This document discusses nonsurgical cardiac interventions for children with congenital heart disease in India. It estimates that 130,000-270,000 children are born with CHD in India each year, with 80,000 requiring intervention as infants. While early correction is ideal, many children previously died untreated. Now, catheter-based interventions can treat conditions like PDA, ASD, and VSD without surgery. The document reviews the history, techniques, and current scope of these procedures. It concludes that 20-30% of children with CHD can now be treated in the cath lab, and future innovations may allow treating more complex cases nonsurgically.
2. Estimates of Congenital Heart Disease
(CHD) Prevalence Among Live-born
Infants in India*
• Total CHD at birth ~130-270,000
• Critical CHD (requiring intervention in infancy):
~ 80,000
• Infant mortality: India- 63/ 1000
Kerala- 13/ 1000
Andhrapradesh-33/1000
• CHD mortality as a fraction of infant mortality:
3-20% (10-12% in AP?)
*Based on available data of CHD prevalence at birth in developed
countries and present birth rates in India
3. Timing for CHD
• Early correction of congenital heart disease is
desirable because it avoids a number of
adverse cardiac, neurodevelopment and
other consequences
• Early correction of a variety of congenital
heart lesions is feasible and realistic with
excellent results in most of the developed
nations and selected Indian centers
4. What Happens if Congenital
Heart Disease is Untreated?
• Majority of them succumb to
death in infancy and early
childhood
• The rest live a turbulent and
truncated life
11. Interventions in CHD: Well
Accepted
• Coil and device closure of PDA*
• ASD device closure*
• Coil / device closure of coronary cameral
fistulas
• Balloon dilation / stenting of native
coarctation in older children and adults
• Balloon dilation / stenting of baffle obstruction
• Static balloon dilation of atrial septum
12. Interventions in CHD: Performed
in Few Selected Centers
• VSD device closure
• Recanalization (laser/RF assisted) of
valvar pulmonary atresia
• RVOT dilation for TOF
• Stenting of PDA
• Balloon dilation and stenting of conduits
• Closure of paravalvar leaks
15. The High Parasternal or “Ductal View”
MPA
Ao
The two small white arrows indicate the points where the duct is
measured at its PA insertion. The white line indicates the ampulla.
20. The Amplatzer PDA Occluder
• Greater ease, better
control and precision
during deployment
• Size of the duct and
shape of the duct is less
of an issue (as against
coils)
• Concerns regarding
protrusion of parts of
the device in the aorta
or PA
• Some reluctance to use
the device < 4-5 kg
24. PDA Closure
• Most PDAs can potentially be closed in
the catheterization lab
• The role of surgery is now essentially
limited to large ducts with short
ampullae in small infants
• There is scope for further improvements
in the coil / device technology
39. • All fossa ovalis type defects < 30 –35
mm with at least 5 mm margin all
around (except anterior margin which
can be absent altogether): 40-60% of all
fossa ovalis ASDs
• Stricter criteria for younger children
• “Safe” distance from mitral valve,
pulmonary vein, coronary sinus, SVC
Transcatheter ASD Closure:
Scope (Amplatzer ASD
occluder)
54. Conclusions
• Today, by just stretching, tearing and
plugging alone 20-30% of children with CHD
can be treated in the cath lab
• The future is exciting because we are the
threshold of going beyond the paradigm of
“stretching, tearing and plugging”
– Creation of new channels: covered stents, special
devices
– Transcatheter gene therapy, biodegradable
devices
