Pediatric Cardiology and Cardiac Surgery
Vol.26 No.5 2010 (368-374)
Kenichi Hayashi,1, 2) Seiyo Yasui,2)Kaori Sekine,2)Ari Iwaoka,2) Daiki Miyata,2) Sadamitsu Yanagi,2)Hideaki Ueda,2) and Toshihide Aso3)
1)Department of Pediatrics, Yokosuka General Hospital Uwamachi, Kanagawa, Japan, 2)Department of Cardiology and 3)Department of Cardiovascular Surgery, Kanagawa Children’s Medical Center, Kanagawa, Japan
Abstract
Background: To achieve biventricular circulation (BVC) in patients with pulmonary atresia with intact ventricular septum (PAIVS), various additional treatments are performed for right ventricular growth after a pulmonary valvotomy is performed as an initial procedure.
Subjects and Method: Eight patients with PAIVS received strategic additional balloon pulmonary valvuloplasty (aBPV) to achieve BVC after surgical or catheter valvotomy of the atretic valve.
Results: The follow-up period was 9.6±4.3 years. The eight patients received a total of 14 aBPVs. The median time for the first aBPV in each patient was the 36th day (range: 14th to 302nd day) after the pulmonary valvotomy. An aBPV was performed an average of 1.8±1.2 times (maximum: 4) in each patient. In three patients who received aBPVs more than twice, all were finished within one year after the first aBPV. The right ventricular end-diastolic volume (% of normal) was an average of 56.0±18.5 (minimum: 33.2) before the pulmonary valvotomy, but was normalized with an average of 93.6±15.0 at the time of the last evaluation using angiography. All eight patients achieved complete BVC. Two patients underwent additional surgical intervention at the age of more than 1 year.
Conclusions: A therapeutic strategy that involves aBPV in the early clinical stage for patients with PAIVS is useful to achieve BVC.