Long-term results of catheter-based treatment of pulmonary atresia and intact ventricular septum

Abstract

Objective: To review the outcome of patients with pulmonary atresia with intact ventricular septum after interventional perforation of the pulmonary valve, to assess the capability of this procedure to avoid neonatal or late intervention and to obtain a long-term biventricular repair.

Design: Retrospective interventional study and clinical follow-up study.

Setting: Tertiary referral centre.

Patient population: Between November 1994 and December 2007, 40 neonates underwent radiofrequency perforation. Median age at pulmonary valvotomy was 28 hours (range 1–147 hours) and median weight was 2925 g (range 1900–4400 g).

Main outcome measures: Procedural success and complication rates; early-term and long-term follow-up results.

Results: The procedure was successful in 39 patients but 16 of them needed neonatal surgery. The overall mortality was 7.5%. At a median follow-up of 82 months, four patients underwent a bidirectional Glenn procedure, whereas all the other patients achieved a biventricular circulation without any further intervention in 19 of them. Patients who died or needed additional intervention with or without biventricular circulation failure had a higher incidence of bipartite right ventricular (65% vs 15.8% of those not needing additional intervention; p = 0.004) and a lower median tricuspid Z value (−2 (range −3.5 to 1) vs −0.5 (range −2 to 1); p = 0.004)).

Conclusions: The results confirm that percutaneous interventional perforation is an effective first-stage procedure in patients with pulmonary atresia with intact ventricular septum. The right heart appeared to be adequate to maintain a long-term biventricular circulation in the large majority of cases.