Current Status and Prospect of Interventional Congenital Heart Disease 先天性心脏病介入治疗现状及展望 Fu Wai Hospital Cardiovascular Institute Chinese Academy of Medical Sciences Dai Ru Ping 戴汝平 2009.11.13

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 Interventions Homemade Devices were used in 3/4--4/5 ps. Hybrid procedure were performed Good results with low complications

Homemade Devices Biocompatibility study of Domestic Devices VSD ASD PDA Biocompatibility study of Domestic Devices

Homemade Devices PDA,ASD,VSD, Occluders Quality Price

Hybrid Procedure More than 20 hospitals performed Hybrid procedure 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 for alternative treating complex CHD with cyanosis Balloon atrial septostomy for alternative treating complex CHD with cyanosis

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

Hybrid Procedure Stenting for treating branch pulmonary artery stenoses

Hybrid Procedure for treating pulmonary atresia Laser valvotomy with balloon valvoplasty for treating pulmonary atresia

Complications of VSD intervention ( No 9311) Complication Number % III°AVB 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% Successful rate：96.40% Mortality：0.05% (Data from 2007 CHD Salon)

Later Complications ( 6m-2y after ) 1, PH with right cardiac failure. 2, Arrhythmia (LBBB, II-III°AV-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 Pulmonary hypertension with right heart failure RV LV LV F 12y，ECG：RVH，TTE：ASD : 11mm， Treated by Interventional technique with Amplazer occluder of 18mm。 After 2 years, die from right heart failure , Pulmonary systolic pressure：153mmHg (by Echo) Plex & arteritis

Later Complications Cardiomegaly with left heart failure. pre Immediately Post 1 year M 3y，ECG：Normal，TTE：VSD : 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

Prospect of Interventional CHD Develop New Technique and Device National 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 Transcatheter valve replacement

Prospect of Structural Heart Disease 1, Modify Guideline of Interventional SHD 2, 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 cases 5, Develop new Technique

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