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Technical factors are associated with complications and repeat intervention in neonates undergoing transcatheter right ventricular decompression for pulmonary atresia and intact ventricular septum: results from the congenital catheterisation research collaborative

Published online by Cambridge University Press:  18 June 2018

Christopher J. Petit ,
Athar M. Qureshi ,
Andrew C. Glatz ,
Michael S. Kelleman ,
Courtney E. McCracken ,
R. Allen Ligon ,
Namrita Mozumdar ,
Wendy Whiteside ,
Asra Khan  and
Bryan H. Goldstein
Christopher J. Petit*
Affiliation:
Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA, USA
Athar M. Qureshi
Affiliation:
Baylor College of Medicine, Texas Children’s Hospital, Houston, TX USA
Andrew C. Glatz
Affiliation:
University of Pennsylvania School of Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Michael S. Kelleman
Affiliation:
Emory University School of Medicine, Department of Pediatrics, Atlanta, GA, USA
Courtney E. McCracken
Affiliation:
Emory University School of Medicine, Department of Pediatrics, Atlanta, GA, USA
R. Allen Ligon
Affiliation:
Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA, USA
Namrita Mozumdar
Affiliation:
University of Pennsylvania School of Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Wendy Whiteside
Affiliation:
Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Asra Khan
Affiliation:
Baylor College of Medicine, Texas Children’s Hospital, Houston, TX USA
Bryan H. Goldstein
Affiliation:
Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
*
Author for correspondence: C. J. Petit, MD, Associate Professor of Pediatrics, Emory University School of Medicine, Children’s Healthcare of Atlanta, 1405 Clifton Road, Atlanta, GA 30322, USA. Tel: 404 695 0711; Fax: 404 785 0998; E-mail: [email protected]
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Abstract

Background

Transcatheter right ventricle decompression in neonates with pulmonary atresia and intact ventricular septum is technically challenging, with risk of cardiac perforation and death. Further, despite successful right ventricle decompression, re-intervention on the pulmonary valve is common. The association between technical factors during right ventricle decompression and the risks of complications and re-intervention are not well described.

Methods

This is a multicentre retrospective study among the participating centres of the Congenital Catheterization Research Collaborative. Between 2005 and 2015, all neonates with pulmonary atresia and intact ventricular septum and attempted transcatheter right ventricle decompression were included. Technical factors evaluated included the use and characteristics of radiofrequency energy, maximal balloon-to-pulmonary valve annulus ratio, infundibular diameter, and right ventricle systolic pressure pre- and post-valvuloplasty (BPV). The primary end point was cardiac perforation or death; the secondary end point was re-intervention.

Results

A total of 99 neonates underwent transcatheter right ventricle decompression at a median of 3 days (IQR 2–5) of age, including 63 patients by radiofrequency and 32 by wire perforation of the pulmonary valve. There were 32 complications including 10 (10.5%) cardiac perforations, of which two resulted in death. Cardiac perforation was associated with the use of radiofrequency (p=0.047), longer radiofrequency duration (3.5 versus 2.0 seconds, p=0.02), and higher maximal radiofrequency energy (7.5 versus 5.0 J, p<0.01) but not with patient weight (p=0.09), pulmonary valve diameter (p=0.23), or infundibular diameter (p=0.57). Re-intervention was performed in 36 patients and was associated with higher post-intervention right ventricle pressure (median 60 versus 50 mmHg, p=0.041) and residual valve gradient (median 15 versus 10 mmHg, p=0.046), but not with balloon-to-pulmonary valve annulus ratio, atmospheric pressure used during BPV, or the presence of a residual balloon waist during BPV. Re-intervention was not associated with any right ventricle anatomic characteristics, including pulmonary valve diameter.

Conclusion

Technical factors surrounding transcatheter right ventricle decompression in pulmonary atresia and intact ventricular septum influence the risk of procedural complications but not the risk of future re-intervention. Cardiac perforation is associated with the use of radiofrequency energy, as well as radiofrequency application characteristics. Re-intervention after right ventricle decompression for pulmonary atresia and intact ventricular septum is common and relates to haemodynamic measures surrounding initial BPV.

