Percutaneous pulmonary valvotomy and arterial duct stenting in neonates with right ventricular hypoplasia

Abstract

In neonates with critical pulmonary valve stenosis or atresia associated with intact ventricular septum, the prognosis is determined by the size of the right ventricle. If the right ventricle is of a satisfactory size, pulmonary valvotomy alone is the treatment of choice.1 If the right ventricle is hypoplastic, a systemic to pulmonary artery shunt is performed in addition to the pulmonary valvotomy to maintain pulmonary blood flow. If the right ventricle is extremely small, only a shunt is usually performed. Subsequently, a biventricular circulation is achieved in those in whom the right ventricular size and function are adequate, but the remaining neonates are candidates for a Fontan repair.In patients with critical pulmonary valve stenosis, balloon dilation of the pulmonary valve is now the treatment of choice.2 More recently, in patients with pulmonary valve atresia, percutaneous laserand radiofrequency-assisted balloon valvotomy have been shown to be feasible.3,4 Patients in whom the right ventricle is unable to support the pulmonary circulation are either given a prolonged infusion of prostaglandins to maintain arterial duct patency or have a systemic to pulmonary artery shunt created in the neonatal period. Neither of these options is without morbidity or complications. After experimental assessment5 we have used an alternative nonsurgical approach to maintain patency of the arterial duct by implantation of a stent.