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Use of a telescopic system for transcatheter radiofrequency perforation and balloon valvotomy in infants with pulmonary atresia and intact ventricular septum

Published online by Cambridge University Press:  26 April 2012

Sara Bondanza ,
Maria Derchi ,
Giulia Tuo ,
Lucio Zannini  and
Maurizio Marasini
Sara Bondanza*
Affiliation:
Department of Pediatric Cardiology and Cardiovascular Surgery, Gaslini Insitute, Genova, Italy
Maria Derchi
Affiliation:
Department of Pediatric Cardiology and Cardiovascular Surgery, Gaslini Insitute, Genova, Italy
Giulia Tuo
Affiliation:
Department of Pediatric Cardiology and Cardiovascular Surgery, Gaslini Insitute, Genova, Italy
Lucio Zannini
Affiliation:
Department of Pediatric Cardiology and Cardiovascular Surgery, Gaslini Insitute, Genova, Italy
Maurizio Marasini
Affiliation:
Department of Pediatric Cardiology and Cardiovascular Surgery, Gaslini Insitute, Genova, Italy
*
Correspondence to: Dr S. Bondanza, Department of Pediatric Cardiology and Cardiovascular Surgery, Gaslini Insitute, Largo G. Gaslini 5, I-16147 Genova, Italy. Tel: 39 010 56250; Fax: 39 010 386804; E-mail: sarabondanza@ospedale-gaslini.ge.it
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Abstract

Background

Pulmonary atresia and intact ventricular septum is a complex congenital heart disease with great morphological variability. Approximately two-thirds of patients may be suitable for transcatheter pulmonary valvotomy. We reviewed our experience in the use of two different percutaneous approaches to evaluate the impact on fluoroscopy time and morbidity of a new technique to perform transcatheter radiofrequency perforation and valvotomy in newborns with pulmonary atresia and intact ventricular septum.

Methods and Results

In all, 31 patients underwent radiofrequency perforation of the pulmonary valve. The first 14 infants were treated using a 5 French Judkins right coronary catheter, which was manoeuvred directly underneath the atretic pulmonary valve (Group A). The others were treated using a telescopic system consisting of Northstar Lumax Flex and White Lumax Guiding Catheters (Cook; Group B). In both groups, after radiofrequency perforation of the pulmonary valve, a 0.014-inch superfloppy guidewire was advanced into the descending aorta and balloon dilations were performed. Required fluoroscopy time was significantly lower in Group B (48.5 ± 28.1 versus 24.9 ± 14.4 minutes, respectively; p < 0.01). A higher incidence of unfavourable events including the need for early surgery was found in Group A.

Conclusion

In our experience, telescopic catheter proved to be a valid option able to decrease the fluoroscopy time of percutaneous radiofrequency perforation of pulmonary valve and consequently patients’ exposure to procedure-related risks.

Keywords

Atretic pulmonary valvevalvuloplastycatheter stabilityfluoroscopy time
Type
Original Article
Information
Cardiology in the Young , Volume 23 , Issue 2 , April 2013 , pp. 203 - 208
Copyright
Copyright © Cambridge University Press 2012 

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