LIMITATIONS AND COMPLICATIONS OF
INTERVENTIONAL CATHETERIZATION
Toshio
Nakanishi
Pediatric
Cardiology, Heart Institute of Japan, Tokyo Women’s Medical University,
Tokyo Japan
During the last 30 years, a number of
devices have been developed for transcatheter occlusion of patent ductus
arteriosus (PDA) and atrial septal defect (ASD) and have been greeted with
enthusiasm initially and a varying degree of disappointment afterwards.
Although the Amplatzer occluder is increasingly used for ASD closure,
surgical closure is still the standard treatment and we need to see the
long-term results. Excellent results have been obtained with coils for the
closure of a small PDA, but major complications, including hemolysis, can
occur in 1%. After balloon dilation of coarctation, aneurysm is observed in
about 5% and restenosis in 20 -30%. Mild stenosis may remain and upper body
hypertension may persist, especially during excercise. Stent placement may solve some of
the problems of balloon dilation, but the stents currently available are
not perfect for implantation in the aorta. Restenosis and aortic
regurgitation are common long after balloon dilation of the aortic valve,
and balloon dilation should be considered to be a palliative therapy. The
success rate of balloon dilation of pulmonary artery stenosis is low
(60-80%), and restenosis is common (about 20%). Stent placement in the branch pulmonary artery usually
results in good relief of stenosis, but the pulmonary artery with the stent
does not grow. Major complications including death during interventional
catheterization occur in 1-2%. Further progress is necessary to overcome
these limitations and decrease complications of interventional
catheterization in infants and children.