PUNCTURE-DILATION OF PULMONARY ATRESIA WI TH INTACT INTERVENTRICULAR SEPTUM IN THE NEONATE AND INFANT

Sixteen children (14 neonates less than 1 week old and 2 infants aged 3 and 6 months) had a ''favorable'' type of pulmonary atresia with an intact interventricular septum in which the hypoplasia of the right ve ntricle was mild and the cavity tripartite with a well developed infun dibulum arriving in contact with a good-sized pulmonary artery from wh ich it was separated by a totally or almost totally imperforate dome. They underwent a procedure associating an infusion of prostaglandin. E 1 and an attempted pulmonary valve disobliteration by interventional c atheterisation : needle puncture followed by balloon dilatation. There were 4 failed procedures (impossible puncture or dilatation), only on e of which in the last 10 cases. The outcome of the 12 primary success es was related to the rapidity of recovery of right ventricular diasto lic function : 7 patients were cured within a few days or weeks with p rostaglandin therapy: 5 children required surgical anastomosis with a longer recovery period - 3 cures but 2 deaths. Overall, there were two myocardial effractions without serious complications and 1 enterocoli ties which was long-lasting but eventually cured. Two mild residual st enoses were redilated. In conclusion, the puncture-dilatation techniqu e may be used instead of surgical valvectomy in favorable forms of pul monary atresia with intact septum in the neonate. With experience, it was possible to remove the obstruction in 9 out of 10 cases with a min imum of complications. It is the compulsory first stage to complete cu re, the probability and rapidity of which depend on recovery of right ventricular compliance.