Closure of Residual Postsurgical Defects

Abstract

Residual defects following repair of congenital heart disease can occur after a variety of surgical procedures. Depending on defect size and accompanying anatomic features, they may cause significant residual left-to-right shunt with ventricular volume overload and pulmonary hypertension but also right-to-left shunt resulting in cyanosis and/or paradoxical embolism. Repeated surgery may be associated with increased operative risk. Catheter interventional therapies have evolved to an auspicious and safe alternative that can nowadays be offered in a wide spectrum of residual defects and have become the first choice of treatment. The variety of available devices and techniques helps to overcome even complex anatomic situations such as baffle leaks after the Mustard and Senning procedure. Multimodality imaging (echocardiography, MRI, CT) facilitates to plan and echocardiography can monitor the interventional procedure helping to avoid potential complications. Interference of the implanted device with surrounding structures (e.g., valves, conduction system, pulmonary venous return) has to be ruled out carefully. Indication for treatment is derived from symptoms, amount of shunt/signs of volume overload, increase in pulmonary pressure, cyanosis, or specific risks such as paradoxical embolism.