title: Outcomes of Radiofrequency Perforation for Pulmonary Atresia and Intact Ventricular Septum: A Single-Centre Experience.
abstract: Percutaneous radiofrequency perforation (RFP) of the pulmonary valve is used as a primary therapy in neonates with pulmonary atresia and intact ventricular septum (PAIVS). We sought to determine the safety and efficacy of RFP for PAIVS in a single center and assess the pre-intervention anatomical parameters associated with a biventricular outcome. We retrospectively reviewed all cases of PAIVS treated with RFP at a single center from 1999 through 2012. We collected baseline imaging data, technical aspects of the procedure, adverse events and outcomes. RFP was attempted in 18 patients with 17 successful procedures. There was no mortality; one patient had an acute complication requiring surgical intervention. All were alive at the most recent follow-up (median 4.9 years; IQR = 2.0-6.8 years), 12/17 (71%) had a biventricular circulation, 2/17 (12%) had a 1½ ventricle repair, 2/17 (12%) had a univentricular repair and 1/17 was lost to follow-up. A biventricular outcome in patients with PAIVS was associated with the pre-intervention tricuspid valve/mitral valve (TV/MV) ratio and tricuspid valve (TV) z-score. The median TV/MV ratio for patients who underwent a biventricular repair and a non-biventricular repair was 0.82 (IQR = 0.71-0.90) and 0.59 (IQR = 0.39-0.76), P = 0.036, respectively. The median TV z-scores were -3.2 [(-4.9 to -2.6), and -6.8 (-9.7 to -4.8] P = 0.036 for the biventricular and non-biventricular groups, respectively. RFP is a safe primary therapy for PAIVS. With appropriate patient selection, RFP will often result in a biventricular circulation. Both the TV/MV and TV z-score were found to be a predictor of a biventricular outcome in our cohort.
authors.affiliation: Children's Heart Center, British Columbia Children's Hospital and the University of British Columbia, 1F27-4480 Oak Street, Vancouver, BC, V6H 3V4, Canada.
authors.forename: Steven
authors.initials: S
authors.lastname: Rathgeber
authors.affiliation: Children's Heart Center, British Columbia Children's Hospital and the University of British Columbia, 1F27-4480 Oak Street, Vancouver, BC, V6H 3V4, Canada.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Auld
authors.affiliation: Children's Heart Center, British Columbia Children's Hospital and the University of British Columbia, 1F27-4480 Oak Street, Vancouver, BC, V6H 3V4, Canada.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Duncombe
authors.affiliation: Children's Heart Center, British Columbia Children's Hospital and the University of British Columbia, 1F27-4480 Oak Street, Vancouver, BC, V6H 3V4, Canada.
authors.forename: Martin C K
authors.initials: MC
authors.lastname: Hosking
authors.affiliation: Children's Heart Center, British Columbia Children's Hospital and the University of British Columbia, 1F27-4480 Oak Street, Vancouver, BC, V6H 3V4, Canada. kharris2@cw.bc.ca.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Harris
mesh_terms: D000792:Angiography / Q000379:methods; D063126:Balloon Valvuloplasty / Q000009:adverse effects / Q000379:methods*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D004452:Echocardiography / Q000379:methods; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008943:Mitral Valve / Q000503:physiopathology; D018633:Pulmonary Atresia / Q000601:surgery*; D011664:Pulmonary Valve / Q000503:physiopathology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000503:physiopathology
keywords: Cardiac catheterization; Pulmonary atresia; Valvotomy