Technique of percutaneous laser-assisted valve dilatation for valvar atresia in congenital heart disease.
OBJECTIVE
To investigate the efficacy and safety of transcatheter laser-assisted valve dilatation for atretic valves in children with congenital heart disease.


METHODS
Prospective clinical study.


METHODS
Supraregional paediatric cardiology centre.


METHODS
Eleven children (aged 1 day-11 years; weight 2.1-35.7 kg) with atresia of pulmonary (10) or tricuspid (one) valve underwent attempted laser-assisted valve dilatation as part of the staged treatment of their cyanotic heart disease.


METHODS
After delineating the atretic valve by angiography and/or echocardiography a 0.018 inch "hot tip" laser wire was used to perforate the atretic valve. Subsequently the valve was dilated with conventional balloon dilatation catheters up to the valve annulus diameter.


RESULTS
Laser-assisted valve dilatation was successfully accomplished in nine children. In two neonates with pulmonary valve atresia, intact ventricular septum, and coexistent infundibular atresia the procedure resulted in cardiac tamponade: one died immediately and one later at surgery. During a follow up of 1-17 months (mean 11) two infants with pulmonary valve atresia and intact ventricular septum died (one with congestive cardiac failure). The remainder are either well palliated and do not require further procedures (three), or are awaiting further transcatheter or surgical procedures because of associated defects (four).


CONCLUSIONS
Laser-assisted valve dilatation is a promising adjunct to surgery in this high risk group of patients. It may avoid surgery in some patients, and may reduce the number of surgical procedures in those requiring staged operations.
Rosenthal
E
E
Department of Paediatric Cardiology, Guy's Hospital, London.
Qureshi
S A
SA
Kakadekar
A P
AP
Anjos
R
R
Baker
E J
EJ
Tynan
M
M
D021721:Balloon Occlusion; D002305:Cardiac Tamponade / Q000209:etiology; D002404:Catheterization; D002648:Child; D002675:Child, Preschool; D004106:Dilatation / Q000379:methods; D005260:Female; D005263:Femoral Artery / Q000293:injuries; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053685:Laser Therapy / Q000009:adverse effects / Q000379:methods; D008297:Male; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000293:injuries; D011664:Pulmonary Valve / Q000002:abnormalities / Q000601:surgery; D014261:Tricuspid Valve / Q000002:abnormalities / Q000601:surgery