Advanced

Long-Term Outcome Following Catheter Valvotomy for Pulmonary Atresia With Intact Ventricular Septum

Chubb, Henry; Pesonen, Erkki LU ; Sivasubramanian, Sivasankaran; Tibby, Shane M.; Simpson, John M.; Rosenthal, Eric and Qureshi, Shakeel A. (2012) In Journal of the American College of Cardiology 59(16). p.1468-1476
Abstract
Objectives This study investigated the outcome for all patients undergoing catheter valve perforation for pulmonary atresia with intact ventricular septum (PAIVS) 21 years after the first procedure at their center. Background Catheter perforation for PAIVS is now an established procedure. However, the management of the borderline right ventricle (RV) is controversial, and there may be a place for novel techniques such as stenting of the arterial duct. Methods There were 37 successful valve perforations (total 39 patients). Median length of follow-up was 9.2 years (range 2.2 to 21.0 years). Seventeen patients had stenting of the arterial duct. The mean (SD) initial z-score for the tricuspid valve was -5.1 (+/- 3.4), and a further 142 sets... (More)
Objectives This study investigated the outcome for all patients undergoing catheter valve perforation for pulmonary atresia with intact ventricular septum (PAIVS) 21 years after the first procedure at their center. Background Catheter perforation for PAIVS is now an established procedure. However, the management of the borderline right ventricle (RV) is controversial, and there may be a place for novel techniques such as stenting of the arterial duct. Methods There were 37 successful valve perforations (total 39 patients). Median length of follow-up was 9.2 years (range 2.2 to 21.0 years). Seventeen patients had stenting of the arterial duct. The mean (SD) initial z-score for the tricuspid valve was -5.1 (+/- 3.4), and a further 142 sets of measurements were taken to assess the growth of the RV of survivors. Results There were 8 deaths (21%), and no deaths after the first 35 days. There were no late arrhythmias or ischemic events. Twenty-five patients (83% of survivors) have a biventricular circulation. For patients who had stenting of the arterial duct, significant reductions in early reintervention (0 vs. 7 patients, p = 0.009) and hospital stay (17.4 +/- 18.1 days vs. 33.8 +/- 28.6 days, p = 0.012) occurred, with no increase in mortality or morbidity. There was no catch-up growth of the RV in patients who had a biventricular outcome (z-score increase +0.08/year, p = 0.26). Conclusions Long-term survival is good, and even small RVs may be amenable to this procedure. Multiple interventions may be required to achieve biventricular circulation, but stenting of the arterial duct may reduce hospital stay and repeat procedures. (J Am Coll Cardiol 2012;59:1468-76) (C) 2012 by the American College of Cardiology Foundation (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
arterial duct, biventricular circulation, catheter valvotomy, hypoplastic right ventricle, laser perforation, pulmonary atresia with, intact ventricular septum, radiofrequency perforation, stent
in
Journal of the American College of Cardiology
volume
59
issue
16
pages
1468 - 1476
publisher
Elsevier USA
external identifiers
  • wos:000302785500009
  • scopus:84859585226
ISSN
0735-1097
DOI
10.1016/j.jacc.2012.01.022
language
English
LU publication?
yes
id
c2bc8062-3803-4432-afd1-e42be5efd81d (old id 2571574)
date added to LUP
2012-06-01 08:57:23
date last changed
2017-09-17 03:11:48
@article{c2bc8062-3803-4432-afd1-e42be5efd81d,
  abstract     = {Objectives This study investigated the outcome for all patients undergoing catheter valve perforation for pulmonary atresia with intact ventricular septum (PAIVS) 21 years after the first procedure at their center. Background Catheter perforation for PAIVS is now an established procedure. However, the management of the borderline right ventricle (RV) is controversial, and there may be a place for novel techniques such as stenting of the arterial duct. Methods There were 37 successful valve perforations (total 39 patients). Median length of follow-up was 9.2 years (range 2.2 to 21.0 years). Seventeen patients had stenting of the arterial duct. The mean (SD) initial z-score for the tricuspid valve was -5.1 (+/- 3.4), and a further 142 sets of measurements were taken to assess the growth of the RV of survivors. Results There were 8 deaths (21%), and no deaths after the first 35 days. There were no late arrhythmias or ischemic events. Twenty-five patients (83% of survivors) have a biventricular circulation. For patients who had stenting of the arterial duct, significant reductions in early reintervention (0 vs. 7 patients, p = 0.009) and hospital stay (17.4 +/- 18.1 days vs. 33.8 +/- 28.6 days, p = 0.012) occurred, with no increase in mortality or morbidity. There was no catch-up growth of the RV in patients who had a biventricular outcome (z-score increase +0.08/year, p = 0.26). Conclusions Long-term survival is good, and even small RVs may be amenable to this procedure. Multiple interventions may be required to achieve biventricular circulation, but stenting of the arterial duct may reduce hospital stay and repeat procedures. (J Am Coll Cardiol 2012;59:1468-76) (C) 2012 by the American College of Cardiology Foundation},
  author       = {Chubb, Henry and Pesonen, Erkki and Sivasubramanian, Sivasankaran and Tibby, Shane M. and Simpson, John M. and Rosenthal, Eric and Qureshi, Shakeel A.},
  issn         = {0735-1097},
  keyword      = {arterial duct,biventricular circulation,catheter valvotomy,hypoplastic right ventricle,laser perforation,pulmonary atresia with,intact ventricular septum,radiofrequency perforation,stent},
  language     = {eng},
  number       = {16},
  pages        = {1468--1476},
  publisher    = {Elsevier USA},
  series       = {Journal of the American College of Cardiology},
  title        = {Long-Term Outcome Following Catheter Valvotomy for Pulmonary Atresia With Intact Ventricular Septum},
  url          = {http://dx.doi.org/10.1016/j.jacc.2012.01.022},
  volume       = {59},
  year         = {2012},
}