title: Transcatheter ventricular septal defect (VSD) creation for restrictive VSD in double-outlet right ventricle.
abstract: BACKGROUND
  Double-outlet right ventricle (DORV) with a restrictive ventricular septum is a rare but highly morbid phenomenon that can be complicated by progressive left ventricular hypertrophy, arrhythmias, aneurysm formation, severe pulmonary hypertension, and death in the newborn. Surgical creation or enlargement of a ventricular septal defect (VSD) is palliative but may damage the conduction system or the atrioventricular valves in the newborn. This report presents a transcatheter approach to palliation for a newborn that had DORV with a restrictive ventricular septum.
  
  
  RESULTS
  A full-term infant girl (2.9 kg) referred for hypoxia (80% with room air) and murmur was found to have DORV, interrupted inferior vena cava, and restrictive VSD (95-mmHg gradient). Transhepatic access was performed, and an internal mammary (IM) catheter was advanced through the atrial septal defect and into the left ventricle. By transesophageal echocardiographic guidance, a Baylis radiofrequency perforation wire was used to cross the ventricular septum, and the defect was enlarged using a 4-mm cutting balloon. A bare metal stent then was deployed to maintain the newly created VSD. The patient did well after the procedure but required pulmonary artery banding 4 days later. She returned 5 months later with cyanosis and the development of obstructing right ventricle muscle bundles, requiring further surgical palliation.
  
  
  CONCLUSIONS
  This report describes the first transcatheter creation of VSD in DORV with a restrictive ventricular septum in a newborn infant. Use of the radiofrequency catheter in combination with cutting balloon dilation and stent implantation is an efficient method for creating a VSD in such a patient.
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Washington University School of Medicine, 8th Floor NWT, 1 Children's Place, St. Louis, MO 63110, USA. lin_c@kids.wustl.edu
authors.forename: C Huie
authors.initials: CH
authors.lastname: Lin
authors.forename: Charles
authors.initials: C
authors.lastname: Huddleston
authors.forename: David T
authors.initials: DT
authors.lastname: Balzer
mesh_terms: D000792:Angiography / Q000379:methods; D006328:Cardiac Catheterization / Q000295:instrumentation / Q000379:methods*; D004310:Double Outlet Right Ventricle / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D017548:Echocardiography, Transesophageal / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006345:Heart Septal Defects, Ventricular / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D007231:Infant, Newborn; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D010166:Palliative Care; D035583:Rare Diseases; D018570:Risk Assessment; D015607:Stents; D016896:Treatment Outcome; D054088:Ventricular Septum / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*