Pulmonary Atresia and Intact Ventricular Septum in Transcatheter Perforation of Atretic Pulmonary Valve

Background and Objective: The use of mechanical perforation as an alternative to radiofrequency wire in the treatment of pulmonary valve atresia with an intact ventricular septum, which is a duct-dependent cyanotic congenital heart disease. We share our experience with this method, which is especially relevant for centers that do not have access to radiofrequency wires. Methods: This cross-sectional study was conducted between October 2011 and August 2022 on all infants referred to Shaheed Almehrab cardiac surgery and Catheterization Center‎ in Babylon, Iraq whose severe cyanosis and patent ductus arteriosus (PDA) dependent pulmonary valve atresia with an intact ventricular septum were confirmed by transthoracic echocardiography. A chronic total occlusion (CTO) wiring procedure was used to create perforation through the atretic pulmonary valve with subsequent pulmonary valve balloon dilation, through an antegrade (n=18) or retrograde approach (n=10). Findings: A total number of 28 infants with 14 infants younger than one month and 14 infants older than one month of age were included. 15 cases (53%) were male. The mean oxygen saturation before the intervention was 44.48±7.43% which significantly improved to 88.35±7.71% (p 0.001). Tripartite ventricles were found in 56.5% of patients. Successful perforation with subsequent balloon valvuloplasty was achieved in 23 cases (82.1%) and death as a complication of perforation was reported in 5 cases. The antegrade operation was associated with higher survival than the retrograde (p=0.041). There were 21.5% of patients who required an additional procedure including a bidirectional cavopulmonary shunt (Glenn shunt) or Blalock-Taussig (BT) shunt to augment pulmonary blood flow. Tricuspid regurgitation improvement was confirmed in 87% of patients‎. Conclusion: In conclusion, transcatheter perforation of atretic pulmonary valves followed by balloon valvuloplasty is a feasible and effective treatment option for pulmonary atresia and intact ventricular septum.