| CHD affecting the RV |
Indication for intervention or
medical therapy |
Contraindication or pitfalls |
| Atrial septal defects |
Closure in the presence of:
- right atrial or RV enlargement (I)
- paradoxical embolism (IIa)
- document orthodoxia or platypnea (IIa)
- if tricuspid valve surgery planned (IIa) |
Patients with severe “irreversible” PH
PAP > 2/3 systemic pressures
PVR > 2/3 of SVR
Failure occlusion test of defect |
| Ventricular septal defects |
Closure if
- Qp/Qs > 2 and signs of LV volume
overload (I)
-Qp/Qs > 1.5 and reversible PH (IIa) or LV systolic or diastolic dysfunction (IIa)
-history of infective endocarditis (I) |
Patients with severe “irreversible” PH
cf criteria above |
| RV outflow tract obstruction |
Balloon valvotomy for a domed valve if:
-asymptomatic with peak Doppler PG > 60mmHg or mean PG > 40 mmHg and less than moderate PR (I)
- symptomatic with peak Doppler PG > 50mmHg or mean PG > 30 mmHg (I)
For a dysplasic valve, same criteria but (IIb) recommendation |
Balloon valvotomy not recommended if
- peak Gradient by Doppler < 50 mmHg in the presence of normal
- PS with severe PR
- symptomatic patients with peak
gradient < 30 mmHg. |
| Tetralogy of Fallot |
Surgery for adults with previous repair of TOF
- symptomatic severe PR (I)
- severe PR with RV enlargement or
dysfunction (IIa)
- severe TR (IIa)
- significant residual RVOT stenosis (IIa)
- sustained arrhythmias (IIa)
- residual VSD or severe AR (IIa) |
Always ascertain coronary anatomy before surgery
Never forget to stratify the risk of sudden death in patients with TOF |
| Ebstein Anomaly |
Tricuspid valve repair and closure ASD if
- symptomatic (I)
- cyanosis (I)
- progressive RV dilatation or RV
dysfunction (I)
- paradoxial embolism (I) |
Always consider ventricular pre-excitation |
| ccTGA |
Moderate or progressive AV valve regurgitation
Refer to guidelines for more specific consideration
|
Careful use of AV nodal blocking agents |
