Peratrial Balloon Pulmonary Valvotomy in Infants: Right Ventricular Wall None-Touch Technique.

Peratrial balloon pulmonary valvotomy, an alternative technique for severe pulmonary valve stenosis (PVS) in infants, performed exclusively under transesophageal echocardiographic guidance, is hereby described. The technique is performed using a hollow probe through a right minithoracotomy in the fourth intercostal space. The hollow probe introduces a guidewire through the PVS without touching the right ventricular wall, therefore avoiding eliciting ventricular arrhythmias, spasm of the right ventricular outflow tract, and subsequent hemodynamic instability. Unlike conventional approaches, the peratrial technique permits quicker orientation and dilatation and allows quick conversion to open heart surgery when needed.

Percardiac closure of large apical ventricular septal defects in infants: Novel modifications and mid-term results.

BACKGROUND/AIM: Both open heart surgery and percutaneous approaches retain several limitations in closing large apical muscular ventricular septal defects (AmVSD) in infants. We present probe-assisted percardiac device closure (PDC), an exclusively transoesophageal-echocardiography guided technique, as an alternative with midterm results. METHODS: Thirty-six infants with large AmVSDs (single or multiple-holed) underwent PDC in our department. Mean AmVSD for single and multiple-holed measured 7.2 ± 2.4 mm and 6.3 ± 3.4 mm, respectively. Subjects presented with a spectrum of cardiopulmonary sequelae and growth retardation, either alone or combined. Some were ventilator dependent and re-do cases. In addition, AmVSDs were categorized: cylindrical, tunnel and cave-like shaped as per color Doppler interrogation. Pursuant to cardiac access and deployment technique, subjects were apportioned: group A; inferior median sternotomy (perventricular), B; right mini-thoracotomy (peratrial) and C; complete median sternotomy (perventricular). Under exclusive echocardiography, the Z- or J probe-assisted delivery system was utilized to access AmVSDs and implant device(s) via aforementioned techniques. RESULTS: Forty-two muscular ventricular septal devices (8.4 ± 2.6 mm) were implanted in 36 subjects uneventfully. Seventeen "complex," and 10 cylindrical or straight tunnel-shapedAmVSDs (including 2 re-do patients) suited perventricular and peratrial techniques respectively. Comparatively, group B exhibited shorter procedural indices than A (p < .01). Five of 15 multiple-holed AmVSDs (four Swiss cheese) required two or three devices for a satisfactory occlusion. Nevertheless, post occlusion insignificant residual shunts( ≤ 2 mm) seldom achieved spontaneous closure, and at 36-month follow-up complete closure was 67%. Residual shunt persisted amongst multiple-holed. All patients improved during follow up. CONCLUSION: PDC is feasible, safe and effective alternative technique for AmVSD in infants.