Document Detail

Percutaneous balloon valvotomy in pulmonary atresia with intact ventricular septum: impact on patient care.
MedLine Citation:
PMID:  12885744     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Pulmonary atresia with intact ventricular septum (PA-IVS) is a rare congenital lesion with high mortality. Therapy was exclusively surgical until recently, when the use of radiofrequency-assisted perforation of the atretic valve was introduced as a treatment option. This study analyzes the outcomes and morphological changes to right heart structures after percutaneous perforation and balloon dilation of the atretic valve. METHODS AND RESULTS: Between April 1992 and August 2000, 30 patients with PA-IVS underwent attempted percutaneous valve perforation and balloon dilation of the pulmonary valve. Longitudinal echocardiographic measurements of the tricuspid valve diameter, right ventricular length and area were recorded. Z scores were calculated according to published formulas. Perforation was achieved in 27 patients. In 14 patients a modified Blalock-Taussig shunt was performed between 2 and 24 days after valve dilation. There were 3 early and 2 late deaths. Among the survivors (follow-up time of 1 to 87 months), 16 patients had a biventricular circulation, 3 a 1(1/2)-ventricle circulation, and 1 a Fontan operation. Four patients are awaiting further palliation. There was no significant change of the tricuspid valve Z score or right ventricular length Z score with time. CONCLUSIONS: Percutaneous balloon valvotomy is an effective treatment strategy for patients with PA-IVS provided that there is a patent infundibulum and a lack of a right ventricle-dependent coronary circulation. Despite the observation that right heart growth does not increase with body growth in early follow-up, it appears adequate to maintain a biventricular circulation in many patients.
Tilman Humpl; Björn Söderberg; Brian W McCrindle; David G Nykanen; Robert M Freedom; William G Williams; Lee N Benson
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Publication Detail:
Type:  Case Reports; Comparative Study; Journal Article     Date:  2003-07-28
Journal Detail:
Title:  Circulation     Volume:  108     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2003 Aug 
Date Detail:
Created Date:  2003-08-19     Completed Date:  2003-09-22     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  826-32     Citation Subset:  AIM; IM    
Department of Pediatrics, Division of Cardiology, The Hospital for Sick Children, The University of Toronto School of Medicine, Toronto, ON M5G 1X8, Canada.
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MeSH Terms
Balloon Dilatation* / instrumentation,  methods,  mortality
Cardiac Surgical Procedures* / mortality
Catheter Ablation* / mortality
Child, Preschool
Follow-Up Studies
Heart / growth & development
Heart Septum / surgery*
Hospital Mortality
Infant, Newborn
Intraoperative Complications
Patient Care / statistics & numerical data
Postoperative Complications
Pulmonary Atresia / diagnosis,  surgery*
Pulmonary Valve / surgery
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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