[The lymphatics of the heart (peroperative injections)].
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Morphologic evaluation of operatively excised native cardiac valves can lead to an etiologic diagnosis in most instances using a simple 10-step approach. With few exceptions, histologic evaluation of excised cardiac valves provides little additional information beyond this proposed morphologic assessment.
Interventional cardiac procedures for patients with congenital heart disease, developed for the pediatric patient, have been adapted for the adult patient. In this review these unique procedures are reviewed with emphasis on the experience at The Toronto Congenital Cardiac Centre for Adults. Procedures directed to closing shunts include: occlusion of patent ductus arteriosus, coil embolization of aorto-systemic collaterals, coronary fistulas, and Blalock-Taussig shunts, and early attempts at nonsurgical occlusion of atrial septal defects. Balloon dilation procedures include management of pulmonary valve stenosis, peripheral pulmonary artery stenosis, and more recently the application of stents in dilation of coarctation of the aorta. Development of interventional techniques for adult congenital heart disease involves a diverse number of procedures which provide successful nonsurgical options for many patients with congenital heart disease.
Percutaneous balloon valvuloplasty of stenoses has been introduced into medical practice in the late 70ies. Over the past decade, the method has evolved to a valid alternative to valve surgery in selected cases. Balloon valvuloplasty of isolated mitral stenosis is to date the therapy of choice and yields results comparable to those of surgery. It is even superior in only moderately diseased valves. However, the most frequent valve stenosis, that is aortic stenosis of the elderly, is not suitable for balloon dilatation. Dilatation of congenital aortic stenosis can be attempted if the valve is bicuspid or tricuspid. The recurrence rates for valvular stenoses after valvuloplasty are similar to those after surgical commissurotomy.