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  • Review Article
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Interventions for adult congenital heart disease

Nature Reviews Cardiology volume 22, pages 510–526 (2025)Cite this article

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Abstract

Advances in imaging diagnostics, surgical techniques and transcatheter interventions for paediatric patients with severe congenital heart disease (CHD) have substantially reduced mortality, thereby extending the lifespan of these individuals and increasing the number of adults with complex CHD. Transcatheter interventions have emerged as an alternative to traditional open-heart surgery to mitigate congenital defects. The evolution of techniques, the introduction of new devices and the growing experience of operators have enabled the treatment of patients with progressively more complex conditions. The general cardiology community might be less aware of contemporary interventions for adult CHD, their clinical indications and associated outcomes than interventional cardiologists and congenital heart specialists. In this Review, we provide a comprehensive evaluation of the available transcatheter interventions for adult patients with CHD.

Key points

  • The prevalence of adults with congenital heart disease (CHD) has risen and now substantially exceeds the paediatric population with CHD, presenting new challenges in the management of these patients with complex disease.

  • Novel transcatheter procedures have emerged as an alternative to open-heart surgery in adults with CHD, reducing the need for repeat operations and improving both quality of life and prognosis.

  • Transcatheter technology is a rapidly evolving field; new shunt closure devices and techniques for aortic, mitral, pulmonary and tricuspid valve repair or replacement are being developed for use in adults with CHD.

  • Comprehensive, multicentre and population-based registries of adult patients with CHD, including extended periods of follow-up, are needed to address unanswered questions.

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Fig. 1: Main types of atrial and ventricular septal defect.
Fig. 2: Transcatheter ostium secundum ASD and superior SVD closure.
Fig. 3: Transcatheter closure of patent ductus arteriosus and correction of native coarctation of the aorta.
Fig. 4: Transcatheter interventions in right-sided defects.

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Acknowledgements

P.C.-G. is the recipient of a grant from the Fundación Alfonso Martín Escudero (Madrid, Spain). E.H. is supported by the Peter Munk Chair in Structural Heart Disease Intervention. J.R.-C. holds the Research Chair ‘Fondation Famille Jacques Larivière’ for the Development of Structural Heart Interventions (Laval University, Québec City, Canada).

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Authors and Affiliations

  1. Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada

    Pedro Cepas-Guillén & Josep Rodés-Cabau

  2. Hospital Clinic, Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain

    Eduardo Flores-Umanzor & Xavier Freixa

  3. Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada

    Eric Horlick & Lee Benson

  4. UCLA Adult Congenital Heart Disease Center, University of California Los Angeles, Los Angeles, CA, USA

    Jamil Aboulhosn

  5. Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada

    Lee Benson

  6. Centre Hospitalier Universitaire de Quebec, Centre Mère-Enfant Soleil, Quebec, Quebec, Canada

    Christine Houde & Josep Rodés-Cabau

  7. Department of Research and Innovation, Clínic Barcelona, Barcelona, Spain

    Josep Rodés-Cabau

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  1. Pedro Cepas-Guillén
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  2. Eduardo Flores-Umanzor
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Contributions

P.C.-G. researched data for the article. P.C.-G. and J.R.-C. discussed the content of the article. P.C.-G. and E.F.-U. wrote the manuscript. All the authors reviewed/edited the article before submission.

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Correspondence to Josep Rodés-Cabau.

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Competing interests

J.A. is a consultant and proctor for Edwards Lifesciences, Medtronic and Siemens, and has received research funding from Venus Medtech. L.B. is a consultant for Medtronic. X.F. is a proctor for Abbott Medical. J.R.-C. has received institutional research grants and speaker/consultant fees from Edwards Lifesciences and Medtronic. The other authors declare no competing interests.

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Cepas-Guillén, P., Flores-Umanzor, E., Horlick, E. et al. Interventions for adult congenital heart disease. Nat Rev Cardiol 22, 510–526 (2025). https://doi.org/10.1038/s41569-025-01118-1

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