A perforation procedure for pulmonary atresia with intact ventricular septum : Egyptian experience and adaptations.

Abstract

Pulmonary atresia with intact ventricular septum (PA-IVS) is an uncommon disorder with significant morphological heterogeneity. The use of percutaneous radiofrequency (RF)-assisted perforation of the atretic valve and subsequent balloon dilation provides arelatively easy but expensive procedure that is expected to establish ante-grade flow through the pulmonary valve in most patients. The aim of the study was to attempt a cost reduction by using catheters and wires readily available in our catheter laboratory. Atotal of 50patients presenting with PA-IVS to Cairo University Children's Hospital (CUCH) were taken to the catheterization laboratory for radiofrequency perforation using the Baylis RFP-100 generator (Baylis Medical, Montréal, Canada) or the stiff end of a coronary wire. A hybrid approach was used in selected cases. The overall success rate for valve perforation was 92% (46cases), 80% of which had successful primary perforation (40cases). Success correlated with both tricuspid valve (TV) annulus and pulmonary valve (PV) annulus Z-scores, with Pvalues of 0.2 and 0.5, respectively. The management of PA-IVS is complex. This is adisease that necessitates adedicated team and working collaboration between the cardiologists and cardiac surgeons. Cost limitation is essential in developing countries and innovative ideas to reduce costs are essential, especially if comparable success can be expected.