@Article{chd.12812,
AUTHOR = {Bruno Lefort, Christophe Saint‐Etienne, Nathalie Soulé, Iris Ma, Fanny Dion, Alain Chantepie},
TITLE = {Perforation of the atretic pulmonary valve using chronic total occlusion (CTO) wire and coronary microcatheter},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {14},
YEAR = {2019},
NUMBER = {5},
PAGES = {814--818},
URL = {http://www.techscience.com/schd/v14n5/38849},
ISSN = {3071-1738},
ABSTRACT = {<b>Background and objective:</b> Chronic total occlusion (CTO) guidewire have been recently reported as an alternative to radiofrequency for perforating atretic pulmonary 
valve. Since procedure failures or perforation of the right ventricle still occurred with 
CTO, we tried to enhance the stability, steering, and pushability of the wire using a 
microcatheter in order to improve the safety and efficacy of the procedure.<br/>
<b>Methods:</b> We performed pulmonary valve perforation with CTO guidewire and microcatheter in five consecutive newborns with pulmonary atresia with intact ventricular septum (PA‐IVS) under fluoroscopic and echocardiographic control.<br/>
<b>Results:</b> The valve was easily perforated at the first attempt for all patients. After 
perforation, the microcatheter positioned in the main pulmonary artery allowed the 
exchange of the CTO guidewire for a more flexible wire, avoiding lesion and facilitating manipulation in the distal pulmonary branch arteries. The pulmonary valve was 
then dilated with balloons of increasing size as usually performed. We did not experience any procedural or early complications. Blalock‐Taussig shunt was performed in 2 
children because of a persistent cyanosis, 4 and 10 days after perforation.<br/>
<b>Conclusion:</b> The combined use of a CTO guide and a microcatheter appears to 
be a safe and reliable technique for perforating the pulmonary valve of newborns 
with PA‐IVS. Further procedures with this approach are needed to confirm this first 
experience.},
DOI = {10.1111/chd.12812}
}