Pulmonary Atresia and Intact Ventricular Septum in Transcatheter Perforation of Atretic Pulmonary Valve

The use of mechanical perforation as an alternative to radiofrequency wire in the treatment of pulmonary valve atresia with an intact ventricular septum, which is a duct-dependent cyanotic congenital heart disease. We share our experience with this method, which is especially relevant for centers that do not have access to radiofrequency wires.

This cross-sectional study was conducted between October 2011 and August 2022 on all infants referred to Shaheed Almehrab cardiac surgery and Catheterization Center‎ in Babylon, Iraq whose severe cyanosis and patent ductus arteriosus (PDA) dependent pulmonary valve atresia with an intact ventricular septum were confirmed by transthoracic echocardiography. A chronic total occlusion (CTO) wiring procedure was used to create perforation through the atretic pulmonary valve with subsequent pulmonary valve balloon dilation, through an antegrade (n=18) or retrograde approach (n=10).

A total number of 28 infants with 14 infants younger than one month and 14 infants older than one month of age were included. 15 cases (53%) were male. The mean oxygen saturation before the intervention was 44.48±7.43% which significantly improved to 88.35±7.71% (p<0.001). Tripartite ventricles were found in 56.5% of patients. Successful perforation with subsequent balloon valvuloplasty was achieved in 23 cases (82.1%) and death as a complication of perforation was reported in 5 cases. The antegrade operation was associated with higher survival than the retrograde (p=0.041). There were 21.5% of patients who required an additional procedure including a bidirectional cavopulmonary shunt (Glenn shunt) or Blalock-Taussig (BT) shunt to augment pulmonary blood flow. Tricuspid regurgitation improvement was confirmed in 87% of patients‎.

In conclusion, transcatheter perforation of atretic pulmonary valves followed by balloon valvuloplasty is a feasible and effective treatment option for pulmonary atresia and intact ventricular septum.