Cardiovascular Interventions in Congenital Heart Disease

Congenital heart disease encompasses a spectrum of structural cardiac anomalies present at birth, many of which require intervention to restore normal haemodynamics and prevent long-term complications. Over the past decades, surgical repair has evolved from open-heart techniques to include less invasive transcatheter procedures. Pulmonary valve replacement, for instance, can now be achieved via both surgical implantation and percutaneous approaches designed to reduce right ventricular volume overload and mitigate arrhythmic risk. Optimal timing of intervention is guided by a combination of clinical assessment, exercise testing and advanced imaging, with the aim of promoting cardiac reverse remodelling and preserving ventricular function. Emerging risk stratification tools integrate imaging biomarkers such as myocardial fibrosis and ventricular strain with biochemical markers to personalise decision-making. These advances have transformed the prognosis for patients with repaired defects, delivering improved survival, enhanced quality of life and reduced need for repeat surgery.

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Cardiovascular Interventions in Congenital Heart Disease publication trend

The graph below shows the total number of articles in cardiovascular interventions in congenital heart disease across all publications each year (not limited to Nature Index journals).

Technical terms

Percutaneous pulmonary valve implantation: A catheter-based procedure to implant a valve in the right ventricular outflow tract without open surgery, often used to treat pulmonary regurgitation in repaired congenital lesions.

Cardiovascular magnetic resonance (CMR): A non-invasive imaging technique that provides high-resolution assessment of ventricular volumes, function, tissue characterisation and flow dynamics.

Reverse remodelling: The process by which abnormal ventricular enlargement and dysfunction improve following relief of volume or pressure overload, as seen after valve replacement.

Late gadolinium enhancement (LGE): A CMR method to detect focal myocardial fibrosis by visualising regions of delayed contrast wash-out, serving as a surrogate for scar burden.

Ventricular strain: A quantitative measure of myocardial deformation during contraction, used to detect subtle changes in systolic function beyond ejection fraction.

References

1. Immediate and Midterm Cardiac Remodeling After Surgical Pulmonary Valve Replacement in Adults With Repaired Tetralogy of Fallot. Circulation (2017).
2. Predicting Survival in Repaired Tetralogy of Fallot A Lesion-Specific and Personalized Approach. JACC Cardiovascular Imaging (2021).
3. Early experience with the Venus p‑valve for percutaneous pulmonary valve implantation in native outflow tract. Netherlands Heart Journal (2016).