Perforation of the atretic pulmonary valve using chronic total occlusion (CTO) wire and coronary microcatheter

Abstract

Background and objective Chronic total occlusion (CTO) guidewire have been recently reported as an alternative to radiofrequency for perforating atretic pulmonary valve. Since procedure failures or perforation of the right ventricle still occurred with CTO, we tried to enhance the stability, steering, and pushability of the wire using a microcatheter in order to improve the safety and efficacy of the procedure. Methods We performed pulmonary valve perforation with CTO guidewire and microcatheter in five consecutive newborns with pulmonary atresia with intact ventricular septum (PA‐IVS) under fluoroscopic and echocardiographic control. Results The valve was easily perforated at the first attempt for all patients. After perforation, the microcatheter positioned in the main pulmonary artery allowed the exchange of the CTO guidewire for a more flexible wire, avoiding lesion and facilitating manipulation in the distal pulmonary branch arteries. The pulmonary valve was then dilated with balloons of increasing size as usually performed. We did not experience any procedural or early complications. Blalock‐Taussig shunt was performed in 2 children because of a persistent cyanosis, 4 and 10 days after perforation. Conclusions The combined use of a CTO guide and a microcatheter appears to be a safe and reliable technique for perforating the pulmonary valve of newborns with PA‐IVS. Further procedures with this approach are needed to confirm this first experience.

Type I and II pulmonary atresia with intact ventricular septum in infants: a 10-year experience in initial surgery at one center

“…Although much more surgical methods of right ventricular decompression are available for PA/IVS [ 4 , 8 – 12 ], surgical failure [ 13 ] and complications [ 14 – 17 ] are also universal. Hypoxemia is one of the most common complications for the following reasons: (1) SpO2 in the early stage is not well maintained because of muscle edema of the right ventricle; (2) Hypoplastic right ventricle is not capable of maintaining the sufficient forward blood flow after the opening of pulmonary valve [ 18 ], and the pulmonary vascular bed pressure that has not been fully decreased in the neonatal period also limits the blood flow.…”

Transcatheter Interventions for Neonates with Congenital Heart Disease: A Review

“…Transcatheter perforation of the atretic pulmonary valve is usually achieved with the use of a radiofrequency coaxial system, which is anterogradely advanced from the RV [ 37 ]. More recently, chronic total occlusion (CTO) guidewires have been recently reported as an alternative to radiofrequency, with encouraging results [ 38 , 39 , 40 ]. Using a stiff end of a coronary wire may be a sustainable alternative to achieve pulmonary valve perforation in developing countries [ 41 ].…”

Current status of transcatheter intervention for complex right ventricular outflow tract abnormalities

“…With the refinement of chronic total occlusion (CTO) hardware technology, mechanical valve perforation using a CTO wire has been introduced as a technique with lower cost and risk of complications [25][26][27][28] . Because CTO wires are specially designed to penetrate occluded coronary arteries, they can provide better penetrability, straightforward pushability, and stability during perforation, which can reduce catheter displacement and subsequent cardiac perforation 16 .…”