Over the past two decades, the approach to diagnosis and treatment of adults with congenital heart disease has been radically transformed. For many years, the catheterization laboratory was the site of diagnosis, while the operating room was the site of treatment. Now, the imaging laboratory (echocardiography, magnetic resonance imaging [MRI], computed tomography [CT], etc.) is the site of diagnosis, and invasive primary treatment is most often performed in the cardiac catheterization and hemodynamics laboratory.
Disease and Treatment in Adults
When this disease presents in adulthood, patients have more marked symptoms than younger patients; Subvalvular obstruction usually occurs in them due to the hypertrophy produced by chronic valve obstruction, the valves present a higher degree of calcification, and significant post-stenotic dilation of the pulmonary artery is very common (because most cases are dome valves).
For valvuloplasty, a balloon diameter 1.25 times the pulmonary annulus is used, so in adults, it is frequently necessary to use two simultaneous balloons. In the case of dysplastic valves, it is recommended to use a larger diameter of the balloon, which can reach 1.5 times the size of the annulus. In pediatric patients, there is some positive experience with cutting balloons, but there are currently no diameters large enough for adults.
Taking into account a large number of adult patients with congenital heart disease due to right ventricular outflow tract dysfunction (RVOT), the possibility of catheter valve replacement represents a drastic change in the treatment of these patients. Therefore, one of the most important advances in the treatment of heart disease in adults is the development of the Melody valve.
Disease and Treatment in Children
In newborns and infants less than 3 months with a severe case of congenital heart disease, medical treatment will be given to stabilize the patient. In newborns, PGE1 will be administered to keep the ductus open, inotropic agents, and correction of acidosis. Once the child is stabilized, surgery (coarctectomy with resection of the ductal tissue and end-to-end anastomosis) is recommended. Angioplasty through interventional catheterization (balloon catheter angioplasty) should be considered in critically ill patients with HF due to severe ventricular dysfunction as a bridge to surgical treatment.
The Medical Professionals
Medical professionals work hard in conquering congenital heart disease. With the advent of new technology and medicine, it is much easier to initiate treatment for better results. Doctors will often try different kinds of treatments to see which one works for each patient on an individual basis.