Current Status and Prospect of Interventional Congenital Heart DiseaseFu Wai HospitalCardiovascular Institute Chinese Academy of Medical Sciences Dai Ru Ping2009.11.13

Current Situation on CHD Intervention 2009 In China, 0.15 million newborn have CHD per year. 0.1millin patients need treat by surgery. Up to the present, total 2.5 million patients who have various CHD in China. 50 thousand were treated by surgery per year. 30 thousand were treated by Intervention in 2009 estimated. Homemade devices were used in 3/4--4/5 ps.

Current Status of CHD Interventions CHD ASD PDA VSD PS Others Total Case 12000 8000 7000 3000 30000

Current Status of CHD InterventionsHomemade Devices were used in 3/4--4/5 ps.Hybrid procedure were performedGood results with low complications

Homemade DevicesVSDASDPDA Biocompatibility study of Domestic Devices

Homemade Devices PDA,ASD,VSD, Occluders Quality Price

Balloon atrial septostomy Embolization to occlude aortopulmonary collateral vessels and shunts Balloon angioplasty Stenting for branch pulmonary artery stenoses Stent implantation of the arterial duct in newborns with duct- dependent circulation Transcatheter occlusion of residual interatrial communications after Fontan Procedure. Laser valvotomy with balloon valvoplasty for pulmonary atresia with intact ventricular septum

Hybrid Procedure More than 20 hospitals performed Hybrid procedure

Balloon atrial septostomy for alternative treating complex CHD with cyanosis Hybrid Procedure

Hybrid ProcedureEmbolization to occlude aortopulmonary collateral vessels and shunts for treating PA+VSD

Hybrid Procedure Stenting for treating branch pulmonary artery stenoses

Laser valvotomy with balloon valvoplasty for treating pulmonary atresia Hybrid Procedure

Complication Number % IIIAVB 63(8) 0.72% TI 60 0.60% Residual shunt (6 month) 36(8980) 0.40% Hemolysis 25 0.27% Device migration 16 0.17% Outlet stenosis of RV 14 0.15% AI 9 0.10% Cardiomegaly 6 0.07% Tamponade 5 0.05% Stroke 2 0.02% MI 1 0.01% Death 5 0.05% Total 242 2.60%

Complications of VSD intervention ( No 9311) Successful rate96.40% Mortality0.05% (Data from 2007 CHD Salon)

1, PH with right cardiac failure.2, Arrhythmia (LBBB, II-IIIAV-B Pacemaker-6m) 3, Cardiomegaly with heart failure.4, Device migration .5, Tamponade ( Occluder Erosion ).6, Stenosis of RV Outlet.7, Valvular damage (AI ,TI, MI )Later Complications ( 6m-2y after )

Pulmonary hypertension with right heart failure

F 12yECGRVHTTEASD : 11mm Treated by Interventional technique with Amplazer occluder of 18mm After 2 years, die from right heart failure , Pulmonary systolic pressure153mmHg (by Echo)

RVLVRVLV Later ComplicationsPlex & arteritis

Later Complications preImmediately Post 1 year Cardiomegaly with left heart failure. M 3yECGNormalTTEVSD : 4mm Treated by Interventional technique with Amplazer occluder of 6mm. ECG : CLBBB ( QRS : 152mS), immediately after intervention. After 1 years, Cardiomegaly with heart failure occurred.

Later Complications Tamponade ( occluder erosion of left atrial wall) Occlusion of ASD with Amplatzer device half year later, Tamponade occurred , due to occluder erosion of left atrial wall .

Later Complications Tricuspid damage VSD

Tricuspid Insufficiency : Leaflet perforation due to procedure Chord rupture due to procedure Chord or / and leaflets were pressed by occluder TV&M-Aneurysm VSD & Chord Chord rupture + TI

Develop New Technique and DeviceNational Support for Scientific Research Natural Scientific Found 863 Scientific Found 11-5 National Support Plan Found Design New Occluder Transcatheter valve replacement Aortic Valve Pulmonary Valve Prospect of Interventional CHD

Prospect of Interventional CHD Transcatheter valve replacement

Prospect of Structural Heart Disease

1, Modify Guideline of Interventional SHD2, National Permit: Interventional Technique 3, National Training Center.4, 11-5 National Support Plan, Long-term results and long-term follow-up National registration of interventional cases5, Develop new Technique

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