Risk factors for augmentation of the flow of blood to the lungs in pulmonary atresia with intact ventricular septum after radiofrequency valvotomy

Mazeni Alwi, Geetha Kandavello, Kok Kuan Choo, Bilkis Banu Shri Abd. Aziz, Hasri Samion, Haifa A. Latiff

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Some patients with pulmonary atresia with an intact ventricular septum, mild to moderate tight ventricular hypoplasia, and a patent infundibulum remain duct dependent on the flow of blood through the arterial duct despite adequate relief of the obstruction within the right ventricular outflow tract. The objective of our study was to review the risk factors for stenting of the patent arterial duct, or construction of a Blalock-Taussig shunt, in the patients with pulmonary atresia and an intact ventricular septum who remain duct-dependent following radiofrequency valvotomy and dilation of the imperforate pulmonary valve. We reviewed the data from 53 patients seen between November 1995 and December 2001. Of the 47 patients who survived, 6 required stenting of the patent arterial duct, while 4 needed construction of a modified Blalock-Taussig shunt to augment the flow of blood to the lungs at a mean of 7 plus or minus 5.7 days following the initial intervention. The remaining 37 patients required no additional procedures. We compared the findings in these two groups. The mean diameter of the tricuspid valve in the patients requiring early reintervention was 8.5 plus or minus 3.7 millimetres, giving a Z-score of -1.1 plus or minus 1.47, whilst those in the group without early reintervention had values of 10.7 plus or minus 2.2 millimetres, giving a Z-score of -0.58 plus or minus 1.18 (p equal to 0.003). No statistically significant differences were found in right ventricular morphology, McGoon ratio, or residual obstruction across the right ventricular outflow tract after decompression of the right ventricle. The diameter of the tricuspid valve, therefore, appears to be the only factor predicting the need for augmentation of flow of blood to the lungs. As just over one-fifth of our survivors required such augmentation, we hypothesize that stenting of the patent arterial duct may be performed as an integral part of primary transcatheter therapy in patients with pulmonary atresia and intact ventricular septum who have moderate right ventricular hypoplasia and a small tricuspid valve.

Original languageEnglish
Pages (from-to)141-147
Number of pages7
JournalCardiology in the Young
Volume15
Issue number2
DOIs
Publication statusPublished - Apr 2005
Externally publishedYes

Fingerprint

Lung
Tricuspid Valve
Blalock-Taussig Procedure
Ventricular Outflow Obstruction
Pulmonary Valve
Pituitary Gland
Decompression
Pulmonary Atresia with Intact Ventricular Septum
Heart Ventricles
Survivors
Dilatation
Therapeutics

Keywords

  • Duct-dependent circulation
  • Patent arterial duct
  • Radiofrequency valvotomy
  • Right ventricular hypoplasia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pediatrics, Perinatology, and Child Health

Cite this

Risk factors for augmentation of the flow of blood to the lungs in pulmonary atresia with intact ventricular septum after radiofrequency valvotomy. / Alwi, Mazeni; Kandavello, Geetha; Choo, Kok Kuan; Shri Abd. Aziz, Bilkis Banu; Samion, Hasri; Latiff, Haifa A.

In: Cardiology in the Young, Vol. 15, No. 2, 04.2005, p. 141-147.

Research output: Contribution to journalArticle

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