How to Catheterize Some Common Complex Lesions

Abstract

Following the dramatic advances in surgical and interventional catheterization techniques, prolonged survival is now common in patients with complicated lesions, some heretofore considered inoperable such as hypoplastic left heart syndrome (HLHS). In the course of management of 3 such complex lesions, namely SV, TOF — PA and PA — IVS, surgery and catheterization at planned intervals are necessary. In the past 10 years at our institution, among 6,441 patients (11,593 catheterizations) were 952 patients with SV, including patients with HLHS, tricuspid atresia (TA), corrected transposition with a hypoplastic right ventricle (SLL-hypoRV), malaligned common atrioventricular canal and a straddling atrioventricular valve with hypoplasia of a ventricle. The final surgical procedure, a modified Fontan approach is preceded by staged surgeries, catheterizations and interventional procedures. These patients underwent 2,318 catheterizations and 1,198 interventional procedures. There were also 517 patients with TOF-PA in this population (1,319 catheterizations and 873 interventional procedures), the goal in these being to achieve a biventricular repair with an adequate pulmonary arterial tree ¹ and 178 patients with PA-IVS (351 catheterizations and 207 interventional procedures) the desired end point in these being achievement of a biventricular repair and when not feasible a modified Fontan approach.