Pulmonary atresia with intact ventricular septum percutaneous radiofrequency-assisted valvotomy and balloon dilation versus surgical valvotomy and blalock taussig shunt

Alwi, Mazeni; Geetha, Kayla; Bilkis, A.A; Lim, M.K.; Samion, Hasri; Haifa, Abdul L; Sallehudin, Ahmad; Zambahari, Robaayah

doi:10.1016/s0735-1097(99)00549-5

Cited by 118 publications

(82 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In children born in Sweden with PA-IVS between 1980 and 1999, when transcatheter management was not available, a systemic to pulmonary shunt was created in 93% of patients, 22 whereas the number of shunts constructed in our institution in this population was 46%. Whereas 44% of the patients undergoing a successful interventional valvotomy did not require a surgical shunt procedure in 1 series, 23 84% of the patients reported by Alwi et al 24 achieved a biventricular circulation without a shunt. Initially, in our unit, a shunt was offered with failure of the first attempt at weaning prostaglandins, but more recently a policy has evolved allowing the patients a longer time period to accommodate and improve right ventricular compliance.…”

Section: Discussionmentioning

confidence: 94%

Percutaneous Balloon Valvotomy in Pulmonary Atresia With Intact Ventricular Septum

et al. 2003

View full text Add to dashboard Cite

Background— Pulmonary atresia with intact ventricular septum (PA-IVS) is a rare congenital lesion with high mortality. Therapy was exclusively surgical until recently, when the use of radiofrequency-assisted perforation of the atretic valve was introduced as a treatment option. This study analyzes the outcomes and morphological changes to right heart structures after percutaneous perforation and balloon dilation of the atretic valve. Methods and Results— Between April 1992 and August 2000, 30 patients with PA-IVS underwent attempted percutaneous valve perforation and balloon dilation of the pulmonary valve. Longitudinal echocardiographic measurements of the tricuspid valve diameter, right ventricular length and area were recorded. Z scores were calculated according to published formulas. Perforation was achieved in 27 patients. In 14 patients a modified Blalock-Taussig shunt was performed between 2 and 24 days after valve dilation. There were 3 early and 2 late deaths. Among the survivors (follow-up time of 1 to 87 months), 16 patients had a biventricular circulation, 3 a 1 ½-ventricle circulation, and 1 a Fontan operation. Four patients are awaiting further palliation. There was no significant change of the tricuspid valve Z score or right ventricular length Z score with time. Conclusions— Percutaneous balloon valvotomy is an effective treatment strategy for patients with PA-IVS provided that there is a patent infundibulum and a lack of a right ventricle–dependent coronary circulation. Despite the observation that right heart growth does not increase with body growth in early follow-up, it appears adequate to maintain a biventricular circulation in many patients.

show abstract

Section: Discussionmentioning

confidence: 94%

Percutaneous Balloon Valvotomy in Pulmonary Atresia With Intact Ventricular Septum

et al. 2003

View full text Add to dashboard Cite

show abstract

“…Opening of the right ventricular outflow tract through interventional catheterization is gaining acceptance as the initial therapeutic modality for patients with pulmonary atresia and intact ventricular septum [10][11][12][13][14][15][16][17] . In patients who have tripartite right ventricle 4 , with a patent infundibulum 18 , moderate ventricular hypoplasia at most, and coronary circulation not depending on the right ventricle [6][7][8] , this technique promotes efficient decompression of the ventricular cavity, stimulating its growth 14,19 .…”

Section: Discussionmentioning

confidence: 99%

“…The initial therapeutic approach in the neonatal period should, whenever possible (if the coronary circulation pattern allows), open the pulmonary valve to decompress the right ventricle and stimulate its growth 3,[6][7][8] . During the last decade, perforation of the pulmonary valve to establish continuity between the right ventricle and the pulmonary artery with the aid of interventional catheterization became a reality [10][11][12][13][14][15] , even in Brazil 16 . We report 2 percutaneous techniques of valve perforation, which were recently introduced into clinical practice, and their advantages and disadvantages are discussed.…”

Section: New Percutaneous Techniques For Perforating the Pulmonary Vamentioning

confidence: 99%

New percutaneous techniques for perforating the pulmonary valve in pulmonary atresia with intact ventricular septum

Pedra¹,

Sousa²,

Pedra³

et al. 2001

Arq. Bras. Cardiol.

