Radiofrequency-assisted balloon dilatation in patients with pulmonary valve atresia and an intact ventricular septum.

Abstract

Objective-To investigate the efficacy and safety of transcatheter radiofrequency-assisted valve dilatation for infants with pulmonary valve atresia and intact ventricular septum as an alternative to the use of laser heated wires.Design-Prospective clinical study. Setting-Three paediatric cardiology centres.Patients-Four children (aged 5-101 days, weight 2'8-4-3 kg) with pulmonary valve atresia and intact ventricular septum underwent percutaneous radiofrequency-assisted valve dilatation. Methods-After delineating the atretic valve by angiography, 0-020 inch or 0-018 inch radiofrequency wires were used to perforate the atretic valve. The valve was then dilated with conventional balloon dilatation catheters up to the valve annulus diameter.Results-In all four cases the radiofrequency wire perforated the atretic pulmonary valve and balloon dilatation was successful. In one patient the radiofrequency wire also passed through the anterior wall of the pulmonary artery causing tamponade which required surgical repair shortly afterwards. This patient died from sepsis six days later. One patient died three weeks after the procedure from septicaemia and a paradoxical coronary embolus. Two patients were discharged after 4 and 14 days respectively.Conclusions-Radiofrequency-assisted valve dilatation is a promising alternative to the recently developed laser wire technique. The major advantages are a reduction in cost and improved safety for the staff performing the procedure. (Br HeartJ_ 1993;69:347-351) Patients with pulmonary valve atresia and intact ventricular septum present a formidable therapeutic challenge to both surgeons and cardiologists. Despite the recent improved outlook for patients with many congenital heart defects this defect continues to be associated with a high mortality. Currently the most common surgical approach to neonates and infants consists of creating a systemic to pulmonary artery shunt together with an open pulmonary valvotomy either at the same or at a later procedure. The final corrective operation entails closure of the atrial septal defect and the systemic to pulmonary shunt but can only be performed if the right ventricle develops sufficiently.Alternatively further palliative shunting procedures or a Fontan repair are required if the right ventricle remains hypoplastic. We, and others, have recently shown the feasibility of percutaneous transcatheter "hot tip" laserassisted balloon dilatation.' 2 In some patients this approach can replace some or all of the conventional operative stages. To overcome some disadvantages associated with the use of lasers, we have investigated the use of transcatheter radiofrequency-assisted balloon dilatation of the pulmonary valve as an alternative and report our initial experience. Patients and methods PATIENTSPatient 1-A full term male infant with a birth weight of 2-8 kg became cyanosed and hypotensive a few hours after birth. After emergency resuscitation he was ventilated and prostaglandin and dobutamine infusions were started. Echocardiograph...

Percutaneous Balloon Valvotomy in Pulmonary Atresia With Intact Ventricular Septum

“…2 An alternative to primary surgical decompression strategies is the use of percutaneous laser or radiofrequency (RF)-assisted perforation of the atretic valve and subsequent balloon dilation. 3,4 This study reviews the clinical outcomes and morphological changes to the tricuspid valve and RV after a percutaneous perforation and balloon dilation strategy.…”

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

“…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 .…”

“…In addition, reperfusion lesions usually observed after the use of extracorporeal circulation may be extremely noxious in these patients with potential or real histological anomalies in the coronary arteries 1,14 . The percutaneous techniques already described in the literature for establishing the right ventricle-pulmonary trunk continuity include the use of laser or radiofrequency energy and mechanical perforation [10][11][12][13][14][15][16][17] . Laser energy, despite being the first to be used, especially by British groups 11,12 , was gradually abandoned due to its high cost, risks to the staff of the hemodynamics laboratory, and the difficulty of transporting it 17 .…”

“…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.…”

Características morfológicas angiográficas na atresia pulmonar com septo interventricular íntegro

“…With the development of interventional techniques for the pediatric patient, a new alternative for the treatment of this malformation appeared with cardiac catheterization. Due to its effectiveness and low incidence of complications, it has been increasingly regarded as a very attractive form of treatment for a great number of investigators [31][32][33][34][35][36][37][38][39][40][41] . Through angiographic analysis, our study aimed at providing indispensable information for the selection of candidates to the different alternatives of treatment currently available for this malformation.…”