Transcatheter treatment of three patients with pulmonary atresia and intact ventricular septum using different techniques

Three patients with pulmonary atresia with intact ventricular septum (PA-IVS) were treated with different transcatheter perforation techniques. In two patients, one with patent ductus arteriosus- (PDA) dependent pulmonary circulation (age 2 months) and the other with a previous surgical systemic-pulmonary artery shunt in the neonatal period (age 10 months), anterograde perforation of the atretic valves was performed with the use of the stiff-end of a 0.014-inch guide-wire. In the former, the guide-wire was snared in the main pulmonary artery and pulled with the catheter into the pulmonary artery for perforation followed by pulmonary balloon valvuloplasty (PBV). In the latter, prior to PBV, a low-profile coronary artery balloon catheter was advanced over the guide-wire for predilatation. The third (age 14 months) required stabilization by stenting of the PDA because of severe cyanosis. Retrograde perforation was achieved using the guide-wire which was snared and pulled in the right ventricle together with the catheter for PBV. No significant complications occurred during perforation and PBV. Transcatheter guide-wire perforation with different techniques and with complementary ductal stent implantation before or after the procedure is a safe and effective alternative to surgical valvotomy for PA-IVS.