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Prelims-Heart Disease-8014.qxd 12/21/2006 11:59 AM Page i

Percutaneous
Interventions
for Congenital
Heart Disease
Prelims-Heart Disease-8014.qxd 12/21/2006 11:59 AM Page ii
Prelims-Heart Disease-8014.qxd 12/21/2006 11:59 AM Page iii

Percutaneous
Interventions
for Congenital
Heart Disease
Edited by

Horst Sievert MD
Professor of Internal Medicine, Cardiology, Vascular Medicine
CardioVascular Center Frankfurt
Sankt Katharinen
Frankfurt
Germany

Shakeel A Qureshi FRCP

Department of Congenital Heart Disease
Evelina Children’s Hospital
Guy’s and St Thomas’s Hospital Foundation Trust
London
UK

Neil Wilson FRCP

Consultant Paediatric Cardiologist
Department of Paediatric Cardiology
John Radcliffe Hospital
Oxford
UK

Ziyad M Hijazi MD MPH FACC FSCAI

George M Eisenberg Professor of Pediatrics and Medicine
Staff Cardiologist, Section of Pediatric Cardiology
University of Chicago, Pritzker School of Medicine
Chicago, IL
USA
Prelims-Heart Disease-8014.qxd 12/21/2006 11:59 AM Page iv

© 2007 Informa UK Ltd

First published in the United Kingdom in 2007 by Informa Healthcare, 4 Park Square, Milton Park, Abingdon, Oxon OX14
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Prelims-Heart Disease-8014.qxd 12/21/2006 11:59 AM Page v

Contents

List of Contributors ix 9. Transhepatic access 101

Foreword – Michael Tynan xiii Makram R Ebeid
Foreword – Martin B Leon xv
Preface xvii 10. Recanalization methods for post-catheter
Color plates vessel occlusion 111
Frank F Ing
Section I 1
11. Transseptal left heart catheterization 121
1. The ideal cardiac catheterization laboratory: Igor F Palacios
not just for cardiologists anymore… it is
hybrid time! 3
Section IV 129
John P Cheatham
12. Fetal cardiac interventions 131
Section II Michael Tynan
Imaging modalities in the cath-lab 13
2. Angiography 15 Section V 135
Lee Benson and Haverj Mikailian
13. Special considerations in small infants
3. Transesophageal echocardiographic guidance and newborns 137
of transcatheter closure of atrial septal defects 33 Martin BE Schneider
Charles S Kleinman
Section VI
4. Imaging during cardiac catheterization: Valves 151
intracardiac echocardiography (ICE) using
the AcuNav® catheter 41 14. Aortic valve, congenital stenosis 153
Peter R Koenig, Qi-Ling Cao, and Ziyad M Hijazi Oleg Reich

5. Intracardiac echocardiography by Ultra ICE 49 15. Aortic valve stenosis in neonates 163
Eustaquio Onorato, Francesco Casilli, and Alejandro J Torres and William Hellenbrand
Mario Zanchetta
16. Balloon aortic valvuloplasty for aortic valve
6. Three-dimensional echocardiography: stenosis in the elderly 171
present and future applications in the Alain Cribier, Helene Eltchaninoff, and
catheterization laboratory 61 Vasilis Babaliaros
Gerald R Marx, Wayne Tworetzky, and
Audrey Marshall 17. Percutaneous mitral balloon
valvuloplasty 177
7. Cardiac computed tomography in the cath-lab 73 Igor F Palacios
Carlos E Ruiz, Vladimir Jelnin, and Sibyl C Medie
18. Pulmonary valve stenosis 185
Section III P Syamasundar Rao
Vascular access 95
19. Pulmonary valve in cyanotic heart defects
8. Access from the common carotid artery 97 with pulmonary oligemia 197
Grazyna Brzezinska-Rajszys P Syamasundar Rao
Prelims-Heart Disease-8014.qxd 12/21/2006 11:59 AM Page vi

