Transcatheter device intervention is now offered as first line therapy for many congenital heart defects (CHD) which were traditionally treated with cardiac surgery. While off-label use of devices is common and appropriate, a growing number of devices are now specifically designed and approved for use in CHD. Advanced imaging is now an integral part of interventional procedures including pre-procedure planning, intra-procedural guidance, and post-procedure monitoring. There is robust societal and industrial support for research and development of CHD-specific devices, and the regulatory framework at the national and international level is patient friendly. It is against this backdrop that we review transcatheter implantable devices for CHD, the role and integration of advanced imaging, and explore the current regulatory framework for device approval.

Management of congenital heart disease (CHD) has recently increased utilization of cross-sectional imaging to plan percutaneous interventions. Cardiac computed tomography (CT) and cardiac magnetic resonance (CMR) imaging have become indispensable tools for pre-procedural planning prior to intervention in the pediatric cardiac catheterization lab. In this article, we review several common indications for referral and the impact of cross-sectional imaging on procedural planning, success, and patient surveillance.

Background Individuals with single ventricle physiology who are palliated with superior cavopulmonary anastomosis (Glenn surgery) may develop pulmonary arteriovenous malformations (PAVMs). The traditional tools for PAVM diagnosis are often of limited diagnostic utility in this patient population. We sought to measure the pulmonary capillary transit time (PCTT) to determine its value as a tool to identify PAVMs in patients with single ventricle physiology. Methods We defined the angiographic PCTT as the number of cardiac cycles required for transit of contrast from the distal pulmonary arteries to the pulmonary veins. Patients were retrospectively recruited from a single quaternary North American pediatric center, and angiographic and clinical data was reviewed. PCTT was calculated in 20 control patients and compared to 20 single ventricle patients at the pre-Glenn, Glenn, and Fontan surgical stages (which were compared with a linear-mixed model). Correlation (Pearson) between PCTT and hemodynamic and injection parameters was assessed using 84 Glenn angiograms. Five independent observers calculated PCTT to measure reproducibility (intra-class correlation coefficient). Results Mean PCTT was 3.3 cardiac cycles in the control population, and 3.5, 2.4, and 3.5 in the pre-Glenn, Glenn, and Fontan stages, respectively. PCTT in the Glenn population did not correlate with injection conditions. Intraclass correlation coefficient was 0.87. Conclusions Pulmonary angiography can be used to calculate the pulmonary capillary transit time, which is reproducible between observers. PCTT accelerates in the Glenn stage, correlating with absence of direct hepatopulmonary venous flow.

Objectives: The aim of this study is to evaluate the impact of anticoagulation strategy, stent type, and pulmonary artery (PA) jailing on unplanned reintervention rates and PA growth in neonates undergoing patent ductus arteriosus (PDA) stenting. Specifically, we compared aspirin monotherapy versus aspirin plus Enoxaparin, bare metal versus drug-eluting stents, and jailed versus non-jailed PAs. Methods: A retrospective chart review was conducted on neonates who underwent PDA stenting between 2014 and 2024. Patients were categorized by stent type, anticoagulation regimen, and PA jailing status. Unplanned reintervention rates were assessed using chi-square analysis and logistic regression. PA growth was evaluated using catheterization, MRI, and CT imaging. Statistical analyses of PA growth included t-tests and regression models. Results: Among 116 neonates analyzed, aspirin monotherapy was associated with a significantly lower unplanned reintervention rate compared to combination therapy with Enoxaparin ( p = 0.0447). Stent type did not significantly impact reintervention rates. Additionally, intrapatient jailed PAs exhibited significantly reduced distal growth compared to non-jailed PAs ( p = 0.0070). Conclusions: For neonatal PDA stenting, aspirin monotherapy may be as effective as aspirin plus Enoxaparin for post-stenting anticoagulation, and drug eluting stents may not have a significant benefit over bare metal stents. Furthermore, PA jailing may negatively impact distal vessel growth, highlighting the need for refined stent placement techniques, although further prospective studies are needed to optimize procedural strategies and long-term outcomes in this high-risk neonatal population.