Hostname: page-component-77c89778f8-sh8wx Total loading time: 0 Render date: 2024-07-23T18:03:43.275Z Has data issue: false hasContentIssue false
  • English
  • Français

Pulmonary atresia with intact septum: the use of Conquest Pro coronary guidewire for perforation of atretic valve and subsequent interventions

Published online by Cambridge University Press:  29 May 2012

Mazeni Alwi ,
Rahmat R. Budi ,
Marhisham Che Mood ,
Ming C. Leong  and
Hasri Samion
Mazeni Alwi*
Affiliation:
Department of Pediatric Cardiology, National Heart Institute, Kuala Lumpur, Malaysia
Rahmat R. Budi
Affiliation:
Department of Pediatric Cardiology, National Heart Institute, Kuala Lumpur, Malaysia
Marhisham Che Mood
Affiliation:
Department of Pediatric Cardiology, National Heart Institute, Kuala Lumpur, Malaysia
Ming C. Leong
Affiliation:
Department of Pediatric Cardiology, National Heart Institute, Kuala Lumpur, Malaysia
Hasri Samion
Affiliation:
Department of Pediatric Cardiology, National Heart Institute, Kuala Lumpur, Malaysia
*
Correspondence to: Dr M. Alwi, MRCP, Department of Paediatric Cardiology, National Heart Institute, 145 Jalan Tun Razak, 50400 Kuala Lumpur, Malaysia. Tel: +603 261 78465; Fax: +60 3 26946478; E-mail: mazeni@ijn.com.my
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

To determine the feasibility and safety of the Conquest Pro wire as an alternative to radiofrequency wire for perforation of atretic pulmonary valve and subsequent balloon dilatation and patent ductus arteriosus stenting in patients with pulmonary atresia with intact ventricular septum.

Background

Radiofrequency valvotomy and balloon dilatation has become the standard of care for pulmonary atresia with intact ventricular septum in many institutions today.

Methods

We report eight consecutive patients in whom we used the Conquest Pro coronary guidewire, a stiff wire normally reserved for revascularisation of coronary lesions with chronic total occlusion, for perforation of atretic pulmonary valve and subsequent balloon dilatation, and stenting of the patent ductus arteriosus.

Results

Perforation of atretic pulmonary valve was successful in seven out of eight cases. Radiofrequency valvotomy was employed after failure of perforation by the Conquest Pro wire in one case where the right ventricular outflow tract was broad based and tapered towards the pulmonary valve, and was heavily trabeculated. Failure of the Conquest Pro wire to perforate the pulmonary valve plate was mainly attributed by the failure to engage the wire at the correct position.

Conclusion

The Conquest Pro wire for perforation and subsequent interventions in the more straightforward cases of pulmonary atresia with intact ventricular septum is effective and safe, simplifying the entire procedure. However, the radiofrequency generator and wires remain essential tools in the paediatric interventional catheter laboratory.

Keywords

Neonatalinterventionvalvotomy
Type
Original Article
Information
Cardiology in the Young , Volume 23 , Issue 2 , April 2013 , pp. 197 - 202
Copyright
Copyright © Cambridge University Press 2012 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Bull, C, De Leval, M, Mercanti, C, Macartney, FJ, Anderson, RH. Pulmonary atresia and intact ventricular septum: a revised classification. Circulation 1982; 66: 266–272.CrossRefGoogle ScholarPubMed
2. Justo, RN, Nykanen, DG, Williams, WG, Freedom, RM, Benson, LN. Transcatheter perforation of the right ventricular outflow tract as initial therapy for pulmonary valve atresia and intact ventricular septum in the newborn. Cathet Cardiovasc Diagn 1997; 40: 408–413.Google Scholar
3. Alwi, M, Choo, KK, Radzi, NAM, Samion, H, Pau, KK, Hew, CC. Concomitant stenting of the patent ductus arteriosus and radiofrequency valvotomy in pulmonary atresia with intact ventricular septum and intermediate right ventricle: early in-hospital and medium-term outcomes. J Thorac Cardiovasc Surg 2011; 141: 1–7; (published online January 10, 2011).Google Scholar
4. Gewillig, M, Boshoff, DE, Dens, J, Merten, L, Benson, L. Stenting the neonatal duct in duct dependent pulmonary circulation: new techniques, better results. J Am Coll Cardiology 2004; 43: 107–112.CrossRefGoogle ScholarPubMed
5. Humpl, T, Söderberg, B, McCrindle, BW, et al. Percutaneous balloon valvotomy in pulmonary atresia with intact ventricular septum: impact on patient care. Circulation 2003; 108: 826–832.CrossRefGoogle ScholarPubMed
6. Agnoletti, G, Fiechaud, JF, Bonhoeffer, P, et al. Perforation of the atretic pulmonary valve. J Am Coll Cardiol 2003; 41: 1399–1403.Google Scholar
7. Cheatham, JP. The transcatheter management of the neonate and infant with pulmonary atresia and intact ventricular septum. J Interven Cardiol 1998; 11: 363–387.CrossRefGoogle Scholar
8. Alwi, M. Management algorithm in pulmonary atresia with intact ventricular septum. Cathet Cardiovasc Intervent 2006; 67: 679–686.Google Scholar
9. Qureshi, SA, Rosenthal, E, Tynan, M, Anjos, R, Baker, EJ. Transcatheter laser-assisted balloon pulmonary valve dilation in pulmonic valve atresia. Am J Cardiol 1991; 67: 428–431.CrossRefGoogle ScholarPubMed
10. Latson, LA. Nonsurgical treatment of a neonate with pulmonary atresia and intact ventricular septum by transcatheter puncture and balloon dilation of the atretic valve membranous. Am J Cardiol 1991; 68: 277–279.CrossRefGoogle Scholar
11. Rosenthal, E, Qureshi, SA, Chan, KC, et al. Radiofrequency-assisted balloon dilatation in patients with pulmonary valve atresia and an intact ventricular septum. Br Heart J 1993; 69: 347–351.CrossRefGoogle Scholar
12. Gibbs, JL, Blackburn, ME, Uzun, O, Dickinson, DF, Parsons, JM, Chatrath, RR. Laser valvotomy with balloon valvoplasty for pulmonary atresia with intact ventricular septum: five years’ experience. Heart 1997; 77: 225–228.CrossRefGoogle ScholarPubMed