Pulmonary atresia with intact ventricular septum percutaneous radiofrequency-assisted valvotomy and balloon dilation versus surgical valvotomy and Blalock Taussig shunt

OBJECTIVE We compared the result of radiofrequency (RF)-assisted valvotomy and balloon dilation with closed surgical valvotomy and Blalock Taussig (BT ) shunt as primary treatment in selected patients with pulmonary atresia an d intact ventricular septum (PA-IVS). BACKGROUND Patients with PA-IVS who have mild to moderate hypoplasia of the right ventricle (RV) and patent infundiblum have the greatest potential fo r complete biventricular circulation. The use of RF or laser wires to perfo rate the atretic valve followed by balloon dilation provides an alternative to surgery. METHODS Between May 1990 and March 1998, 33 selected patients underwent eit her percutaneous RF valvotomy and balloon dilation (group 1, n = 21; two cr ossed over to group 2) or surgical valvotomy with concomitant BT shunt (gro up 2, n = 14). Second RV decompression by balloon dilation or right ventric ular outflow tract (RVOT) reconstruction were performed if necessary. Patie nts who remained cyanosed were subjected to transcatheter trial closure of the interatrial communication. Partial biventricular repair was offered to those with inadequate growth of the RV. RESULTS The primary procedure was successful in 19 patients in group 1. The re was one in-hospital death and two late deaths. Of the remaining 16 survi vors, 12 achieved complete biventricular circulation, 7 of whom required no further interventions. Two patients required repeat balloon dilation, 1 RV OT reconstruction and 2 transcatheter closure of interatrial communication. Two patients underwent partial biventricular repair. In group 2, there wer e 3 in-hospital deaths after the primary procedure and 1 patient died four months later. All survivors (n = 10) required a second RV decompression, 8 by balloon dilation and 2 by RVOT reconstruction, after which, two patients died. Of the final 8 survivors, 7 achieved complete biventricular circulat ion, 5 after coil occlusion of the BT shunt and 2 after closure of interatr ial communication. CONCLUSIONS Radiofrequency valvotomy and balloon dilation is more efficacio us and safe compared with closed pulmonary valvotomy and BT shunt in select ed patients with PA-IVS. (J Am Coil Cardiol 2000;35:468-76) (C) 2000 by the American College of Cardiology.