Outcomes of transcatheter valvotomy in patients with pulmonary atresia andintact ventricular septum

The results of transcatheter valvotomy in pulmonary atresia with intact ven tricular septum (PA-IVS) patients are presented with an attempt to identify the predictive factors for pulmonary valvotomy alone as definitive treatme nt. Between June 1995 and December 1997, 14 PA-IVS neonates with tripartite right ventricle underwent an attempted pulmonary valvotomy. For perforatio n of the pulmonary valve, a guidewire was used in 4, and a radiofrequency g uidewire in 10 patients. Two outcome groups were identified. Group I includ ed those in whom transcatheter treatment achieved a definitive success grou p II patients required surgery despite an initial successful valvotomy. The attempt failed in 3 patients, 1 of whom had pericardial effusion. Perforat ion of the pul monary valve was achieved in 11 patients: 2 with tr guidewir e and 9 with a radiofrequency guidewire. A subsequent balloon valvuloplasty was performed in these 11 patients. After valvuloplasty, mean right ven tr icular pressure decreased from 124 +/- 24 to 60 +/- 15 mm Hg (p <0.01). One died of heart failure and infection 10 days later, despite successful wean ing from prostaglandin E-1. Group I patients (n = 6) were treated with tran scatheter valvotomy alone. Group II patients (n = 4) required right ventric ular outflow patch. Significant differences between the 2 groups (group I v s II) were identified in tricuspid valve Z value (0.52 +/- 0.37 VS -1.25 +/ - 0.48, p <0.05), pulmonary valve Z value (-3.47 +/- 0.59 vs -5.43 +/- 0.94 , p <0.05), and ratio of right-to-left ventricular area on the apical Q-cha mber view (0.73 +/- 0.06 vs 0.49 +/- 0.03, p <0.05). There were no signific ant differences in hemodynamic characteristics between the 2 groups. After a follow-up period ranging from 7 to 35 months (mean 18 +/- 10.3), the mast recent echocardiograms in the 10 patients showed a mean pressure gradient across the pulmonary valve of 17 +/- 15 mm Hg. All 10 patients had an oxyge n saturation of >92%. Transcatheter valvotomy using a radio-frequency guide wire is a safe and effective treatment in selected patients with PA-IVS. Tr anscatheter valvotomy can be a definitive treatment in PA-IVS patients with a tricuspid valve Z value greater than or equal to-0.1, pulmonary valve Z value greater than or equal to- 4.1 and ratio of right-to-left ventricular area greater than or equal to 0.65. (C) 1999 by Excerpta Medico, Inc.