Long-Term Outcome Following Catheter Valvotomy for Pulmonary Atresia With Intact Ventricular Septum

Henry Chubb*, Erkki Pesonen, Sivasankaran Sivasubramanian, Shane Tibby, John Simpson, Eric Rosenthal, Shakeel Qureshi

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    55 Citations (Scopus)

    Abstract

    Objectives

    This study investigated the outcome for all patients undergoing catheter valve perforation for pulmonary atresia with intact ventricular septum (PAIVS) 21 years after the first procedure at their center.

    Background

    Catheter perforation for PAIVS is now an established procedure. However, the management of the borderline right ventricle (RV) is controversial, and there may be a place for novel techniques such as stenting of the arterial duct.

    Methods

    There were 37 successful valve perforations (total 39 patients). Median length of follow-up was 9.2 years (range 2.2 to 21.0 years). Seventeen patients had stenting of the arterial duct. The mean (SD) initial z-score for the tricuspid valve was -5.1 (+/- 3.4), and a further 142 sets of measurements were taken to assess the growth of the RV of survivors.

    Results

    There were 8 deaths (21%), and no deaths after the first 35 days. There were no late arrhythmias or ischemic events. Twenty-five patients (83% of survivors) have a biventricular circulation. For patients who had stenting of the arterial duct, significant reductions in early reintervention (0 vs. 7 patients, p = 0.009) and hospital stay (17.4 +/- 18.1 days vs. 33.8 +/- 28.6 days, p = 0.012) occurred, with no increase in mortality or morbidity. There was no catch-up growth of the RV in patients who had a biventricular outcome (z-score increase +0.08/year, p = 0.26).

    Conclusions

    Long-term survival is good, and even small RVs may be amenable to this procedure. Multiple interventions may be required to achieve biventricular circulation, but stenting of the arterial duct may reduce hospital stay and repeat procedures.

    Original languageEnglish
    Pages (from-to)1468-1476
    Number of pages9
    JournalJournal of the American College of Cardiology
    Volume59
    Issue number16
    DOIs
    Publication statusPublished - 17 Apr 2012

    Keywords

    • arterial duct
    • biventricular circulation
    • catheter valvotomy
    • hypoplastic right ventricle
    • laser perforation
    • pulmonary atresia with intact ventricular septum
    • radiofrequency perforation
    • stent
    • DEPENDENT CORONARY-CIRCULATION
    • CONGENITAL HEART-DISEASE
    • STENT IMPLANTATION
    • ARTERIAL DUCT
    • VALVE ATRESIA
    • BALLOON DILATATION
    • PERFORATION
    • MANAGEMENT
    • IMPACT
    • GROWTH

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