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Risk factors for augmentation of the flow of blood to the lungs in pulmonary atresia with intact ventricular septum after radiofrequency valvotomy

Published online by Cambridge University Press:  22 April 2005

Mazeni Alwi ,
Geetha Kandavello ,
Kok-Kuan Choo ,
Bilkis A. Aziz ,
Hasri Samion  and
Haifa A. Latiff
Mazeni Alwi
Affiliation:
Department of Paediatric Cardiology, National Heart Institute, Kuala Lumpur, Malaysia
Geetha Kandavello
Affiliation:
Department of Paediatric Cardiology, National Heart Institute, Kuala Lumpur, Malaysia
Kok-Kuan Choo
Affiliation:
Department of Paediatric Cardiology, National Heart Institute, Kuala Lumpur, Malaysia
Bilkis A. Aziz
Affiliation:
Department of Paediatric Cardiology, National Heart Institute, Kuala Lumpur, Malaysia
Hasri Samion
Affiliation:
Department of Paediatric Cardiology, National Heart Institute, Kuala Lumpur, Malaysia
Haifa A. Latiff
Affiliation:
Department of Paediatric Cardiology, National Heart Institute, Kuala Lumpur, Malaysia
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Abstract

Some patients with pulmonary atresia with an intact ventricular septum, mild to moderate right ventricular hypoplasia, and a patent infundibulum remain duct dependent on the flow of blood through the arterial duct despite adequate relief of the obstruction within the right ventricular outflow tract.

The objective of our study was to review the risk factors for stenting of the patent arterial duct, or construction of a Blalock-Taussig shunt, in the patients with pulmonary atresia and an intact ventricular septum who remain duct-dependent following radiofrequency valvotomy and dilation of the imperforate pulmonary valve.

We reviewed the data from 53 patients seen between November 1995 and December 2001. Of the 47 patients who survived, 6 required stenting of the patent arterial duct, while 4 needed construction of a modified Blalock-Taussig shunt to augment the flow of blood to the lungs at a mean of 7 plus or minus 5.7 days following the initial intervention. The remaining 37 patients required no additional procedures. We compared the findings in these two groups.

The mean diameter of the tricuspid valve in the patients requiring early reintervention was 8.5 plus or minus 3.7 millimetres, giving a Z-score of −1.1 plus or minus 1.47, whilst those in the group without early reintervention had values of 10.7 plus or minus 2.2 millimetres, giving a Z-score of −0.58 plus or minus 1.18 (p equal to 0.003). No statistically significant differences were found in right ventricular morphology, McGoon ratio, or residual obstruction across the right ventricular outflow tract after decompression of the right ventricle.

The diameter of the tricuspid valve, therefore, appears to be the only factor predicting the need for augmentation of flow of blood to the lungs. As just over one-fifth of our survivors required such augmentation, we hypothesize that stenting of the patent arterial duct may be performed as an integral part of primary transcatheter therapy in patients with pulmonary atresia and intact ventricular septum who have moderate right ventricular hypoplasia and a small tricuspid valve.

Keywords

Duct-dependent circulationright ventricular hypoplasiaradiofrequency valvotomypatent arterial duct
Type
Original Article
Information
Cardiology in the Young , Volume 15 , Issue 2 , March 2005 , pp. 141 - 147
Copyright
© 2005 Cambridge University Press

