GROWTH OF THE RIGHT VENTRICLE AFTER SUCCESSFUL TRANSCATHETER PULMONARY VALVOTOMY IN NEONATES AND INFANTS WITH PULMONARY ATRESIA AND INTACT VENTRICULAR SEPTUM

Objectives: Since 1990, transcatheter pulmonary valvotomy has become a n alternative to surgical valvotomy in the management of neonates and infants with pulmonary atresia and intact ventricular septum. We sough t to determine whether right ventricular growth after transcatheter pu lmonary valvotomy is commensurate with body growth. Methods: Laser or radiofrequency-assisted balloon valvotomy was attempted in 12 neonates and infants with pulmonary atresia and intact ventricular septum. Tri cuspid and mitral valve dimensions were measured retrospectively on th e cross-sectional echocardiograms performed before the procedure and d uring follow-up. Z-values were used to standardize tricuspid valve dim ensions with body size. Results: The atretic pulmonary valve was succe ssfully perforated and dilated in nine of 12 patients. Five of these n ine patients required additional transcatheter or surgical procedures to augment the pulmonary blood flow. Of six survivors, five are regula rly followed up with a median follow-up of 60 months (range 37 to 68 m onths). All five have two-ventricle circulation, two of the five patie nts requiring surgical enlargement of the right ventricular outflow tr act with or without closure of the atrial septal defect. Echocardiogra phic tricuspid valve dimensions and Z-values before transcatheter valv otomy tended to be smaller in the patients who died than in the surviv ors. Zn the survivors, the absolute tricuspid valve dimensions increas ed after valvotomy but the Z-values tended to decrease or stayed const ant. Conclusions: Transcatheter valvotomy is a good alternative to sur gical valvotomy in patients with pulmonary atresia and intact ventricu lar septum. Two-ventricle circulation can be achieved despite subnorma l right ventricular growth.