MIDTERM
RESULTS AFTER PULMONARY
VALVULOTOMY
IN NEONATAL PULMONARY ATRESIA WITH INTACT VENTRICULAR SEPTUM
G. Favia Guarnieri, J.D. Piot, V. Lambert, A. Touchot,
E. Belli, A. Serraf, C. Planché, J. Losay
Centre Chirurgical Marie-Lannelongue, Paris, France
Pulmonary atresia with intact
ventricular septum lacks an uniform surgical approach. The nature and the
success of early management strategies are critical to subsequent changes
in function of the right ventricle (RV) and suitability for definitive repair.
The aim of this study was to analyse the midterm outcome of pts with PA-IVS
who underwent pulmonary valvotomy (Pvy) in relation to neonatal
echocardiographic data.
From 1990 to 2003, 45 pts were retrospectively studied.
The median age at PVy was 6 days, median weight 3,1 kg. The exclusion
criteria included a monopartite RV, RV-dependent coronary circulation and
severe Ebstein anomaly. The mean tricuspid valve (TV) diameter was 10,2 mm
(5-20) and mean Z value was –2,26
(+2 to –6,5), mean TV/mitral valve (MV) ratio was 0,83 (.35-1.81). RV
morphology was bipartite in 7 pts, tripartite in 38. Open PVy was performed
in 33 pts as the initial procedure and Blalock-Taussig (BT) shunt was
required in 30 of them 0 to 14 days after. Percutaneous PVy was performed
in 12 pts and 6 of them required BT shunt 3 to 21 days after.
Preinterventional echocardiograms were not different; BT was needed
significantly more often after surgical PVy. There were 5 early and 1 late sudden death. Among the
survivors ( mean follow up 6 + 4.4 years) 27 pts had a biventricular repair, 4 had one
ventricular repair and 8 pts are awaiting for further surgery. Comparison
of initial parameters with the most recent clinical status showed
significant difference (p<.05) of the TV diameter (11.3 vs 7.5), RV
lenght (19.6 vs 13), and TV/MV ratio (.9 vs .46). Percutaneous valvotomy may avoid the need of
secondary BT.Neonatal echo parameters allow
prediction of the pts who will have complete repair.