View full text Add to dashboard Cite

Even though pulmonary atresia with intact ventricular septum is an infrequent defect, accounting for less than 1% of congenital heart defects, it is the 3 rd most frequent cyanotic heart defect in the neonatal period 1 . Its morphological spectrum is broad with cases ranging from extremely hypoplastic tricuspid valves and right ventricles to ventricular cavities of almost normal dimensions [2][3][4] . Ebstein's anomaly of the tricuspid valve and extreme ventricular dilation have also been reported, and they are associated with a poor prognosis 5 . In addition, communication between the right ventricular cavity and the coronary arteries is a relatively common finding, which is sometimes associated with coronary circulation partially or totally dependent on the right ventricle [6][7][8] . Due to this anatomic heterogeneity, the therapeutic algorithm should be individualized 6 . The final objective is always to attain biventricular correction with total separation between systemic and pulmonary circulations 6 . However, this is sometimes impossible, and correction with a 1½ ventricle or of the univentricular type (Fontan) is necessary [6][7][8][9] . Cardiac transplantation should also be considered for treating cases with severe stenoses or multiple interruptions in the coronary arteries and secondary left ventricular dysfunction 6,8 . The initial therapeutic approach in the neonatal period should, whenever possible (if the coronary circulation pattern allows), open the pulmonary valve to decompress the right ventricle and stimulate its growth 3,[6][7][8] . During the last decade, perforation of the pulmonary valve to establish continuity between the right ventricle and the pulmonary artery with the aid of interventional catheterization became a reality [10][11][12][13][14][15] , even in Brazil 16. We report 2 percutaneous techniques of valve perforation, which were recently introduced into clinical practice, and their advantages and disadvantages are discussed. Case reportWe report the cases of 3 patients referred to our service from other neonatal units for investigation or treatment of cyanotic congenital heart defects. The clinical, echocardiographic, and hemodynamic data, are listed in tables I, II, and III. It is worth noting that patient 2 had a previous diagnosis of critical pulmonary stenosis. All patients had mild to moderate cyanosis under continuous infusion of prostaglandin; on auscultation, the 2 nd cardiac sound was single and low, and was followed by a mild systolic murmur in the dorsum. On chest X-ray, the cardiac silhouette was slightly enlarged, mainly because of the right atrium, and the pulmonary flow was reduced. The electrocardiogram showed sinus rhythm and left ventricular hypertrophy in all patients. QRS axes ranged from 90º to 120º. In regard to the echocardiographic findings, all patients had situs solitus, pulmonary atresia with imperforate pulmonary valve, and intact ventricular septum. The right ventricle was hy-

show abstract

“…Em se tratando apenas de casos de atresia pulmonar com septo interventricular íntegro, a mortalidade sobe para 23,5% (4/17). Alwi et al 11 , em um estudo comparando dados coletados em portadores de atresia pulmonar com septo interventricular íntegro submetidos a valvotomia por radiofrequência e valvotomia cirúrgica complementada com shunt sistêmico-pulmonar, evidenciaram taxa de mortalidade de 15% para o grupo da abordagem percutânea e de 42% para aqueles submetidos a cirurgia como tratamento inicial. Já Caspi et al 13 relatam mortalidade cirúrgica em torno de 25%.…”

unclassified

Cateterismo intervencionista na estenose valvar pulmonar crítica do recém-nascido e na atresia pulmonar com septo interventricular íntegro: 13 anos de experiência de um serviço terciário

Mânica¹,

Bodini²,

Borges³

et al. 2011

Rev. Bras. Cardiol. Invasiva

View full text Add to dashboard Cite

Background:The percutaneous approach is the therapy of choice in neonates with critical pulmonary stenosis (PS) and pulmonary atresia with intact interventricular septum (PAIVS). Consecutive cases treated at a reference center and their midterm follow-up was reported in this study. Methods: Most of the patients received an intravenous infusion of prostaglandin preoperatively, regardless of the need. For the PAIVS approach, a stiff-tip guidewire was used and more recently, radiofrequency valvotomy. In most cases, sequential balloon dilation was performed until 110% to 120% of the pulmonary valve ring diameter was reached. Results: Between 1998 and 2011, 17 neonates with PAIVS (median age of 5 days, mean weight of 3.1 + 0.6 kg) and 30 neonates with PS (median age of 12 days, mean weight of 3 + 1.4 kg) were treated at a tertiary center. In PAIVS patients, a stiff-tip guidewire was used in 14 cases, with a success rate of 71.4%, and radiofrequency perforation in 3 cases, with a success rate of 100%. In PS patients, success was achieved in all of the cases. Hospital death was 23.5% for the PAIVS group and 3.3% for the PS group, none related to the percutaneous procedure. In the midterm follow-up, the reintervention rate due to restenosis was 21.4% in the PAIVS group and 10% in the PS group. Conclusions: Pulmonary valvuloplasty in PS or PAIVS has acceptable clinical and hemodynamic results, as long as favorable anatomic characteristics are observed and patent pulmonary flow is maintained until the procedure. Morbidity and mortality of patients with critical PS are lower than patients with PAIVS.

show abstract

Pulmonary atresia with intact ventricular septum percutaneous radiofrequency-assisted valvotomy and balloon dilation versus surgical valvotomy and blalock taussig shunt

Abstract: Radiofrequency valvotomy and balloon dilation is more efficacious and safe compared with closed pulmonary valvotomy and BT shunt in selected patients with PA-IVS.

Cited by 118 publications

References 27 publications

Percutaneous Balloon Valvotomy in Pulmonary Atresia With Intact Ventricular Septum

Percutaneous Balloon Valvotomy in Pulmonary Atresia With Intact Ventricular Septum

New percutaneous techniques for perforating the pulmonary valve in pulmonary atresia with intact ventricular septum

Cateterismo intervencionista na estenose valvar pulmonar crítica do recém-nascido e na atresia pulmonar com septo interventricular íntegro: 13 anos de experiência de um serviço terciário

Contact Info

Product

Resources

About