Therapeutic catheter intervention for adult patients with congenital heart disease (ASD, PDA)

Various types of interventional procedure indicate for adult patients with congenital heart disease. The most common procedure is transcatheter closure of atrial septal defect (ASD). After the introduction of catheter intervention for ASD in the pediatric population, therapeutic advantages of this less invasive procedure were focused on adult through geriatric populations. Currently, two types of devices, such as Amplatzer Septal Occluder and Occlutech Figulla Flex II are available in Japan. The most valuable clinical benefits of this procedure are the significant improvement of symptoms and daily activities, which result from the closure of left-to-right shunt without thoracotomy and cardiopulmonary bypass surgery. These benefits contribute to increase the number of adult ASD device closure candidates who have hesitated over surgical closure. In terms of technical point of view for catheter closure of ASD, the difficulties still exist in some morphological features of defect, or hemodynamic features in the adult population. Morphological features of difficult ASD closure are (1) large (≥30 mm) ASD, (2) wide rim deficiency, and (3) multiple defects. Hemodynamic features of difficult ASD are (1) severe pulmonary hypertension, (2) ventricular dysfunction, and (3) restrictive left ventricular diastolic dysfunction after ASD closure. To complete the catheter ASD closure under these difficult conditions, various procedural techniques have been introduced. These include imaging modalities such as real-time threedimensional imaging, intracardiac echocardiography, fusion imaging of echocardiography, and fluoroscopic imaging. In adult patients, optimal management for their comorbidities is important issues, which include cardiac function, atrial arrhythmias, respiratory function, and renal function. Management of atrial arrhythmias is a key issue for the long-term outcome in adult patients.