@Article{chd.12552,
AUTHOR = {David Aurigemma, John W. Moore, Gabrielle Vaughn, Nasser Moiduddin, Howaida G. El-Said},
TITLE = {Perforation and right ventricular outflow tract stenting: Alternative palliation for infants with pulmonary atresia/ventricular septal defect},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {13},
YEAR = {2018},
NUMBER = {2},
PAGES = {226--231},
URL = {http://www.techscience.com/schd/v13n2/38961},
ISSN = {3071-1738},
ABSTRACT = {<b>Background:</b> Right ventricular outflow tract (RVOT) stents have been used as palliation in patients
with severe tetralogy of Fallot (TOF). Radiofrequency perforation of the RVOT has also been
described in patients with pulmonary atresia (PA)/ventricular septal defect (VSD). However, RVOT
stenting in conjunction with radiofrequency perforation as a means for establishing reliable pulmonary blood flow in patients with PA/VSD has not previously been reported.<br/>
<b>Objectives:</b> Our aim is to report our experience with using perforation of plate-like pulmonary
valve atresia combined with stenting of RVOT as an alternative and equally efficacious intervention for infants with PA/VSD, as compared to a surgical pulmonary artery shunt (SPS).<br/>
<b>Methods:</b> A retrospective review of patients with PA/VSD at our institution from Jan 2006 to
October 2015 was performed.<br/>
<b>Results:</b> Twenty-seven patients received palliation for PA/VSD. Five (median 2.5 kg, 2.1-4.1 kg)
underwent RVOT stenting and 22 (3.5 kg, 2.1-4.6 kg) underwent surgical SPS. Of the patients who
received an RVOT stent, 3 underwent guidewire perforation and balloon dilation of the plate-like
pulmonary valve, and 2 underwent radiofrequency perforation of the pulmonary plate, followed by
balloon dilation. Postprocedure saturations averaged 93% in the stent group and 89% in the shunt
group. One of the patients who underwent RVOT stenting required additional stenting of the PDA
for isolation of the LPA, but none required re-intervention. Four patients in the SPS cohort
required re-intervention (18%). Two required stenting of the shunt, and 2 required surgical revision
of the shunt. There was one death in the stent group, however this was secondary to withdrawal
of support given an underlying genetic diagnosis (trisomy 13). There was one fatality in the SPS
cohort prior to hospital discharge.<br/>
<b>Conclusions:</b> Perforation followed by RVOT stenting may be a safe and effective alternative to
surgical SPS in infants with PA/VSD.},
DOI = {10.1111/chd.12552}
}