Radiofrequency perforation in the treatment of congenital heart disease

Abstract

Catheter-directed perforation of cardiac tissue with radiofrequency (RF) energy has expanded the horizon of the interventional cardiologist dealing with congenital heart disorders. The focus of the following discussion will be to detail the biophysical basis behind RF perforation and review its application in the management of congenital heart lesions.

Recanalization of systemic venous baffles by radiofrequency perforation and stent implantation

“…The wire differs from that used in standard RF ablation in that it utilizes low power and high voltage to generate higher tissue temperatures. In contrast RF energy used in ablation results in lower tissue temperatures and irreversible cell damage that causes an electrically inactive tissue scar [8].…”

“…In congenital heart disease, RF perforation has been previously employed in neonates with pulmonary valve atresia and an intact ventricular septum [9]. Other clinical applications include perforation of the atrial septum as an alternative to transseptal needle puncture, and recanalization of occluded pulmonary arteries [8, 10]. The obvious advantage of RF perforation wires over other techniques of perforation, such as transseptal needle or stiff guidewires wires is its flexibility and the minimal forward force required for perforation.…”

Excimer laser ablation for valvular angioplasty in pulmonary atresia and intact ventricular septum

“…A steerable 5 French RF catheter has been developed to penetrate the imperforate valve and more recently a 2 French end-hole RF catheter became available [30,31]. This technology remains the most frequent method for pulmonary valve perforation worldwide [32][33][34].…”

Radiofrequency perforation of the right ventricular outflow tract as a palliative strategy for pulmonary atresia with ventricular septal defect

“…In this regard, a treatment strategy, which could reduce myocardial and pulmonary endothelial injury, may result in more favorable hemodynamic outcomes [7]. Given the reported success of radiofrequency perforation (RF) with pulmonary atresia and intact ventricular septum [8][9][10][11][12], we investigated the possibility of employing this technique as a palliative treatment strategy to augment pulmonary blood flow, in lieu of surgery [13][14][15].…”