vi Contents

20. Tricuspid valve stenosis 201 34. Patent foramen ovale – Premere™ PFO
Ramesh Arora Closure System 325
Franziska Buescheck and Horst Sievert
21. Pulmonary atresia 207
Joseph V De Giovanni
35. Closure of muscular VSD using the
Amplatzer muscular VSD occluder 339
22. Transcatheter valve replacement of the
Yun-Ching Fu, Qi-Ling Cao, and
aortic valve 217
Ziyad M Hijazi
Alain Cribier, Helene Eltchaninoff, and
Vasilis Babaliaros
36. Transcatheter closure of muscular
ventricular septal defects: tips regarding
23. Transcatheter valve replacement of the
CardioSEAL double umbrella technique 345
pulmonary valve 227
Michael Landzberg
Sachin Khambadkone and Philipp Bonhoeffer

24. Transcatheter valve repair for mitral 37. Closure of perimembranous VSD using the
insufficiency – direct repair 233 Amplatzer membranous VSD occluder 349
Peter C Block Yun-Ching Fu, Qi-Ling Cao, and
Ziyad M Hijazi
25. Transcatheter valve repair for mitral
insufficiency – annuloplasty 239
38. Closure of VSDs – PFM coil 357
Motoya Hayase and Martin B Leon
Trong-Phi Lê
26. Percutaneous closure of paravalvular leaks 251
39. Amplatzer™ post-myocardial infarction
Jean-François Piéchaud
VSD occluder 363
Kevin P Walsh and Patricia Campbell
27. Catheter closure of perforated sinus of Valsalva 257
Ramesh Arora
40. Transcatheter closure of post-myocardial
infarction muscular ventricular septal rupture:
Section VII
tips regarding CardioSEAL double umbrella
Septal defects 263 technique 373
28. Closure of secundum atrial septal defect Michael Landzberg
using the Amplatzer Septal Occluder 265
Yun-Ching Fu, Qi-Ling Cao, and Ziyad M Hijazi Section VIII
Aorto-pulmonary shunts 375
29. Atrial septal defect closure with Starflex device 277
Mario Carminati, Massimo Chessa, Gianfranco 41. PDA occlusion with the Amplatzer devices 377
Butera, Luciane Piazza, and Diana Negura Mazeni Alwi

30. Atrial septal defect closure using the 42. Patent ductus arteriosus: coil occlusion 385
Helex device 283 R Krishna Kumar
Neil Wilson
43. Aorto-pulmonary window 403
31. Patent foramen ovale – Amplatzer PFO occluders
Ramesh Arora
Bernhard Meier 289

32. Percutaneous closure of patent foramen Section IX

ovale with the CardioSEAL®/STARflex® Fistulas 409
Occluder 311
Paul Kramer 44. Systemic arterio-venous fistulas 411
Grazyna Brzezinska-Rajszys
33. Helex occluder for occlusion of patent
foramen ovale 321 45. Pulmonary arterio-venous fistulas 419
Yves Laurent Bayard and Horst Sievert John F Reidy
Prelims-Heart Disease-8014.qxd 12/21/2006 11:59 AM Page vii

Contents vii

46. Transcatheter closure of coronary Section XII

artery fistulas 423 Aneurysms 511
Shakeel A Qureshi
57. Aortic aneurysms 513
Section X JP Morales and John F Reidy
Obstructions 431
58. Catheter interventions in dissecting
47. Obstructions of the inferior and superior aneurysms of the aorta 519
vena cava 433 Tim C Rehders, Hüseyin Ince, Stephan Kische,
Marc Gewillig Michael Petzsch, and Christoph A Nienaber

48. Relief of right ventricular outflow Section XIII

tract obstruction 439 Hybrid procedures 529
Neil Wilson
59. A hybrid strategy for the initial management
of hypoplastic left heart syndrome: technical
49. Pulmonary artery stenosis 447
considerations 531
Larry Latson
Mark Galantowicz and John P Cheatham

