[II-IL05-01] Cutting edge of pediatric heart intervention, PVI and VSD closure
For a long time pulmonary valve replacement as well as closure of a ventricular septal defect (VSD) have been performed by a surgical approach only. Today, cutting edge technology in interventional techniques can offer minimally invasive interventional treatment for many of these lesions
Interventional VSD closure was first described in 1988 and is now considered as an alternative to surgical VSD closure in selected cases. Initially the Amplatzer devices improved safety and the results for VSD closure, but an unacceptable high rate of permanent AV block was detected and the widespread use was abandoned. Device technology however has improved since then and VSD coil devices without the development of permanent AV block were developed. Other device companies have produced more flexible devices with better design and flexibility and so far promising results.
Percutaneous pulmonary valve implantation was first performed in 2000 and gained widespread use in Europe and the USA from 2010 onwards with the introduction of the Melody® valve and the Edwards® valves later on. Improved understanding of the preparation of the RVOT and the influence of coronary artery anatomy have made this procedure safe and suitable for many patients with acceptable long term results. Improved design of the valves and delivery system made this technique suitable for children up to a weight of 14 kg. The risk of bacterial endocarditis seems related to the biological valve components and can be minimized by the use of modern valve design.
In summary the new device generations enrich the armentarium of interventionalists for a safe approach in VSD closure and PPVI.
Interventional VSD closure was first described in 1988 and is now considered as an alternative to surgical VSD closure in selected cases. Initially the Amplatzer devices improved safety and the results for VSD closure, but an unacceptable high rate of permanent AV block was detected and the widespread use was abandoned. Device technology however has improved since then and VSD coil devices without the development of permanent AV block were developed. Other device companies have produced more flexible devices with better design and flexibility and so far promising results.
Percutaneous pulmonary valve implantation was first performed in 2000 and gained widespread use in Europe and the USA from 2010 onwards with the introduction of the Melody® valve and the Edwards® valves later on. Improved understanding of the preparation of the RVOT and the influence of coronary artery anatomy have made this procedure safe and suitable for many patients with acceptable long term results. Improved design of the valves and delivery system made this technique suitable for children up to a weight of 14 kg. The risk of bacterial endocarditis seems related to the biological valve components and can be minimized by the use of modern valve design.
In summary the new device generations enrich the armentarium of interventionalists for a safe approach in VSD closure and PPVI.