title: Catheter-based treatment in patients with critical pulmonary stenosis or pulmonary atresia with intact ventricular septum: a single institute experience with comparison between patients with and without additional procedure for pulmonary flow.
abstract: OBJECTIVE
  We report a single institute experience of transcatheter pulmonary valvotomy using the soft end of a guidewire followed or not by a systemic-pulmonary shunt in patients with pulmonary atresia with intact ventricular septum (PAIVS) or critical pulmonary stenosis (CPS). In addition, we compare patients with or without an additional source of flow to support the pulmonary circulation after successful pulmonary valvotomy.
  
  
  METHODS
  All neonates with PAIVS or CPS who underwent primary transcatheter pulmonary valvotomy between January 2004 and December 2010 were reviewed retrospectively. Some of them needed an additional source of flow to support the pulmonary circulation. We performed a comparison between those who required an additional source of pulmonary flow and those who did not.
  
  
  RESULTS
  The initial procedure was successful in 20 out of 22 patients (seven of nine with PAIVS; all of 13 with CPS), but 10 of them needed an additional source of flow to support the pulmonary circulation: nine had arterial duct stenting and one had surgical Blalock-Taussig shunt. There were no deaths or major acute complications, except for femoral artery occlusion in three patients. The bipartite right ventricular morphology, the tricuspid z-score of ≤-0.74, the tricuspid to mitral valve ratio of ≤ 0.9, and the z-score of the diastolic interventricular septal thickness ≥ 2.37 in preprocedural examination showed more tendency of needing shunt placement.
  
  
  CONCLUSIONS
  Transcatheter pulmonary valvotomy using the soft end of a guidewire followed or not by the arterial duct stent implantation was an effective approach in those patients. The angiographic distinction between CPS and PAIVS did not affect anything in this study including the procedural method, success, and odds for reintervention. The degree of right ventricle cavity hypoplasia provided the main restriction to forward flow after pulmonary valvotomy.
authors.affiliation: Pediatrics, Medical Research Institute of Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea.
authors.forename: Min-Jung
authors.initials: MJ
authors.lastname: Cho
authors.forename: Kil-Ho
authors.initials: KH
authors.lastname: Ban
authors.forename: Mun-Ju
authors.initials: MJ
authors.lastname: Kim
authors.forename: Ji-Ae
authors.initials: JA
authors.lastname: Park
authors.forename: Hyoung-Doo
authors.initials: HD
authors.lastname: Lee
mesh_terms: D063126:Balloon Valvuloplasty; D006328:Cardiac Catheterization; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018633:Pulmonary Atresia / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011664:Pulmonary Valve / Q000000981:diagnostic imaging / Q000502:physiology / Q000601:surgery; D011666:Pulmonary Valve Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011859:Radiography; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D016278:Ventricular Function, Right / Q000502:physiology
keywords: Critical Pulmonary Stenosis; Pulmonary Atresia; Stent; Valvuloplasty