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J Thorac Cardiovasc Surg 1998;115:1055-1059
© 1998 Mosby, Inc.

SURGERY FOR CONGENITAL HEART DISEASE

Growth of the right ventricle after successful transcatheterpulmonary valvotomy in neonates and infants with pulmonary atresia and intactventricular septum

From the Department of Paediatric Cardiology, Guy's Hospital,London, United Kingdom.

Received for publication Feb. 3, 1997. Revisions requested March 11, 1997. Revisions received Nov. 11, 1997. Accepted for publication Nov. 11, 1997. Address for reprints: Shakeel Qureshi, MD, Department of PaediatricCardiology, 11th Floor, Guy's Tower, Guy's Hospital, St. ThomasStreet, London SE1 9RT, United Kingdom.

Objectives: Since 1990, transcatheterpulmonary valvotomy has become an alternative to surgical valvotomy in themanagement of neonates and infants with pulmonary atresia and intact ventricularseptum. We sought to determine whether right ventricular growth aftertranscatheter pulmonary valvotomy is commensurate with body growth.
Methods: Laser or radiofrequency-assisted balloonvalvotomy was attempted in 12 neonates and infants with pulmonary atresia andintact ventricular septum. Tricuspid and mitral valve dimensions were measuredretrospectively on the cross-sectional echocardiograms performed before theprocedure and during follow-up. Z-values were used to standardize tricuspidvalve dimensions with body size.
Results:The atretic pulmonary valve was successfully perforated and dilated in nine of12 patients. Five of these nine patients required additional transcatheter orsurgical procedures to augment the pulmonary blood flow. Of six survivors, fiveare regularly followed up with a median follow-up of 60 months (range 37 to 68months). All five have two-ventricle circulation, two of the five patientsrequiring surgical enlargement of the right ventricular outflow tract with orwithout closure of the atrial septal defect. Echocardiographic tricuspid valvedimensions and Z-values before transcatheter valvotomy tended to be smaller inthe patients who died than in the survivors. In the survivors, the absolutetricuspid valve dimensions increased after valvotomy but the Z-values tended todecrease or stayed constant.
Conclusions:Transcatheter valvotomy is a good alternative to surgical valvotomy in patientswith pulmonary atresia and intact ventricular septum. Two-ventricle circulationcan be achieved despite subnormal right ventricular growth. (J ThoracCardiavasc Surg 1998;115:1055-62)

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