50. Pulmonary vein stenoses 455 60. Alternative procedures for hypoplastic left
Lee Benson heart syndrome as a bridge to transplantation 539
Ryan R Davies, Mark M Boucek, and Jonathan
51. Discrete subaortic stenosis 461 M Chen
José Suárez de Lezo, Manuel Pan, José Segura,
Miguel Romero, and Djordje Pavlovic 61. Intraoperative VSD device closure 549
Zahid Amin
52. Supravalvar aortic stenosis 469
José Suárez de Lezo, Manuel Pan, Miguel 62. Intra-operative stent implantation 557
Romero, José Segura, and Djordje Pavlovic Evan M Zahn

53. Stenting in aortic coarctation and Section XIV

transverse arch/isthmus hypoplasia 475 Left atrial appendage closure 569
Shakeel A Qureshi 63. PLAATO device 571
Yves Laurent Bayard, Reinhardt M Becht,
54. Middle aortic syndrome 487 Stephan H Ostermayer, and Horst Sievert
Grazyna Brzezinska-Rajszys and
Shakeel A Qureshi 64. Amplatzer devices 579
Bernhard Meier
Section XI
65. Left atrial appendage closure with the
Hypertrophic obstructive cardiomyopathy 493
Watchman® device 589
55. Catheter intervention for hypertrophic Peter Sick
obstructive cardiomyopathy 495
Ulrich Sigwart and Haran Burri Index 597

56. Hypertrophic obstructive

cardiomyopathy – radiofrequency
septal reduction 503
Joseph V De Giovanni
Prelims-Heart Disease-8014.qxd 12/21/2006 11:59 AM Page viii
Prelims-Heart Disease-8014.qxd 12/21/2006 11:59 AM Page ix

Contributors

Mazeni Alwi MRCP Peter C Block MD

Department of Paediatric Cardiology Principal Investigator
National Heart Institute School of Medicine
Kuala Lumpur Emory University Hospital
Malaysia Atlanta, GA
USA
Zahid Amin, MD
Professor and Medical Director Philipp Bonhoeffer MD
Children’s Hospital of Omaha Chief of Cardiology and Director, Cardiac
Omaha, NE Catheterisation Laboratory
USA Great Ormond Street Hospital
London
Ramesh Arora MD DM FICC FACC(USA) UK
Chief Cardiologist-Metro Hospitals &
Heart Institute Mark M Boucek MD
Formerly Director Professor Joe Dimaggio Children’s Hospital
& Head of Cardiology Hollywood, FL
GB PANT Hospital and
New Delhi University of Colorado
India Denver, CO
USA
Vasilis Babaliaros MD
Assistant Professor of Medicine Grazyna Brzezinska-Rajszys MD
Emory University Hospital The Heart Catheterization Laboratory
Atlanta, GA The Children Memorial Health Institute
USA Warsaw
Poland
Yves Laurent Bayard MD
Cardiovascular Center Franziska Buescheck
Sankt Katharinen Medical Student
Frankfurt Cardiovascular Center Frankfurt
Germany Sankt Katharinen
Frankfurt
Reinhardt M Becht MD Germany
Cardiovascular Center Frankfurt
Sankt Katharinen Haran Burri MD
Frankfurt Division of Cardiology
Germany University Hospital
Geneva
Lee Benson MD FRCPC FACC FSCAI Switzerland
Professor of Pediatrics (Cardiology)
Director, Cardiac Diagnostic and Interventional Gianfranco Butera
Unit (CDIU) Paediatric Cardiology Center
Department of Pediatrics, Division of Cardiology Istituto Policlinico San Donato
The Hospital for Sick Children San Donato
University of Toronto School of Medicine Milanese
Toronto, ON Milan
Canada Italy
Prelims-Heart Disease-8014.qxd 12/21/2006 11:59 AM Page x

