The role of catheter-directed therapies in the treatment of congenital heart disease.

Over the past decade, transcatheter interventions have become increasingly important in the treatment of patients with congenital heart defects. These procedures may be broadly grouped as dilations (valvuloplasty, angioplasty, and endovascular stenting) or as closures (vascular embolizations and device closure of defects). Balloon valvuloplasty has become the treatment of choice for simple valvar pulmonic stenosis in all age groups and, although not curative, appears at least comparable to surgery for noncalcific aortic stenosis in newborns through young adults. Balloon angioplasty is successfully applied to a wide range of aortic, pulmonary artery, and venous stenoses. Catheter-delivered coils are used to embolize a wide range of arterial, venous, and prosthetic vascular connections. Although still investigational, devices have been successfully used for closure of large numbers of atrial and ventricular septal defects. In this review, the current role of each major catheter intervention is discussed and results are compared with alternative forms of therapy. Catheter-based therapeutics are then placed in context in a discussion of combined catheter-surgical treatment of patients with complex congenital heart defects.