Skip to main content
Log in

The Use of Chronic Total Occlusion (CTO) Wires for Perforation of Atretic Pulmonary Valve; Two Centers Experience

  • Original Article
  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

Abstract

Pulmonary valve atresia with intact ventricular septum (PA-IVS) can be treated either surgically or transcatheterly for eligible patients. Perforation of pulmonary valves using chronic total occlusion (CTO) guidewires has been reported as an alternative to radiofrequency (RF) perforation. We sought to report our experience with CTO guidewires for perforation of atretic pulmonary valves and subsequent balloon dilatation (with or without patent ductus arteriosus stenting) in patients with PA-IVS from two centers. A retrospective study was carried out on PA-IVS patients who underwent intervention between March 2014 and September 2019, in which CTO guidewire was employed for pulmonary valve perforation. A total of 26 patients were identified. The median age and weight of the patients were 5.2 days (range 1–21 days) and 3.1 kg (range 2.2–3.8 kg), respectively. All patients were situs solitus, except one patient with left atrial isomerism. The right ventricle (RV) morphology was bipartite in 22/26 patients and tripartite in 4/26 patients. Before the procedure, the mean saturation was 76% (range 70–86%) while the patients were under prostaglandin infusion. The pulmonary valve perforation attempt was performed with the Asahi Conquest Pro 9 CTO wire (n = 6) or Asahi Pro 12 CTO wire (n = 18) and/or Asahi Miracle CTO wire (n = 2). The procedure was successful in 20/26 (77%) patients using CTO wires. We analyzed the efficiency of CTO wire based on the subtypes: Conquest Pro 9 in 6/6 (100%) patients, Conquest Pro 12 in 12/18 (67%) patients, and Miracle in 2/2 (100%) patients. Before CTO wire usage in 3 patients, radiofrequency (RF) perforation was unsuccessful. Among these 3 patients, pulmonary valve perforation was successful in 2 patients with CTO wire; hence, in the remaining patient, perforation was also unsuccessful with CTO wire. After CTO wire perforation was unsuccessful in 6 patients, RF perforation was attempted in 3 patients (2 successful attempts and 1 unsuccessful attempts), and one patient as referred to surgery. Desaturation was persistent in 19 cases, which necessitated ductus arteriosus stenting. Early procedural complication was observed in 3/26 (11%) patients. Two of these patients had vascular complications due to the sheath, which was treated with heparin infusion and streptokinase, and the remaining patient had sudden bradycardia and cardiac arrest during the procedure and did not respond to cardiac resuscitation. CTO wires should be keep in mind for atretic pulmonary valve perforation as a first choice or when RF perforation is unsuccessful.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Cheung EW, Richmond ME, Turner ME, Bacha EA, Torres AJ (2014) Pulmonary atresia/intact ventricular septum: influence of coronary anatomy on single-ventricle outcome. Ann Thorac Surg 98:1371–1377

    Article  Google Scholar 

  2. Guleserian KJ, Armsby LB, Thiagarajan RR, del Nido PJ, Mayer JE Jr (2006) Natural history of pulmonary atresia with intact ventricular septum and right-ventricle-dependent coronary circulation managed by the single-ventricle approach. Ann Thorac Surg 81:2250–2258

    Article  Google Scholar 

  3. Chen RHS, Chau AKT, Chow PC, Yung TC, Cheung YF, Lun KS (2018) Achieving biventricular circulation in patients with moderate hypoplastic right ventricle in pulmonary atresia intact ventricular septum after transcatheter pulmonary valve perforation. Congenit Heart Dis 13(6):884–891

    Article  Google Scholar 

  4. Qureshi SA (2006) Catheterization in neonates with pulmonary atresia with intact ventricular septum. Catheter Cardiovasc Interv 67:924–931

    Article  Google Scholar 

  5. Kim YH (2015) Pulmonary valvotomy with echocardiographic guidance in neonates with pulmonary atresia and intact ventricular septum. Catheter Cardiovasc Interv 85(4):E123–E128

    Article  Google Scholar 

  6. El Saiedi SA, Attia WA, Abd El-Aziz OM, Lotfy WN, Abd El-Rahim AM, Hassanein H, Qureshı S (2017) A perforation procedure for pulmonary atresia with intact ventricular septum: Egyptian experience and adaptations. Herz 43(7):633–641

