Babar Sultan Hasan and Victor Bautista-Hernandez contributed equally to this work.
Pediatric and Congenital Heart Disease
Outcomes of transcatheter approach for initial treatment of pulmonary atresia with intact ventricular septum†
Article first published online: 17 OCT 2012
Copyright © 2012 Wiley Periodicals, Inc.
Catheterization and Cardiovascular Interventions
Volume 81, Issue 1, pages 111–118, 1 January 2013
How to Cite
Hasan, B. S., Bautista-Hernandez, V., McElhinney, D. B., Salvin, J., Laussen, P. C., Prakash, A., Geggel, R. L. and Pigula, F. A. (2013), Outcomes of transcatheter approach for initial treatment of pulmonary atresia with intact ventricular septum. Cathet. Cardiovasc. Intervent., 81: 111–118. doi: 10.1002/ccd.24288
Conflict of interest: Nothing to report.
- Issue published online: 21 DEC 2012
- Article first published online: 17 OCT 2012
- Manuscript Accepted: 5 DEC 2011
- Manuscript Received: 2 MAR 2011
- pulmonary valve;
To review the short and medium term outcome of transcatheter pulmonary valve perforation (PVP) in patients with pulmonary atresia-intact ventricular septum and non-right ventricular dependant coronary circulation (PA/IVS non-RVDCC).
PVP in patients with PA/IVS non-RVDCC has become more common in the past two decades. However, data on outcomes with this strategy are mixed.
Data were reviewed retrospectively for all patients with PA/IVS non-RVDCC treated from 1996- 2010 at our institution. Patients who had severe neonatal Ebstein malformation, or initial interventional management at another institution were excluded.
PVP was attempted in 30 of 50 patients (60%); 26 (87%) of these had a successful procedure. Twenty-four patients (48%) had surgery without PVP. There were no deaths in the cohort. Complications of PVP included 5 (17%) myocardial perforations. Of those with successful PVP, 10 (38%) did not have surgery (PVP-NS) and 16 (62%) had surgery (PVP-S) prior to discharge. Tricuspid valve (TV) Z-score was larger in the PVP-NS than in PVP-S patients, with median TV diameter Z-scores of +0.7 (−0.9, 1.7) and −1.1 (-2.8, 2), respectively (P = 0.01). Time from PVP to either hospital discharge (PVP-NS group) or surgery (PVP-S group) was significantly different between groups: 15 (7, 22) and 8 days (0, 46), respectively (P = 0.01). There were no differences in the number of trials or lowest arterial PaO2 off prostaglandins between groups. All patients in the PVP-NS group had a biventricular circulation at a median follow-up of 4.3 years.
The results of a collaborative approach to treating neonates with PA/IVS non-RVDCC are excellent. Smaller TV size is associated with greater likelihood of surgery prior to discharge, and may serve as a surrogate for early RV inadequacy. © 2012 Wiley Periodicals Inc.