for adult growth potential of the patient.

• 4.

  Accurate measurements and basic techniques of angioplasty and stenting of large pulmonary and systemic vessels are essential in the management of adult CHD.

Relief of vascular obstruction initially described by Dotter and Judkins for peripheral atherosclerotic disease is now routinely applied to a variety of cardiovascular obstructions found in congenital and postsurgical heart disease. Advances in catheters, wires, stents, and therapeutic techniques allow for advanced interventions to relieve these obstructions from the newborn infant to the elderly adult. Although pediatric interventionists manage the majority of these lesions, as CHD patients survive to adulthood and enter into the adult clinics and hospitals, adult interventional cardiologists should become familiar with the diagnosis and management of these lesions as well.

This chapter discusses the diagnosis and interventional management of some commonly encountered cardiovascular obstructions seen in CHD that present in both the pediatric and adult patient. In particular, available balloons and stents as well as techniques and potential complications are reviewed.

Main interventional options for treating CHD obstructions include balloon dilation using standard-pressure balloons, cutting balloons or high-pressure balloons. When angioplasty fails and when the anatomy permits, stent implantation is another option.

23.2

Basic Concepts