Keywords

Pulmonary atresiaperforationvalvuloplastyinterventional (stents, etc.)
Type
Original Article
Information
Cardiology in the Young , Volume 28 , Issue 8 , August 2018 , pp. 1042 - 1049
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Copyright
© Cambridge University Press 2018 

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Footnotes

Cite this article: Petit CJ, Qureshi AM, Glatz AC, Kelleman MS, McCracken CE, Ligon RA, Mozumdar N, Whiteside W, Khan A, Goldstein BH. (2018) Technical factors are associated with complications and repeat intervention in neonates undergoing transcatheter right ventricular decompression for pulmonary atresia and intact ventricular septum: results from the congenital catheterisation research collaborative. Cardiology in the Young 28: 1042–1049. doi: 10.1017/S1047951118000756

References

1. Qureshi, SA, Rosenthal, E, Tynan, M, Anjos, R, Baker, EJ. Transcatheter laser-assisted balloon pulmonary valve dilation in pulmonic valve atresia. Am J Cardiol 1991; 67: 428–431.Google Scholar
2. Latson, LA. Nonsurgical treatment of a neonate with pulmonary atresia and intact ventricular septum by transcatheter puncture and balloon dilation of the atretic valve membrane. Am J Cardiol 1991; 68: 277–279.Google Scholar
3. Parsons, JM, Rees, MR, Gibbs, JL. Percutaneous laser valvotomy with balloon dilatation of the pulmonary valve as primary treatment for pulmonary atresia. Br Heart J 1991; 66: 36–38.Google Scholar
4. Hasan, BS, Bautista-Hernandez, V, McElhinney, DB, et al. Outcomes of transcatheter approach for initial treatment of pulmonary atresia with intact ventricular septum. Catheter Cardiovasc Interv 2013; 81: 111–118.Google Scholar
5. Petit, CJ, Glatz, AC, Qureshi, AM, et al. Outcomes after decompression of the right ventricle in infants with pulmonary atresia with intact ventricular septum are associated with degree of tricuspid regurgitation: results from the Congenital Catheterization Research Collaborative. Circ Cardiovasc Interv 2017; 10: 4428–4439.Google Scholar
6. Rosenthal, E, Qureshi, SA, Kakadekar, AP, Anjos, R, Baker, EJ, Tynan, M. Technique of percutaneous laser-assisted valve dilatation for valvar atresia in congenital heart disease. Br Heart J 1993; 69: 556–562.Google Scholar
7. Alwi, M, Geetha, K, Bilkis, AA, et al. Pulmonary atresia with intact ventricular septum percutaneous radiofrequency-assisted valvotomy and balloon dilation versus surgical valvotomy and Blalock Taussig shunt. J Am Coll Cardiol 2000; 35: 468–476.Google Scholar
8. Humpl, T, Soderberg, 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
9. Rosenthal, E, Qureshi, SA, Chan, KC, et al. Radiofrequency-assisted balloon dilatation in patients with pulmonary valve atresia and an intact ventricular septum. Br Heart J 1993; 69: 347–351.CrossRefGoogle Scholar
10. Chubb, H, Pesonen, E, Sivasubramanian, S, et al. Long-term outcome following catheter valvotomy for pulmonary atresia with intact ventricular septum. J Am Coll Cardiol 2012; 59: 1468–1476.Google Scholar
11. Alwi, M, Budi, RR, Mood, MC, Leong, MC, Samion, H. Pulmonary atresia with intact septum: the use of Conquest Pro coronary guidewire for perforation of atretic valve and subsequent interventions. Cardiol Young 2013; 23: 197–202.Google Scholar
12. Burke, RP, Hannan, RL, Zabinsky, JA, Tirotta, CF, Zahn, EM. Hybrid ventricular decompression in pulmonary atresia with intact septum. Ann Thorac Surg 2009; 88: 688–689.Google Scholar
13. Zampi, JD, Hirsch-Romano, JC, Goldstein, BH, Shaya, JA, Armstrong, AK. Hybrid approach for pulmonary atresia with intact ventricular septum: early single center results and comparison to the standard surgical approach. Catheter Cardiovasc Interv 2014; 83: 753–761.Google Scholar
14. McCrindle, BW. Independent predictors of long-term results after balloon pulmonary valvuloplasty. Valvuloplasty and Angioplasty of Congenital Anomalies (VACA) Registry Investigators. Circulation 1994; 89: 1751–1759.Google Scholar
15. Marasini, M, Gorrieri, PF, Tuo, G, et al. Long-term results of catheter-based treatment of pulmonary atresia and intact ventricular septum. Heart 2009; 95: 1520–1524.Google Scholar
16. Harrild, DM, Powell, AJ, Tran, TX, et al. Long-term pulmonary regurgitation following balloon valvuloplasty for pulmonary stenosis risk factors and relationship to exercise capacity and ventricular volume and function. J Am Coll Cardiol 2010; 55: 1041–1047.Google Scholar