Follow-up results of transcatheter valvotomy in patients with pulmonary atresia and intact ventricular septum

  • Prof Jou-Kou Wang, National Taiwan University Hospital, Taiwan
  • Dr Mei-Hwan Wu, National Taiwan University Hospital, Taipei, Taiwan, Taiwan
  • Dr Ming-Tai Lin, National Taiwan University Hospital, Taipei, Taiwan, Taiwan
  • Dr Chung-I Chang, National Taiwan university Hospital, Taipei,Taiwan, Taiwan
  • Dr Yi-Sharn Chen, National Taiwan University Hospital, Taipei, Taiwan, Taiwan

    • Objective: To investigate the follow-up results of transcatheter valvotomy in patients with pulmonary atresia and intact ventricular septum (PA-IVS)
    Methods: Between 1995 and 2008, 44 neonates diagnosed as PA-IVS with a tricuspid valve Z score > -3.5 underwent attempted transcatheter valvotomy. A radiofrequency guide wire (PA120) was used in 38 and coronary guide wire in 6 for perforation of the atretic pulmonary valve. A subsequent balloon valvuloplasty was performed following perforation of the atretic valve.
    Results: Transcatheter pulmonary valvotomy was successful in 39 patients & failed in 5. Three of 5 failure cases were complicated with pericardial effusion. Of the 39 patients, the mean right ventricular pressure decreased from 116±23 to 56±14 mmHg. following valvuloplasty (p < 0.01). Of the 39 patients, 9 required a right ventricular outflow tract (RVOT) patch with or without a shunt because of persisted cyanosis with significant RVOT obstruction and 2 required a shunt. Three required ligation of the ductus. Acute renal failure occurred in 2 requiring peritoneal dialysis. There were 4 mortalities. (2 sepsis & 2 heart failure). During follow-up, 5 patients underwent balloon dilation for recurrent RVOT gradient. Two required a RVOT patch due to significant stenosis following balloon dilation. Two underwent balloon valvuloplasty for tricuspid valve stenosis. Transcatheter closure of atrial communications was performed in 3. After a mean follow-up period of 4.2 years, 35 surviving patients achieved biventricular circulation with a mean gradient of 18±12 mmHg across RVOT.
    Conclusions: Transcatheter valvotomy can be a definitive treatment in selected patients with PA-IVS.