[The percutaneous treatment of pulmonary atresia with intact ventricular septum].
OBJECTIVE
Describe a mechanical method of perforation-dilatation of the pulmonary valve in pulmonary atresia with intact interventricular septum (PA-IVS), with or without stenting the patent ductus arteriosus (PDA) and medium-term results.


METHODS
Since 2007, all patients with PA-IVS and a right ventricle adequate for biventricular repair, benefited from a transcatheter attempt to perforate-dilate the valve with or without stenting the PDA, and were included in this retrospective study.


METHODS
A catheter was percutaneously introduced through the femoral vein and positionned in front of the atretic pulmonary valve. A lasso catheter was introduced through the femoral artery to the other side of the pulmonary valve. The tip of a rigid guidewire was then pushed through the atretic valve and taken with the lasso, creating a loop that allowed for balloon valvuloplasty. If the child remained ductal dependant following PGE1 withdrawal, a stent is placed in the ductus arteriosus.


RESULTS
Five patients were included in this series. Four patients were successfully dilated, and two patients necessitated stents. The procedure had to be interrupted in one patient.


RESULTS
One patient with a patent stent was operated at the age of one year and died in the postoperative period. The other patient with a stent is now 16 months old with a patent stent and an oxygen saturation of 98%. The two remaining patients without stent are now 3- and 18-month-old with oxygen saturation of 85% and 96% respectively.


CONCLUSIONS
The percutaneous treatment of PA-IVS is feasible and avoids early high risk surgery. Stenting the ductus arteriosus may replace a Blalock shunt. However, the prognosis is still related to the severity of the anomaly.
CHU Hôtel-Dieu de France, Beirut, Lebanon. ChehabGh@cvberia.net.lb
Ghassan
G
Chehab
Elie
E
Chalouhi
Sabine
S
Najarian
Antoine
A
Sarkis
Georges
G
Badaoui
Linda
L
Daou
Issam
I
El-Rassi
Tony
T
Abdel Massih
Zakhia
Z
Saliba
D002404:Catheterization; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D018633:Pulmonary Atresia / Q000628:therapy*; D012189:Retrospective Studies; D015607:Stents