This study analyzes outcomes and predictive factors in cases of percutaneous mechanical perforation and balloon dilation of the atretic valve in cases of Pulmonary atresia with intact interventricular septum (PA-IVS).
Methods and Results. Between September 2003 and November 2008, 20 of 26 neonates with PA-IVS underwent attempted percutaneous balloon pulmonary valvoplasty. In 18 it was successful. According to Z-scores of TV and right ventricle 5 patiens (group1) had no significant hypoplasia of right heart structures (Z–scoreTV > «-2»), 9 patients (group2) had moderate hypoplasia (Z–score TV= «-2» - «-4») and 4 patients (group3) had severe hypoplasia (Z-Score TV < «-4»). In all cases of severe hypoplasia balloon atrial septostomy was performed in addition to valvuloplasty procedure. There was no early and late deaths. Six patients were free of reintervention (n=4 from group1, n=2 from group2). Modified Blalock-Taussig shunt (n=2 from group2, n=4 from group3) or right ventricular outflow tract reconstruction (n=1 from group2) were done between 1 and 9 days after valve dilation. During follow-up of 1 to 48 months 7additional procedures in 5 patients performed. Twelve patients (from group1 and group2) are planned for biventricular repair, 4 a 1½-ventricle circulation (from group2 and group3), and 2 patients from group3 waiting for staged univentricular correction.
Conclusions— Percutaneous balloon valvotomy is an effective treatment strategy for cases of PA-IVS with well formed right ventricle and absence of right ventricular dependent coronary circulation. There is a high rate of reinterventions in patients with moderate and severe right heart structures hypoplasia.