Transcatheter pulmonary valve perforation using chronic total occlusion wire in pulmonary atresia with intact ventricular septum

Abstract

Background:Perforation of pulmonary valve using radiofrequency ablation in pulmonary atresia with intact ventricular septum (PA IVS) is a treatment of choice. However, significant cost of the equipment limits its utility, especially in the developing economies.Objective:To assess the feasibility, safety, and efficacy of perforation of pulmonary valve using chronic total occlusion (CTO) wires in patients with PA IVS as an alternative to radiofrequency ablation.Methods:This is a single-center, nonrandomized, retrospective study conducted during June 2008 to September 2015. Twenty-four patients with PA IVS were selected for the procedure during the study period. The median age and weight of the study population were 8. days and 2.65 kg, respectively. Four patients were excluded after right ventricular angiogram as they showed right ventricular-dependent coronary circulation. The pulmonary valve perforation was attempted using various types of CTO wires based on the tip load with variable penetrating characteristics.Results:The procedure was successful in 16 of twenty patients using CTO wires: Shinobi in nine, Miracle in four, CROSS-IT in two, and Conquest Pro in one. Two patients had perforation of right ventricular outflow tract (RVOT). Pericardiocentesis was required in one patient to relieve cardiac tamponade. Later, the same patient underwent successful hybrid pulmonary valvotomy. The other patient underwent ductus arteriosus (DA) stenting. Balloon atrial septostomy was needed in three cases with systemic venous congestion. Desaturation was persistent in five cases necessitating DA or RVOT stenting to augment pulmonary blood flow. There were two early and two late deaths. The mean follow-up was 22.66 ± 16 months. Three patients underwent one and half ventricle repair and one Blalock–Taussig shunt during follow-up.Conclusion:Perforation of the pulmonary valve can be done successfully using CTO wires in selected cases of pulmonary atresia with intact ventricular septum.

Ductal stenting to improve pulmonary blood flow in pulmonary atresia with intact ventricular septum and critical pulmonary stenosis after balloon valvuloplasty

“…Recently in the literature, it has been discussed that various types of chronic total occlusion coronary stiff wires based on the tip load with variable penetrating characteristics can be used as an alternative to the usage of the stiff tip of a 0.014" coronary guide wire for perforation of atretic pulmonary valve. 19,20 In the last consecutive three patients with pulmonary atresia with intact ventricular septum encountered in our centre, we believe that using the CROSS-IT 200 XT (Abbott Laboratories, Chicago, Illinois, United States of America) or the PROGRESS 200T (Abbott Laboratories) Hi-Torque guide wires contributed to the effectiveness and the safety of the perforation technique while substantially reducing time procedure (Fig 1c).…”

Transcatheter perforation of atretic pulmonary valve by the stiff end of a coronary wire in neonates with pulmonary atresia with intact ventricular septum: A solution in developing countries

“…Bakhru et al [16] reported the successful perforation of PV in 16 out of 20 patients. Cardiac tamponade due to RVOT perforation was seen in one patient, who required pericardiocentesis.…”

“…Alcíbar-Villa et al [13] and Bakhru et al [16] reported the use of special coronary wires for total occlusion (CTO wires) depending on its power of penetration as they were concerned about the degree of risk using the stiff end of the coronary wire. In addition, controlling the stiff end is not easy.…”

“…Six patients required additional procedures in the immediate post-perforation period because of insufficient anterograde pulmonary flow (requiring duct stenting in four patients, RVOT stenting in one patient, and BT shunt in another patient). In that cohort, three patients underwent one and a half ventricular repair [16].…”

Central perforation of atretic pulmonary valve using coronary microcatheter

“…Percutaneous perforation of pulmonary valve, using 0.014” guidewires meant for coronary artery chronic total occlusion (CTO), is increasingly being performed for select cases of pulmonary atresia with intact ventricular septum (PA-IVS). [ 1 2 3 ] Technically, owing to a short segment of atresia, well-defined atretic pulmonary valve, a predictable distal vascular bed, pulmonary arteries, and a patent ductus arteriosus, PA-IVS is equivalent to a “simple CTO.” In the majority, however, the catheter remains noncoaxial and uncomfortably away from pulmonary valve resulting in failures[ 1 2 ] and complications. [ 3 ] Movement of coronary guidewire further destabilizes the catheter and even when the perforation is successful, the orifice created is eccentric.…”