x List of Contributors

Patricia Campbell Ryan R Davies MD

Mater Misericordiae Hospital Pediatric Cardiac Surgery
Dublin The Morgan Stanley Children's Hospital of
Ireland New York – Presbyterian
Columbia University College of Physicians
Qi-Ling Cao MD and Surgeons
Senior Research Scientist New York, NY
Section of Pediatric Cardiology USA
University of Chicago,
Pritzker School of Medicine Joseph V De Giovanni MD FRCP FRCPCH
Chicago, IL Heart Unit
USA Birmingham Children’s Hospital
Birmingham
Mario Carminati MD UK
Pediatric Cardiology Center
Policlinico San Donato Makram R Ebeid MD
Milan Department of Pediatrics (Cardiology)
Italy University of Mississippi Medical Center
Jackson, MI
Francesco Casilli MD
Division of Cardiology USA
Humanitas Gavazzeni Clinic
Helene Eltchaninoff MD
Bergamo
Professor of Medicine (Cardiology)
Italy
Director, Cardiac Catheterization
John P Cheatham MD Laboratory
Director, Cardiac Catheterization and Department of Cardiology
Interventional Therapy Charles Nicolle University Hospital
The Heart Center, Columbus Children’s Hospital Rouen
and France
Professor, Pediatrics and Internal Medicine,
Yun-Ching Fu MD PhD
Cardiology Division
Section of Pediatric Cardiology
The Ohio State University
Taichung Veterans General Hospital
Columbus, OH
Taichung City
USA
Taiwan
Jonathan M Chen MD
Director, Pediatric Cardiac Surgery Mark Galantowicz MD
Weill Cornell Campus Co-Director, Columbus Children’s
New-York Presbyterian Hospital Heart Center
New York, NY Columbus Children’s Hospital
USA Columbus, OH
USA
Massimo Chessa Marc Gewillig MD
Pediatric Cardiology Center Professor, Pediatric Cardiology
Policlinico San Donato University Hospital Gasthuisberg
Milan Leuven
Italy Belgium

Alain Cribier MD Motoya Hayase MD

Professor of Medicine (Cardiology) Skirball Center for Cardiovascular
Chief, Department of Cardiology Research
Charles Nicolle University Hospital Cardiovascular Research Foundation
Rouen Orangeburg, NY
France USA
Prelims-Heart Disease-8014.qxd 12/21/2006 11:59 AM Page xi

List of Contributors xi

William Hellenbrand MD Charles S Kleinman MD

Professor of Pediatrics Professor of Clinical Pediatrics in Obstetrics and
Director Pediatric Catheterization Laboratory Gynecology
Columbia University College of Physicians Columbia University College of Physicians and Surgeons
and Surgeons Weill Medical College of Cornell University
Children’s Hospital of New York Presbyterian New York, NY
New York, NY and
USA Chief, Pediatric Cardiac Imaging
Morgan Stanley Children’s Hospital of
Ziyad M Hijazi MD MPH FACC FSCAI New York- Presbyterian
George M Eisenberg Professor of Pediatrics New York, NY
and Medicine USA
Staff Cardiologist, Section of Pediatric Cardiology Peter R Koenig MD
University of Chicago, Pritzker School of Medicine Associate Professor of Pediatrics
Chicago, IL Section of Pediatric Cardiology
USA Director, Echocardiography Laboratory
Comer Children’s Hospital
Hüseyin Ince MD University of Chicago, Pritzker School of Medicine
Division of Cardiology Chicago, IL
University Hospital Rostock USA
Rostock School of Medicine Paul Kramer MD
Rostock Interventional Cardiologist
Germany Shawnee Mission Medical Center
Shawnee Mission, KS
Frank F Ing MD USA
Associate Professor of Pediatrics
R Krishna Kumar MD DM FACC FSCAI
Baylor College of Medicine
Chief Pediatric Cardiologist
Director, Cardiac Catheterization Laboratories
Amrita Institute of Medical Sciences and
Texas Children’s Hospital
Research Centre
Houston, TX
Kerala
USA
India

