Laser valvotomy with balloon valvoplasty for pulmonary atresia with intact ventricular septum: five years' experience.
OBJECTIVE
To assess immediate and medium term results of transcatheter laser valvotomy with balloon valvoplasty in selected infants with pulmonary atresia and intact ventricular septum.


METHODS
Prospective study.


METHODS
Tertiary cardiac unit.


METHODS
All infants with pulmonary atresia and intact septum with no more than minor tricuspid valve hypoplasia referred between November 1990 and June 1995. Laser valvotomy was attempted in nine infants of median age 4-5 days and median weight 3.6 kg.


METHODS
The pulmonary valve was perforated using a 0.018 inch fibreoptic guidewire attached to a NdYag laser and introduced through a catheter positioned beneath the valve. After perforation the valve was dilated with progressively larger balloons.


METHODS
Successful laser valvotomy and balloon dilatation, complications, pulse oximetry, right ventricular outflow velocities, and need for surgical treatment.


RESULTS
Valvotomy was successful in all but one case, the failure being due to laser breakdown. After perforation the valve was dilated to 6-8 mm diameter. Prostaglandin E was withdrawn immediately in six of the eight duct dependent infants, and 28 and 49 days later in two. No patient required an aortopulmonary shunt. Two patients had repeat valvoplasty at 20 days and three months of age, respectively; one required infundibular resection and closure of the atrial septum at age four and one is awaiting similar treatment.


CONCLUSIONS
Laser valvotomy with balloon valvoplasty is safe and effective treatment for selected patients with pulmonary atresia and intact ventricular septum and should be considered as first line treatment in place of surgical valvotomy.
Gibbs
J L
JL
Killingbeck Hospital, Leeds, West Yorkshire.
Blackburn
M E
ME
Uzun
O
O
Dickinson
D F
DF
Parsons
J M
JM
Chatrath
R R
RR
D002404:Catheterization; D003131:Combined Modality Therapy; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053685:Laser Therapy; D011446:Prospective Studies; D018633:Pulmonary Atresia / Q000601:surgery* / Q000628:therapy; D011664:Pulmonary Valve / Q000601:surgery*; D016896:Treatment Outcome