18 Interventional Techniques Bryan H Goldstein, Christopher J Petit, Alistair Phillips, Betsy Newkirk Keywords interventional; device; congenital; ASD; VSD; transcatheter; catheterization The practice of interventional cardiac catheterization consists of minimally invasive procedures where catheters are used to modify, palliate, or treat congenital or acquired cardiac disease Evolution of interventional techniques has been a natural progression from open surgical procedures used to treat such lesions The development of newer interventional techniques has largely been possible by pushing the boundaries of established interventional procedures to achieve results comparable with traditional surgical techniques Although the aim of interventional catheterization is to provide one or more interventions to alter the course of disease, the basics are nevertheless drawn from experience with diagnostic cardiac catheterization Not all interventional catheterization techniques are therapeutic Some do no more than modify the course of the disease or help to delay future interventional or surgical procedures The design and organization of the catheterization laboratory, personnel, use of equipment, catheters, and techniques are a progression of the exercise of gathering of information related to diagnostic catheterization and angiography However, in sick neonates, infants, and children, any catheterization may be considered an intervention, involving higher risks than therapeutic elective procedures performed in stable patients Historical Background The evolution of interventional techniques has followed the basic principles of cardiac catheterization outlined by Werner Forssman in 1929 The use of interventional catheterization was first initiated by the use of balloon dilation in pulmonary and tricuspid valvoplasty,1 and in dilation of atherosclerotic lesions.2 Rashkind and colleagues widened the therapeutic implications of interventional catheterization with the first intracardiac procedure in pediatrics and congenital cardiac disease when they introduced balloon atrial septostomy.2,3 The use of occlusive devices was first reported by Porstmann and colleagues in 1967, when a patent arterial duct was occluded with the aid of an Ivalon plug.4 Attempts were then made to close left-to-right shunts with other devices, such as an atrial septal occluder for atrial septal defects5 and the double umbrella device for the persistently patent arterial duct and atrial septal defects.6 The application of percutaneous transluminal balloon angioplasty by Gruntzig and Hoppf in 19747 expanded the field of interventional cardiology such that it became recognized as a subspecialty in its own right The principles of percutaneous transluminal balloon angioplasty were first applied by Lock and colleagues8–11 in the field of congenital cardiology, when they addressed stenotic pulmonary arteries, the aorta, and systemic veins, both in animal experiments and in humans Kan and colleagues,12 in 1982, then reported the first use of balloons introduced percutaneously for dilation of congenital valvar pulmonary stenosis This approach has since became an accepted first intervention for treatment of stenotic pulmonary and aortic valves The development of balloon-expandable stents has helped to overcome problems of residual stenosis and restenosis in vessel walls.13 The development of newer materials, such as nitinol, a nickeltitanium alloy, has revolutionized technology and expanded its use in closure of left-to-right shunts.14–16 The use of this shape-memory alloy has simplified the delivery and retrieval of these devices by significantly reducing the sheath or catheter profile used for delivery, thereby increasing their application in infants and smaller children Various designs are now available, with different characteristics, allowing the operator to choose the most appropriate device for the morphology of the defect Transcatheter insertion of valves is the most recent major innovation in the field of interventional catheterization.17 Percutaneous implantation of biologic or pericardial tissue valves mounted on balloon- ... Rashkind and colleagues widened the therapeutic implications of interventional catheterization with the first intracardiac procedure in pediatrics and congenital cardiac disease when they introduced balloon atrial septostomy.2,3 The use of... percutaneous transluminal balloon angioplasty by Gruntzig and Hoppf in 19747 expanded the field of interventional cardiology such that it became recognized as a subspecialty in its own right The principles of percutaneous transluminal... The principles of percutaneous transluminal balloon angioplasty were first applied by Lock and colleagues8–11 in the field of congenital cardiology, when they addressed stenotic pulmonary arteries, the aorta, and systemic veins, both in animal experiments and in humans