Vladimir Jelnin Michael Landzberg MD

Department of Medicine Director, Boston Adult Congenital Heart
Section of Cardiology (BACH) Group
University of Illinois at Chicago Children’s Hospital, Brigham and
Chicago, IL Women’s Hospital
USA and
BIDMC
Harvard Medical School
Sachin Khambadkone MD DCH DNB MRCP Boston, MA
Consultant Pediatric Cardiologist and Honorary USA
Senior Lecturer
Great Ormond Street Hospital Larry Latson MD
London Department of Pediatric Cardiology
UK Cleveland Clinic Foundation
Cleveland, OH
USA
Stephan Kische MD
Division of Cardiology Trong Phi Lê MD
University Hospital Rostock Department of Pediatric Cardiology
Rostock School of Medicine University of Hamburg
Rostock Hamburg
Germany Germany
Prelims-Heart Disease-8014.qxd 12/21/2006 11:59 AM Page xii

xii List of Contributors

Martin B Leon MD Christoph A Nienaber MD FACC

Professor of Medicine and Associate Director Division of Cardiology
Center for Interventional Vascular Therapy University Hospital Rostock
Columbia University Medical Center Rostock School of Medicine
and Rostock
Chairman, Cardiovasular Research Foundation Germany
New York, NY
Eustaquio Onorato MD FSCAI
USA
UO Cardiologia 1
Gerald R Marx MD Humanitas Gavazzeni
Children’s Hospital Boston Department Bergamo
of Cardiology Italy
Boston, MA
USA Stephan H Ostermayer
Cardiovascular Center Frankfurt
Audrey Marshall Sankt Katharinen
Associate in Cardiology Frankfurt
Department of Cardiology Germany
Children’s Hospital Boston Igor F Palacios MD
Boston, MA Director, Cardiac Catheterization Laboratories
USA Director, Interventional Cardiology
Sibyl C Medie Massachusetts General Hospital
Research Asistant Boston, MA
Peditric Cardiology USA
University of Illinois at Chicago Manuel Pan MD PhD
Chicago, IL Assistant Professor
USA Department of Cardiology
Bernhard Meier MD University Hospital Reina Sofia
Professor and Chairman of Cardiology Córdoba
Swiss Cardiovascular Center Bern Spain
University Hospital Djordie Pavlovic MD PhD
Bern Assistant Professor
Switzerland Department of Cardiology
University Hospital Reina Sofia
Haverj Mikailian MRT(R) Córdoba
Department of Medical Imaging Spain
Department of Pediatrics, Division of Cardiology
The Hospital for Sick Children Michael Petzsch MD
University of Toronto School of Medicine Division of Cardiology
Toronto, ON University Hospital Rostock
Canada Rostock School of Medicine
Rostock
Diana Negura Germany
Paediatric Cardiology Department and GUCH Unit Luciane Piazza
Istituto Policlinico San Donato Department of Pediatric Cardiology and Cardiac Surgery
San Donato Milanese Instituto Policlinico San Donato
Milan San Donato Milanese
Italy Milan
Italy
JP Morales MD
Department of Interventional Radiology Jean-François Piéchaud MD
Guy’s and St Thomas’ Hospital Institut Hospitalier Jacques Cartier
London Massy
UK France
Prelims-Heart Disease-8014.qxd 12/21/2006 11:59 AM Page xiii

