Abstract
A case of pulmonary atresia with ventricular septal defect is reported in which a communication was established between the right ventricle and the hypoplastic pulmonary artery by intervention, despite muscular atresia of the right ventricular outflow tract. The atresia was perforated with a special designed radiofrequency catheter (Osypka). After the creation of a canal within the muscular atresia, balloon dilatation (diameters 2, 3.5, and 7.2 mm) was performed. Arterial oxygen saturation increased from 64% to 78%. Lateral deviation of the radiofrequency catheter resulting in a lateral perforation of the atretic muscular infundibulum was well tolerated without later sequelae. Early restenosis within two weeks necessitated the implantation of a stent within the "recanalised" atresia resulting in an increased anterograde flow to the pulmonary artery. This case shows that "recanalisation" of muscular atresia of the pulmonary artery by radiofrequency is a promising technique. Additionally, stent implantation into the infundibulum to prevent restenosis is a first step to interventional right ventricular outflow tract reconstruction.
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- Freedom R. M., Pongiglione G., Williams W. G., Trusler G. A., Rowe R. D. Palliative right ventricular outflow tract construction for patients with pulmonary atresia, ventricular septal defect, and hypoplastic pulmonary arteries. J Thorac Cardiovasc Surg. 1983 Jul;86(1):24–36. [PubMed] [Google Scholar]
- Fäller K., Haworth S. G., Taylor J. F., Macartney F. J. Duplicate sources of pulmonary blood supply in pulmonary atresia with ventricular septal defect. Br Heart J. 1981 Sep;46(3):263–268. doi: 10.1136/hrt.46.3.263. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Gill C. C., Moodie D. S., McGoon D. C. Staged surgical management of pulmonary atresia with diminutive pulmonary arteries. J Thorac Cardiovasc Surg. 1977 Mar;73(3):436–442. [PubMed] [Google Scholar]
- Iyer K. S., Mee R. B. Staged repair of pulmonary atresia with ventricular septal defect and major systemic to pulmonary artery collaterals. Ann Thorac Surg. 1991 Jan;51(1):65–72. doi: 10.1016/0003-4975(91)90452-v. [DOI] [PubMed] [Google Scholar]
- Kirklin J. W., Bargeron L. M., Jr, Pacifico A. D. The enlargement of small pulmonary arteries by preliminary palliative operations. Circulation. 1977 Oct;56(4 Pt 1):612–617. doi: 10.1161/01.cir.56.4.612. [DOI] [PubMed] [Google Scholar]
- Millikan J. S., Puga F. J., Danielson G. K., Schaff H. V., Julsrud P. R., Mair D. D. Staged surgical repair of pulmonary atresia, ventricular septal defect, and hypoplastic, confluent pulmonary arteries. J Thorac Cardiovasc Surg. 1986 Jun;91(6):818–825. [PubMed] [Google Scholar]
- O'Laughlin M. P., Perry S. B., Lock J. E., Mullins C. E. Use of endovascular stents in congenital heart disease. Circulation. 1991 Jun;83(6):1923–1939. doi: 10.1161/01.cir.83.6.1923. [DOI] [PubMed] [Google Scholar]
- Piehler J. M., Danielson G. K., McGoon D. C., Wallace R. B., Fulton R. E., Mair D. D. Management of pulmonary atresia with ventricular septal defect and hypoplastic pulmonary arteries by right ventricular outflow construction. J Thorac Cardiovasc Surg. 1980 Oct;80(4):552–567. [PubMed] [Google Scholar]
- Stewart S., Alexson C., Manning J., Oakes D., Eberly S. W. Long-term palliation with the classic Blalock-Taussig shunt. J Thorac Cardiovasc Surg. 1988 Jul;96(1):117–121. [PubMed] [Google Scholar]