Interventional cardiology in pediatrics

Since the first description of successful pulmonary balloon valvuloplasty in 1982, the field of pediatric interventional cardiology has seen a dramatic development Nowadays, interventional techniques are a standard therapy for a wide range of indications in congenital heart disease: balloon pulmonary and aortic valvuloplasty are therapies of choice as well as the occlusion of the persistent ductus arteriosus by double umbrellas or coils. Dilatation of a recoarctation after initial surgical therapy is safe and successful whereas there is an ongoing debate whether native coarctation should be managed surgically or by catheter intervention. Other common indications for catheter interventions are dilatation and stenting of native or postoperative vessel stenosis and occlusion of abnormal intrathoracic vessels with coils. Other indications such as closure of atrial septal defects are about to become clinical routine, whereas interventional closure of ventricular septal defects must still be considered an experimental approach. Moreover in complex congenital heart disease there are a number of other indications for very specific interventional techniques. Interventional therapies should be seen either as adjuvant to surgical management in some cases or as an alternative approach to avoid surgery in others. It is important that the indications for surgical or interventional therapy result from a discussion involving the pediatric cardiologist and the pediatric cardiac surgeon.