List of Contributors xiii

Shakeel A Qureshi FRCP Peter Sick MD

Department of Congenital Heart Disease University of Leipzig, Heart Center
Evelina Children’s Hospital Leipzig
Guy’s and St Thomas’s Hospital Foundation Trust Germany
London
UK Horst Sievert MD
Professor of Internal Medicine, Cardiology, Vascular Medicine
P Syamasundar Rao CardioVascular Center Frankfurt
Professor and Director, Division of Pediatric Cardiology Sankt Katharinen
The University of Texas/Houston Medical School Frankfurt
Houston, TX Germany
USA
Ulrich Sigwart MD FRCP FACC FESC
Oleg Reich MD PhD Professor and Head of Cardiology
Kardiocentrum University Hospital
University Hospital Motol Geneva
Prague Switzerland
Czech Republic
Vladimir Jelnin
John F Reidy MD
Department of Medicine
Department of Radiology
Section of Cardiology
Guy’s and St Thomas’ Hospital
University of Ilinois at Chicago
London
Chicago, IL
UK
USA
Tim C Rehders MD José Suárez de Lezo MD PhD
Division of Cardiology Professor of Cardiology
University Hospital Rostock Department of Cardiology
Rostock School of Medicine University Hospital Reina Sofia
Rostock Córdoba
Germany Spain
Miguel Romero MD PhD Alejandro J Torres MD
Assistant Professor Assistant Professor
Department of Cardiology Division of Pediatric Cardiology
University Hospital Reina Sofia Columbia University College of Physicians and Surgeons
Córdoba Children’s Hospital of New York Presbyterian
Spain New York, NY
USA
Carlos E Ruiz MD PhD
Professor of Medicine and Pediatrics Wayne Tworetzky MD
Chief, Division of Cardiology Department of Pediatrics Associate in Cardiology
University of Illinois Department of Cardiology
Chicago, IL Children’s Hospital Boston
USA Boston, MA
Martin BE Schneider MD USA
Chief, Department of Congenital Heart Disease Michael Tynan MD FRCP
German Paediatric Heart Centre Emeritus Professor of Paediatric Cardiology
Sankt Augustin Kings College
Germany London
UK
José Segura MD PhD
Assistant Professor Kevin P Walsh MD
Department of Cardiology Consultant Paediatric Cardiologist
University Hospital Reina Sofia Mater Misericordiae Hospital
Córdoba Dublin
Spain Ireland
Prelims-Heart Disease-8014.qxd 12/21/2006 11:59 AM Page xiv

xiv List of Contributors

Neil Wilson FRCP Mario Zanchetta MD FSCAI

Consultant Paediatric Cardiologist Director, Department of Cardiovascular Sciences
Department of Paediatric Cardiology Cittadella General Hospital
John Radcliffe Hospital Cittadella
Oxford Padua
UK Italy
Evan M Zahn MD
Department of Cardiology
Miami Children’s Hospital
Miami, FL
USA
Prelims-Heart Disease-8014.qxd 12/21/2006 11:59 AM Page xv

Foreword

This book is the offspring of the annual Frankfurt course of a slow start, with few innovations until the 1980s, but since
interventional cardiology which has focused strongly then the treatment of cardiovascular diseases has been
on congenital heart disease. This course has, year by year, transformed. The advances that have been made have been
gained in reputation. It is essentially a practical course. The due, in great part, to the partnership of physicians and
live case demonstrations are the heart of such meetings. industry and it would be hard to overstate the importance
This book reflects the course and is a practical book; a ‘how of the contribution of our colleagues in industry.
to’ book. A quick scan of the 60 or so chapters reveals the With the rapid incorporation of advanced technologies
galaxy of talent operating and lecturing during the courses into this field we have seen procedures and devices come
and who are now giving their accounts in writing. and go. We can expect this dynamic to continue; so this
As one who was in at the beginning of catheter interven- book is a statement of where we stand in 2006 and I am sure
tions in congenital heart disease I am filled with wonder- that by 2016 a similar book will have many new techniques
ment at what is now on offer to the patients. As a young to offer.
trainee in the late 1960s, Bill Rashkind’s introduction of
balloon atrial septostomy marked a milestone in the treat- Michael Tynan MD FRCP
ment of transposition. Not only did it transform the out- Emeritus Professor of Paediatric Cardiology
look for babies with this malformation but it marked the Kings College
start of the quest for practical minimally invasive types of London
treatment of structural cardiac anomalies. It was admittedly UK
Prelims-Heart Disease-8014.qxd 12/21/2006 11:59 AM Page xvi
Prelims-Heart Disease-8014.qxd 12/21/2006 11:59 AM Page xvii

