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CLINICAL STUDIES

Pulmonary atresia with intact ventricular septum percutaneous radiofrequency-assisted valvotomy and balloon dilation versus surgical valvotomy and blalock taussig shunt

Mazeni Alwi, MRCP^*, Kandhavello Geetha, MRCP^*, Abdul A. Bilkis, MD^*, Miin K. Lim, MRCP^*, Samion Hasri, MD^*, Abdul L. Haifa, MD^*, Ahmad Sallehudin, FRCS and Robaayah Zambahari, FRCP, FACC^*

^* Department of Cardiology, Institut Jantung Negara (National Heart Institute), Kuala Lumpur, Malaysia
Department of Cardiothoracic Surgery, Institut Jantung Negara (National Heart Institute), Kuala Lumpur, Malaysia

Manuscript received October 19, 1998; revised manuscript received September 27, 1999, accepted October 18, 1999.

Reprint requests and correspondence: Dr. Mazeni Alwi, Department of Cardiology, Institut Jantung Negara, 145, Jalan Tun Razak, 50400 Kuala Lumpur, Malaysia
mazeni{at}ijn.com.my

OBJECTIVE

We compared the result of radiofrequency (RF)-assisted valvotomy and balloon dilation with closed surgical valvotomy and Blalock Taussig (BT) shunt as primary treatment in selected patients with pulmonary atresia and intact ventricular septum (PA-IVS).

BACKGROUND

Patients with PA-IVS who have mild to moderate hypoplasia of the right ventricle (RV) and patent infundiblum have the greatest potential for complete biventricular circulation. The use of RF or laser wires to perforate the atretic valve followed by balloon dilation provides an alternative to surgery.

METHODS

Between May 1990 and March 1998, 33 selected patients underwent either percutaneous RF valvotomy and balloon dilation (group 1, n = 21; two crossed over to group 2) or surgical valvotomy with concomitant BT shunt (group 2, n = 14). Second RV decompression by balloon dilation or right ventricular outflow tract (RVOT) reconstruction were performed if necessary. Patients who remained cyanosed were subjected to transcatheter trial closure of the interatrial communication. Partial biventricular repair was offered to those with inadequate growth of the RV.

RESULTS

The primary procedure was successful in 19 patients in group 1. There was one in-hospital death and two late deaths. Of the remaining 16 survivors, 12 achieved complete biventricular circulation, 7 of whom required no further interventions. Two patients required repeat balloon dilation, 1 RVOT reconstruction and 2 transcatheter closure of interatrial communication. Two patients underwent partial biventricular repair. In group 2, there were 3 in-hospital deaths after the primary procedure and 1 patient died four months later. All survivors (n = 10) required a second RV decompression, 8 by balloon dilation and 2 by RVOT reconstruction, after which, two patients died. Of the final 8 survivors, 7 achieved complete biventricular circulation, 5 after coil occlusion of the BT shunt and 2 after closure of interatrial communication.

CONCLUSIONS

Radiofrequency valvotomy and balloon dilation is more efficacious and safe compared with closed pulmonary valvotomy and BT shunt in selected patients with PA-IVS.

Abbreviations and Acronyms   ASO = Amplatzer Septal Occluder   BT = Blalock Taussig   CVP = central venous pressure   PA-IVS = pulmonary atresia with intact ventricular septum   PDA = patent ductus arteriosus   PFO = patent foramen ovale   PGE1 = prostaglandin E1   RF = radiofrequency   RV = right ventricle   RVOT = right ventricular outflow tract   2DE = two-dimensional echocardiography

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