Hybrid treatment of pulmonary atresia with intact ventricular septum and critical pulmonary stenosis by transesophageal echocardiographic guidance

Abstract

Objective To explore the efficacy and safety of hybrid treatment of pulmonary atresia with intact ventricular septum and critical pulmonary stenosis under transesophageal echocardiographic guidance. Methods A total of 14 neonates with pulmonary atresia with intact ventricular septum and critical pulmonary stenosis were selected. There were 8 boys and 6 girls with a body weight of (2.8-4.9)(3.6±0.7) kg and an age range of 1 hour to 23 days. All right ventricles grew well and tricuspid valve Z score -2-0.5 (-0.8±0.8) on transthoracic and transesophageal echocardiography. The diameter of pulmonary annulus was (6.5-8.0)(7.3±0.6) mm and the balloon sizes were 1.0-1.3 folds greater than those of annellus diameters. Hybrid treatment was offered solely under transesophageal echocardiographic guidance. A minimal median incision was performed after hybrid treatment of balloon valvuloplasty under transesophageal echocardiographic guidance. Results After operations, all patients were transported into intensive care unit (ICU). The mean durations of mechanical ventilation, ICU stay and postoperative hospitalization were (1.7±1.6), (3.9±2.0) and (6.9±2.2) days respectively. Except for one death, there were no postoperative complications. The postoperative transcutaneous oxygen saturation was (89.2±7.0)%. During a follow-up period of 2 to 23 months, there were mild pulmonary stenosis (n=4) and mild pulmonary insufficiency (n=2). Tricuspid insufficiency significantly improved. Conclusions Hybrid treatment of pulmonary atresia with intact ventricular septum and critical pulmonary stenosis under transesophageal echocardiographic guidance is both safe and effective in neonates. It may accelerate right ventricle growth and achieve biventricular repair after modified Blalock-Taussig shunting and ligation of ductus arteriosus. Key words: Pulmonary artery atresia; Pulmonary stenosis; Neonate