Catheter-Based Treatments for Adult Congenital Heart Disease
Catheter-based treatments for adult congenital heart disease can repair a defect or help the heart to function better by managing symptoms, such as pulmonary regurgitation, in which blood flows backward into the heart instead of toward the lungs. Your NYU Langone specialists determine the best procedure to address your symptoms.
Cardiac catheterization can help your doctor to diagnose and manage heart problems, such as coronary artery disease, caused by congenital defects.
In this procedure, your doctor inserts a thin tube called a catheter into a blood vessel in the arm, neck, or groin and guides it to the heart using X-ray or ultrasound imaging. Then, he or she inserts small, specialized tools or devices through the catheter. These are used to correct the heart defect. Examples include implantable cardiac closure devices that permanently plug holes in a septum, which is a wall that separates chambers of the heart. Over time, tissue grows over these devices, which can be made with wire mesh, polyester, or both materials.
This procedure is performed using sedation or general anesthesia, takes 30 to 90 minutes or longer to complete, and requires an overnight stay in the hospital.
Your doctor may perform additional procedures to correct congenital heart defects immediately after performing cardiac catheterization.
For people with pulmonary valve stenosis and, occasionally, those with aortic valve stenosis—a narrowing that prevents the heart valve from opening and closing properly—balloon valvuloplasty is used to help separate the valve’s leaflets, which open and close to regulate blood flow.
During this procedure, which is performed using local anesthesia and sedation, an interventional cardiologist opens the narrowed and stiffened valves with a small balloon. A continuous X-ray called fluoroscopy provides real-time images of the heart, helping to guide the doctor, who inserts a catheter into a vein in the groin and advances it to the heart.
A balloon at the tip of the catheter is expanded to separate the leaflets. The catheter and the balloon are then removed through the same vein.
This procedure requires an overnight stay in the hospital.
Transcatheter Pulmonary Valve Therapy
At NYU Langone, our specialists can treat some people who have narrowed or leaky pulmonary valves without using open heart surgery. Transcatheter pulmonary valve therapy is a cardiac catheterization procedure that involves implanting a valve made from animal tissue to replace the heart valve that regulates blood flow to the lungs.
In this procedure, a catheter that holds the artificial valve is advanced to the heart through a vein. Your doctor then positions the tip of the catheter in the pulmonary artery and inflates a balloon that expands the artificial valve into place. The valve enables blood to flow properly between the right ventricle and the lungs.
The catheter is then removed. Doctors check the positioning of the new valve using fluoroscopy and an echocardiogram, which is an ultrasound test.
Transcatheter pulmonary valve therapy is performed using sedation and takes one to two hours. You remain in the hospital for 24 to 48 hours afterward for observation.
Percutaneous Mitral Valve Repair
Your doctor may recommend a catheterization procedure to repair a leaky mitral valve—the gateway between the heart’s left chambers—by using a metal clip that grasps the valve’s leaflets, which are the flaps that open and close when the heart pumps. Called percutaneous mitral valve repair, this procedure enables the flaps to close more effectively, improving blood flow through the heart.
In this procedure, which is performed using sedation, your doctor inserts a catheter into a vein in the leg and advances it to the heart’s left atrium, or upper chamber. Next, a small, polyester-covered metal clip is inserted through the catheter and positioned above the leaky mitral valve, where it grasps the leaflets. This helps reduce the backward flow of blood through the valve.
After the procedure, the catheter is removed. You remain in the hospital for 24 to 48 hours for observation.
If you have a heart rhythm disorder, such as atrial fibrillation, atrial flutter or other arrhythmias, your doctor may use catheter ablation to manage symptoms. In this procedure, doctors destroy, or ablate, tissue that causes abnormal rhythms in the atria, the heart’s upper chambers. Specialists at NYU Langone’s Heart Rhythm Center are pioneers in this procedure, which can sometimes cure an arrhythmia and prevent the need for surgery.
Your doctor uses radiofrequency energy, or high heat, to destroy abnormal electrical pathways in the heart, forming a scar that cannot conduct electricity. Sometimes extreme cold temperature is used. This is called cryoablation.
Performed with sedation and a local anesthetic, the procedure involves inserting a catheter into the leg and guiding it toward the heart using X-ray imaging. A radiofrequency electrical current is delivered through the catheter to destroy the heart tissue responsible for the arrhythmia.
Catheter ablation can take two to four hours to complete and may require an overnight stay in the hospital. Your doctor may restrict your activities for up to two weeks after the procedure.
Transcatheter Aortic Valve Replacement
If you have aortic valve stenosis, your doctor may recommend implanting an artificial aortic valve without removing the damaged valve. This procedure is called transcatheter aortic valve replacement, or TAVR.
In this minimally invasive technique, an interventional cardiologist compresses the artificial valve, which is made from animal tissue and a metal mesh stent, and places it into a catheter. The catheter is inserted into the femoral artery in the leg and is threaded to the aorta, where the artificial valve is placed into the aortic valve.
The doctor then expands the artificial valve, pushing the damaged parts of the aortic valve out of the way. The new valve regulates blood flow.
TAVR requires sedation and, typically, a two-day hospital stay.