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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

View larger version (173K): [in a new window]   Figure 1 Right ventricular angiogram in the lateral projection showing a well-developed trabecular component, patent infundibulum and atretic pulmonary valve (arrow). Moderate tricuspid regurgitation.

View larger version (22K): [in a new window]   Figure 2 Right ventricular-aorta systolic pressure ratio before and immediately after RF valvotomy and balloon dilation, and during subsequent cardiac catheterization in 19 patients from group 1. One patient was in critical condition at the beginning of the procedure and the initial RV pressure was not available (triangles). Patients with subvalvar stenosis (squares). Patients who underwent repeat balloon dilation (circles). Transvalvar Doppler gradient dropped to < 25 mm Hg at 10 weeks of follow-up (plus signs).

View larger version (15K): [in a new window]   Figure 3 Right ventricular-aortic systolic pressure ratio before and after second RV decompression by balloon dilation in eight patients from group 2.

View larger version (143K): [in a new window]   Figure 4 Right ventricular angiogram in the lateral projection eight months after RF valvotomy and balloon dilation. Unobstructed RV outflow tract but relatively small right ventricle (Z value –3.4). Closure of interatrial communication with ASO eliminated the cyanosis with no deterioration of hemodynamics.

View larger version (21K): [in a new window]   Figure 5 Flow chart summarizing the procedures and outcome of patients in group 1.

View larger version (24K): [in a new window]   Figure 6 Flow chart summarizing the procedures and outcome of patients in group 2.