LASER-ASSISTED PULMONARY VALVOTOMY WITH BALLOON VALVOPLASTY FOR
PULMONARY ATRESIA WITH INTACT VENTRICULAR SEPTUM
Cheung YF, Leung
MP, Chau AKT
Division of Paediatric
Cardiology, Department of Paediatrics, Grantham Hospital, The University of
Hong Kong, Hong Kong, China
Objective: We assessed the early and
intermediate-term results of laser-assisted pulmonary valvotomy with
balloon valvoplasty for management of pulmonary atresia with intact
ventricular septum (PAIVS).
Methods: Between 1996 and 2000,
transcatheter laser-assisted pulmonary valvotomy with balloon valvoplasty
was attempted in 16 children with PAIVS of median age 8 days (range 1 day
to 2 years) and median weight 3.4 (range 2.4 to 7.2) kg. A 0.018 inch Excimer laser
guidewire was used to perforate the pulmonary valve that was subsequently
dilated with progressively larger balloons. Haemodynamic changes, complications, the need for
subsequent transcatheter or surgical interventions, and intermediate-term
outcomes were assessed.
Results: The procedure was successfully
performed in 14 patients, abandoned in 1, and complicated by perforation of
right ventricular outflow tract (RVOT) and death in 1. The procedural and fluoroscopic
time was 203¡À61
minutes and 70¡À35
minutes, respectively. The right
ventricular to systemic systolic pressure ratio decreased from 1.69¡À0.40
to 0.96¡À0.37
(p<0.001) after successful perforation of the atretic pulmonary
valve. There was 1 in-hospital
death due to septicaemia and 1 late death of unknown cause. Of the remaining 12 survivors, 6
required systemic-pulmonary arterial shunt insertion, 4 repeat balloon
valvoplasty, 1 ductal ligation and 1 no further intervention. Two of the 12 survivors eventually
required RVOT reconstruction.
At a median follow-up duration of 2.6 (range 0.6 to 5.6) years, 5
achieved complete biventricular circulation, 1 underwent 1&1/2
ventricular repair, 3 awaiting transcatheter closure of atrial
communications and 3 awaiting shunt occlusion.
Conclusion: The early and intermediate-term results
of laser-assisted pulmonary valvotomy with balloon valvoplasty are
encouraging. This
transcatheter intervention is effective and relatively safe in children
with PAIVS and potentially facilitates eventual achievement of
biventricular circulation.