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Transventricular valvotomy for pulmonary atresia with intact ventricular septum in neonates: a single-centre experience in mid-term follow-up.

OBJECTIVES
Transventricular valvotomy is a kind of hybrid therapy that is widely used in developing countries where cardiac catheter intervention is limited in neonates. The purpose of this study was to evaluate the surgical outcomes and effectiveness of transventricular valvotomy in neonates with pulmonary atresia and an intact ventricular septum.


METHODS
Between August 2008 and July 2013, 22 neonates with pulmonary atresia and an intact ventricular septum underwent transventricular valvotomy at our institution. The mean age and weight at initial palliation were 14.3±5.2 days (range 1-24 days) and 3.3±0.6 kg (range 2.5-3.8 kg), respectively. The mean tricuspid valve Z-score was -1.7±1.09 (range -3.5 to -0.2). All patients presented with membranous atresia and no evidence of Ebstein's malformation or right ventricle-dependent coronary circulation.


RESULTS
There were two hospital deaths and no late deaths. Postoperative echocardiography showed that the gradient over the open pulmonary valve was 26.7±5.4 mmHg (range 20-32 mmHg). Patients who received patent ductus arteriosus ligation and were treated with a modified Blalock-Taussig shunt experienced a shorter intensive care unit stay than those without patent ductus arteriosus ligation (P=0.004). The median follow-up time was 32.5 months (range 6-60 months). The freedom from reoperation was 85, 78.9, 56.5% at 6 months, 1 and 5 years, respectively. Fourteen patients underwent definitive repair, 10 underwent biventricular repair, and four received one and one-half ventricle repair.


CONCLUSIONS
Transventricular valvotomy can be used successfully as an easy and safe alternative to right ventricular decompression. Furthermore, we note that oxygen saturation is a valuable indicator in determining whether a modified Blalock-Taussig shunt should be performed or not.