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References

De Leval M, Bull C, Stark J, Anderson RH, Macartney FJ. Pulmonary atresia and intact ventricular septum: Surgical management based on revise classification. Circulation 1982; 66: 272–280.Google Scholar
Freedom RM, Wilson G, Trusler GA, Williams WG, Rowe RD. Pulmonary atresia and intact ventricular septum: a review of the anatomy, myocardium and factors influencing right ventricular growth and guidelines for surgical intervention. Scand J Thorac Cardiovasc Surg 1983; 17: 1–28.Google Scholar
Jahangiri M, Zurakowski, Bichell D, et al. Improved results with selective management in pulmonary atresia and intact ventricular septum. J Thorac Cardiovas Surgery 1999; 118: 1046–1055.Google Scholar
Hanley FL, Sade RM, Blackstone EH, et al. Outcomes in neonatal pulmonary atresia with intact ventricular septum: a multi-institutional study. J Thorac Cardiovasc Surg 1993; 105: 406–427.Google Scholar
Ovaert C, Qureshi SA, Rosenthal E, Baker EJ, Tynan M. Growth of the right ventricle after successful transcatheter pulmonary valvotomy in neonates and infants with pulmonary atresia and intact ventricular septum. J Thorac Cardiovasc Surg 1998; 115: 1055–1062.Google Scholar
Alwi M, Geetha K, Bilkis AA, et al. Pulmonary atresia with intact ventricular septum – percutaneous radiofrequency valvotomy and balloon dilatation vs surgical valvotomy and Blalock-Taussig shunt. J Am Coll Cardiol 2000; 35: 468–476.Google Scholar
Agnoletti G, Piechand JF, Bonhoeffer P, et al. Perforation of the atretic pulmonary valve. J Am Coll Cardiol 2003; 41: 1399–1403.Google Scholar
Humpl T, Söderberg B, McCrindle BW, et al. Percutaneous balloon valvotomy in pulmonary atresia with intact ventricular septum: impact on patient care. Circulation 2003; 108: 826–832.Google Scholar
Rosenthal E, Qureshi S, Tynan M. Percutaneous pulmonary valvotomy and arterial duct stenting in neonates with right ventricular hypoplasia. Am J Cardiol 1994; 74: 304–306.Google Scholar
Abrahms S, Walsh K. Arterial duct morphology with reference to angioplasty and stenting. Int J Card 1993; 40: 27–33.Google Scholar
Rowlatt JF, Rimoldi MJA, Lev M. The quantitative anatomy of the normal child's heart. Pediatr Clin North Am 1963; 10: 499–588.Google Scholar
Kirklin JW, Barratt-Boyes BG. Cardiac Surgery, 2nd edn. Churchill Livingstone, New York, 1992, pp 3–60.
Bull C, De Leval M, Mercanti C. Macartney FJ, Anderson RH. Pulmonary atresia and intact ventricular septum: a revised classification. Circulation 1982; 66: 266–272.Google Scholar
Justo RN, Nykanen DG, William WG, Freedom RM, Benson LN. Transcatheter perforation of the right ventricular outflow tract as initial therapy for pulmonary valve atresia and intact ventricular septum in the newborn. Cathet Cardiovasc Diagn 1997; 40: 408–413.Google Scholar
Gibbs J, Rothman M, Rees M, Parsons J, Blackburn M, Ruiz C. Stenting the arterial duct: a new approach to palliation for pulmonary atresia. Br Heart J 1992; 67: 240–245.Google Scholar
Tamisier D, Vouhe PR, Vermant F, et al. Modified Blalock-Taussig shunts: results in infants less than 3 months of age. Ann Thorac Surg 1990; 49: 797–801.Google Scholar
Fermanis G, Ekangaki A, Salmon A, et al. Twelve year experience with the modified Blalock-Taussig shunt in neonates. Eur J Cardiothorac Surg 1992; 6: 586–589.Google Scholar
Schneider M, Zartner P, Sidiripoulos A, Konertz W, Hausdorf G. Stent implantation of the arterial duct in newborns with duct-dependent circulation. Eur Heart J 1998; 19: 1401–1409.Google Scholar
Gewillig M, Boshoff DE, Dens J, Mertens L, Benson LN. Stenting the neonatal duct in duct dependant pulmonary circulation: new techniques, better results. J Am Coll Cardiol 2004; 43: 107–112.Google Scholar
Hiatt BL, Carter AJ, Yeung AC. The drug-eluting stent: is it the Holy Grail? Rev Cardiovasc Med 2001; 2: 190–196.Google Scholar