Percutaneous Interventions for Heart Failure in Congenital Heart Disease

Heart failure (HF) is a major cause of morbidity and mortality in patients with congenital heart disease (CHD), driven by residual lesions and progressive ventricular dysfunction. The heterogeneity of CHD anatomy and physiology often limits the applicability of standard HF therapies. This review aims to summarize contemporary catheter-based strategies used to diagnose, stabilize, and treat HF in patients with CHD across both acute and chronic clinical settings, and to evaluate their role in improving outcomes and delaying surgical or transplant-based therapies. Recent advances in transcatheter technology have expanded therapeutic options for HF in CHD. Invasive hemodynamic monitoring and implantable sensors enable more precise assessment and remote management of complex circulations. Short-term mechanical circulatory support systems, including extracorporeal membrane oxygenation and percutaneous ventricular assist devices, are increasingly used as bridges to recovery or transplantation. Catheter-based closure of shunts (e.g., atrial or ventricular septal defects and patent ductus arteriosus) and creation of controlled shunts using devices such as atrial flow regulators provide strategies to optimize hemodynamics. Transcatheter valve therapies, including pulmonary valve implantation and atrioventricular valve repair, have become important alternatives to repeat surgery. In patients with failing Fontan circulation, interventions such as fenestration creation, pathway stenting, collateral embolization, and emerging lymphatic procedures have demonstrated promising clinical benefits. Percutaneous interventions have become central to the management of HF in CHD, offering minimally invasive, anatomy-specific approaches that can stabilize acute decompensation, address residual lesions, and palliate chronic circulatory failure. These strategies enable individualized treatment pathways and may delay or reduce the need for surgical reintervention or transplantation. Continued technological innovation, improved patient selection, and multidisciplinary expertise will be essential to further refine these approaches.