Document Detail


Transcatheter perforation followed by pulmonary valvuloplasty in neonates with pulmonary atresia and ventricular septal defect.
MedLine Citation:
PMID:  19520328     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The classic management of neonates with pulmonary atresia with ventricular septal defect (PAVSD) and moderately hypoplastic pulmonary arteries is usually a systemic to pulmonary artery shunt or ductus arteriosus stenting. We report our experience of transcatheter treatment of PAVSD by perforation followed by balloon dilation of the valve, as it is performed in pulmonary atresia - intact ventricular septum.
PATIENTS AND METHOD: Three patients were treated at a mean age and weight of 7.5 days (range 7-8) and 2.9kg (range 2.5-3.3), respectively. Two newborns were prenatally diagnosed, with micro deletion 22q11 in one case. The three patients had no other pulmonary blood flow support than the ductus arteriosus and were on prostaglandin E1 infusion. The pulmonary atresia was predominantly valvular without significant muscular obstruction. By echocardiography, the mean size of the pulmonary annulus was 6.5mm (range 6-7). In all cases, the valvular perforation was performed with a 0.014 coronary guidewire, followed by balloon dilation when successfully.
RESULTS: The procedure succeeded in two cases but failed in the third newborn in whom a long subvalvar muscular stenosis was found at surgery. In the two successful cases, the mean postprocedural transpulmonary doppler gradient was 33.5mmHg (range 17-50). One patient experienced a femoral venous thrombosis that was successfully treated by heparin and a transient right bundle branch block occurred in another one. In the two successful cases, the prostaglandin E1 infusion was weaned and the surgical repair was performed at 4 and 12 months, respectively.
CONCLUSION: In selected cases with PAVSD, perforation followed by balloon dilation of the pulmonary valve offers an interesting alternative to other surgical or transcatheter palliative therapies.
Authors:
Nicolas Hugues; Sylvia Abadir; Andreea Dragulescu; Claude Nassi; Joel Errera; Pascal Amedro; Olivier Ghez; Alain Fraisse
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Publication Detail:
Type:  Journal Article     Date:  2009-05-14
Journal Detail:
Title:  Archives of cardiovascular diseases     Volume:  102     ISSN:  1875-2136     ISO Abbreviation:  Arch Cardiovasc Dis     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-06-12     Completed Date:  2009-07-31     Revised Date:  2011-04-25    
Medline Journal Info:
Nlm Unique ID:  101465655     Medline TA:  Arch Cardiovasc Dis     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  427-32     Citation Subset:  IM    
Affiliation:
Department of Paediatric Cardiology, hôpital d'enfants de La Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France. alain.fraisse@ap-hm.fr
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MeSH Terms
Descriptor/Qualifier:
Abnormalities, Multiple / diagnosis,  surgery,  therapy*
Balloon Dilation* / adverse effects
Cardiac Surgical Procedures*
Echocardiography, Doppler
Heart Catheterization* / adverse effects
Heart Septal Defects, Ventricular / complications,  diagnosis,  surgery,  therapy*
Humans
Infant, Newborn
Palliative Care
Patient Selection
Pulmonary Atresia / complications,  diagnosis,  surgery,  therapy*
Radiography, Interventional
Risk Assessment
Treatment Outcome

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