Radiofrequency perforation of the right ventricular outflow tract as a palliative strategy for pulmonary atresia with ventricular septal defect.
BACKGROUND
Radiofrequency perforation (RF) of the right ventricular outflow tract (RVOT), while an effective management strategy in children with an intact ventricular septum, has not been fully detailed in those presenting with a ventricular septal defect.


OBJECTIVE
To determine whether transcatheter perforation of the atretic pulmonary valve is an acceptable management strategy prior to surgical repair.


RESULTS
Valve perforation was attempted in eight children seen between May 2000 and March 2006, five being infants between 1 and 9 days of age. In five children, this was the first of two procedures, the second a planned surgical correction. The RF was successful in six children with one child requiring additional stenting of the RVOT. Of these children, three attained a biventricular repair within the next year without additional palliative surgical procedures. Of the remaining three patients, one is awaiting surgical correction, one did not require further surgery, and one had this procedure as the only planned palliation. The two children in whom RF was not possible were referred for surgical augmentation of pulmonary blood flow.


CONCLUSIONS
A treatment strategy that includes pulmonary valve perforation as initial palliation to increase pulmonary blood flow may be effective. Additional experience to better define those children who would benefit from this treatment algorithm is required.
Walsh
Mark A
MA
Department of Pediatrics, Division of Cardiology, The Hospital for Sick Children, University of Toronto School of Medicine, Toronto, Ontario, Canada.
Lee
Kyong-Jin
KJ
Chaturvedi
Rajiv
R
Van Arsdell
Glen S
GS
Benson
Lee N
LN
D000800:Angioplasty, Balloon / Q000295:instrumentation; D006328:Cardiac Catheterization; D017115:Catheter Ablation / Q000009:adverse effects; D002932:Cineangiography; D017023:Coronary Angiography / Q000379:methods; D003326:Coronary Circulation; D005260:Female; D005500:Follow-Up Studies; D006345:Heart Septal Defects, Ventricular / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010166:Palliative Care; D018633:Pulmonary Atresia / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D011652:Pulmonary Circulation; D011664:Pulmonary Valve / Q000601:surgery; D015607:Stents; D016896:Treatment Outcome