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

doi:10.1016/j.jacc.2012.01.022

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 journal › Article › peer-review

57 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 language	English
Pages (from-to)	1468-1476
Number of pages	9
Journal	Journal of the American College of Cardiology
Volume	59
Issue number	16
DOIs	https://doi.org/10.1016/j.jacc.2012.01.022
Publication status	Published - 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

Access to Document

10.1016/j.jacc.2012.01.022

Cite this

@article{53710961ea02486e8d2d001bfb199f8b,

title = "Long-Term Outcome Following Catheter Valvotomy for Pulmonary Atresia With Intact Ventricular Septum",

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.",

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",

author = "Henry Chubb and Erkki Pesonen and Sivasankaran Sivasubramanian and Shane Tibby and John Simpson and Eric Rosenthal and Shakeel Qureshi",

year = "2012",

month = apr,

day = "17",

doi = "10.1016/j.jacc.2012.01.022",

language = "English",

volume = "59",

pages = "1468--1476",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "Elsevier USA",

number = "16",

}

TY - JOUR

T1 - Long-Term Outcome Following Catheter Valvotomy for Pulmonary Atresia With Intact Ventricular Septum

AU - Chubb, Henry

AU - Pesonen, Erkki

AU - Sivasubramanian, Sivasankaran

AU - Tibby, Shane

AU - Simpson, John

AU - Rosenthal, Eric

AU - Qureshi, Shakeel

PY - 2012/4/17

Y1 - 2012/4/17

N2 - 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.

AB - 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.

KW - arterial duct

KW - biventricular circulation

KW - catheter valvotomy

KW - hypoplastic right ventricle

KW - laser perforation

KW - pulmonary atresia with intact ventricular septum

KW - radiofrequency perforation

KW - stent

KW - DEPENDENT CORONARY-CIRCULATION

KW - CONGENITAL HEART-DISEASE

KW - STENT IMPLANTATION

KW - ARTERIAL DUCT

KW - VALVE ATRESIA

KW - BALLOON DILATATION

KW - PERFORATION

KW - MANAGEMENT

KW - IMPACT

KW - GROWTH

U2 - 10.1016/j.jacc.2012.01.022

DO - 10.1016/j.jacc.2012.01.022

M3 - Article

SN - 0735-1097

VL - 59

SP - 1468

EP - 1476

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 16

ER -

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

Abstract

Keywords

Access to Document

Fingerprint

Cite this