Article

Excimer laser ablation for valvular angioplasty in pulmonary atresia and intact ventricular septum†

  1. William B. Moskowitz MD1,
  2. Jack L. Titus MD, PhD2,
  3. On Topaz MD3,*

Article first published online: 20 DEC 2004

DOI: 10.1002/lsm.20106

Issue

Lasers in Surgery and Medicine

Lasers in Surgery and Medicine

Volume 35, Issue 5, pages 327–335, December 2004

Additional Information

How to Cite

Moskowitz, W. B., Titus, J. L. and Topaz, O. (2004), Excimer laser ablation for valvular angioplasty in pulmonary atresia and intact ventricular septum. Lasers Surg. Med., 35: 327–335. doi: 10.1002/lsm.20106

Author Information

  1. 1

    Cardiac Catheterization Laboratories, Division of Pediatric Cardiology, Medical College of Virginia, Virginia Commonwealth University, Richmond, Virginia

  2. 2

    Jesse E. Edwards Registry of Cardiovascular Disease, John Nasseff Hospital, United Hospital Foundation, St. Paul, Minnesota; Department of Pathology, University of Minnesota, Minneapolis, Minnesota

  3. 3

    Cardiac Catheterization Laboratories, Division of Adult Cardiology and Department of Pathology, Medical College of Virginia, Virginia Commonwealth University, Richmond, Virginia

*Professor of Medicine (Cardiology) and Pathology, Director, Interventional Cardiology, McGuire Veterans Affairs Medical Center, Division of Cardiology, Virginia Commonwealth University/Medical College of Virginia, Richmond, VA.

  1. †

    O.T. has disclosed a potential financial conflict of interest with this study.

Publication History

  1. Issue published online: 20 DEC 2004
  2. Article first published online: 20 DEC 2004
  3. Manuscript Accepted: 31 AUG 2004

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Keywords:

  • ablation;
  • congenital heart disease;
  • excimer;
  • intervention;
  • laser;
  • pulmonary atresia

Abstract

Background and Objectives

The prognosis for infants with pulmonary atresia and intact ventricular septum (PA/IVS) is poor and they present a major management challenge. Mechanical penetration of the atretic pulmonary valve is an applicable option for decompression of the right ventricle and optimization of left ventricular function. The utilization of laser energy for debulking and vaporization of the atretic valve tissue is a relevant approach due to the potential for controlled, precise mode of energy distribution.

Study Design/Patients and Methods

A 4-month-old female with PA/IVS whose failure to thrive was accompanied by critical hemodynamic abnormalities received successful percutaneous pulmonary valve plate ablation by a 0.9 mm pulsed-wave ultraviolet excimer laser catheter (308 nm wavelength, fluence 50 mJ/mm2; 30 Hz). A “step-by-step” lasing technique was applied whereby the tip of the emitting laser catheter is advanced ahead of a guide wire that serves mainly as support for positioning of that catheter.

Results

Adequate penetration of the atretic tissue enabled introduction of balloon dilations resulting in patency of the atretic valve, decompression of the right ventricle, improved right and left ventricular hemodynamics, and oxygenation. To further investigate the effect of excimer laser energy on atretic valvular tissue this laser was applied in a specimen of heart from an infant who died because of PA/IVS. Histopathologic examination of the irradiated tissue revealed no laser-induced injury to the pulmonary valve.

Conclusions

Thus, laser ablation and penetration of an atretic pulmonary valve is feasible and safe. The penetration of the atretic valve with the laser catheter enables subsequent introduction of various sizes balloon dilations. The application of available laser sources for treatment of congenital heart diseases is reviewed. Lasers Surg. Med. 35:327–335, 2004. © 2004 Wiley-Liss, Inc.

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