Foreword

Most knowledgeable interventional historians would argue also echocardiography, MR imaging, and CT angiography),
that the era of lesser-invasive non-surgical cardiovascular and hybrid surgical therapists.Finally,since many of the cardiac
therapy began almost 30 years ago when Andreas Gruentzig anomalies targeted for catheter-based treatment occur rarely,
performed the first successful coronary angioplasty, ful- the focused interventionalists working in this rarified zone have
filling his dream to accomplish catheter-based percutaneous clustered into a small, well bonded fraternity. The purpose of
treatment of vascular disease in alert, awake patients. this textbook is to highlight the practical teaching experiences
Undoubtedly, Andreas would have delighted in the astound- of this congenital and structural interventional fraternity.
ing developments of the ensuing decades, as disciples of his For almost a decade, an international live case demon-
‘simple’ procedure applied creativity, technical acumen, and stration workshop has convened in Frankfurt, Germany for
scientific rigor to sculpt the burgeoning interdisciplinary the purpose of observing and discussing interventional pro-
subspecialty of interventional cardiovascular medicine. cedures in this eclectic subspecialty. Directed by Dr Horst
Importantly, over the years, a typical development pattern Sievert (and more recently with Drs Neil Wilson and
has emerged – early stage well characterized procedures Shakeel Qureshi as co-directors), this clinical symposium
involving a restricted lesion subset and patient cohort has become the definitive ‘how to’ educational event for
became generalized to the mainstream patient population practicing congenital and structural interventionalists. The
after equipment innovations and refinement of physician current textbook serves as a comprehensive syllabus includ-
operator skills. Thus, coronary intervention, beginning with ing a virtual ‘who’s who’ author list, representing the
‘plain old balloon angioplasty’, begat bare metal stents, thought leaders from all allied fields under the umbrella of
atherectomy devices, and drug-eluting stents, finally result- congenital and structural heart disease. The organizational
ing in a procedure with safe, predictable, and definitive clin- structure is both authoritative and intuitive with easy to
ical outcomes which could be generalized to most patients navigate sections beginning with the catheterization labora-
with obstructive coronary disease. Soon thereafter, periph- tory environment, new imaging modalities for diagnosis
eral vascular and neurovascular intervention underwent a and procedural guidance, and fetal and infant interven-
similar renaissance, ‘borrowing’ ideas, technology tem- tions, and marching through an orderly progression of
plates, and operator skills from coronary platforms to every conceivable congenital and structural lesion category
extend catheter-based treatments to other regions of the which has been managed using existing or proposed inter-
extracardiac vascular system. ventional therapies. As with the clinical symposium, this
The third chapter of this interventional odyssey applies to textbook has a familiar stylistic consistency emphasizing
the current textbook, entitled Percutaneous Interventions for clinical treatment indications and practical operator tech-
Congenital Heart Disease. This newest and most diverse nique issues with helpful procedural ‘tips and tricks’ and
branch of the inteventional tree embraces a potpourri of con- careful descriptions of potential complications. The breadth
genital and acquired cardiovascular disorders, previously left of this textbook is impressive, extending from commonly
untreated or relegated to surgical therapy alternatives. We have recognized conditions to less well established domains, such
employed the term ‘structural heart disease’ to encompass a as exciting new transcatheter valve therapies and intra-
wide variety of non-atherosclerotic and generally non-vascu- operative hybrid VSD closure and stent implantation.
lar disease entities, ranging from intracardiac septal defects to Lest one think that this textbook is merely a com-
valvular lesions. This newcomer on the interventional horizon pendium of obscure interventional oddities, the subspe-
is unique for several reasons. First, the diversity and complexity cialty exploding from the predicate symposium and this
of interventional skills required to safely and successfully treat textbook represents the greatest potential growth area in all
both neonates and octogenarians with advanced cardiac of interventional cardiovascular medicine. Just imagine the
lesions are unprecedented. Second, the intersecting physician consequences if adult transcatheter valve therapy becomes
groups are far-reaching, spanning pediatric and adult interven- commonplace in patients with aortic stenosis and mitral
tional cardiology, imaging specialists (not just angiography, but regurgitation, or if patent foramen ovale closure becomes a
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