    Article  Google Scholar 

  7. Alwi M, Budi RR, Mood MC, Leong MC, Samion H (2013) Pulmonary atresia with intact septum: the use of Conquest Pro coronary guidewire for perforation of atretic valve and subsequent interventions. Cardiol Young 23(2):197–202

    Article  Google Scholar 

  8. Daubeney PE, Blackstone EH, Weintraub RG, Slavik Z, Scanlon J, Webber SA (1999) Relationship of the dimension of cardiac structures to body size: an echocardiographic study in normal infants and children. Cardiol Young 9:402–410

    Article  CAS  Google Scholar 

  9. Hanley FL, Sade RM, Blackstone EH, Kirklin JW, Freedom RM, Nanda NC (1993) Outcomes in neonatal pulmonary atresia with intact ventricular septum. A multiinstitutional study. J Thorac Cardiovasc Surg 105:406–427 (discussion 423–424)

    Article  CAS  Google Scholar 

  10. Bull C, de Leval MR, Mercanti C, Macartney FJ, Anderson RH (1982) Pulmonary atresia and intact ventricular septum: a revised classification. Circulation 66(2):266–272

    Article  CAS  Google Scholar 

  11. Burkholder H, Balaguru D (2012) Pulmonary atresia with intact ventricular septum: management options and decision- making. Pediatr Ther 01:1–7

    Article  Google Scholar 

  12. Yoshimura N, Yamaguchi M, Ohashi H, Oshima Y, Oka S, Yoshida M, Murakamı H, Tei T (2003) Pulmonary atresia with intact ventricular septum: strategy based on right ventricular morphology. J Thorac Cardiovasc Surg 126:1417–1426

    Article  Google Scholar 

  13. Rychik J, Levy H, Gaynor JW, DeCampli WM, Spray TL (1998) Outcome after operations for pulmonary atresia with intact ventricular septum. J Thorac Cardiovasc Surg 116:924–931

    Article  CAS  Google Scholar 

  14. Qureshi SA, Rosenthal E, Tynan M, Anjos R, Baker EJ (1991) Transcatheter laser-assisted balloon pulmonary valve dilation in pulmonic valve atresia. Am J Cardiol 67:428–431

    Article  CAS  Google Scholar 

  15. Parsons JM, Rees MR, Gibbs JL (1991) Percutaneous laser valvotomy with balloon dilatation of the pulmonary valve as primary treatment for pulmonary atresia. Br Heart J 66:36–38

    Article  CAS  Google Scholar 

  16. Latson LA (1991) Nonsurgical treatment of a neonate with pulmonary atresia and intact ventricular septum by transcatheter puncture and balloon dilation of the atretic valve membrane. Am J Cardiol 68:277–279

    Article  CAS  Google Scholar 

  17. Rosenthal E, Qureshi SA, Kakadekar AP, Anjos R, Baker EJ, Tynan M (1993) Technique of percutaneous laser-assisted valve dilatation for valvar atresia in congenital heart disease. Br Heart J 69:556–562

    Article  CAS  Google Scholar 

  18. Rosenthal E, Qureshi SA, Chan KC, Martın RP, Skehan DJ, Jordan SC, Tynan M (1993) Radiofrequency-assisted balloon dilatation in patients with pulmonary valve atresia and an intact ventricular septum. Br Heart J 69:347–351

    Article  CAS  Google Scholar 

  19. Tanidir IC, Öztürk E, Güzeltas A, Ödemis E (2014) Radiofrequency resistant pulmonary atresia with intact septum: the use of Conquest Pro 12 coronary guidewire. Turk Kardiyol Dern Ars 42:568–570

    Article  Google Scholar 

  20. Mıshra S (2016) Language of CTO interventions–focus on hardware. Indian Heart J 68(4):450–463

    Article  Google Scholar 

  21. Lefort B, Saint-Etienne C, Soulé N, Ma I, Dion F, Chantepie A (2019) Perforation of the atretic pulmonary valve using chronic total occlusion (CTO) wire and coronary microcatheter. Congenit Heart Dis 14(5):814–818

    Article  Google Scholar 

  22. Alwi M, Geetha K, Bilkis AA, Lim MK, Hasri S, Haifa AL, Sallehudin A, Zambaharı R (2000) Pulmonary atresia with intact ventricular septum percutaneous radiofrequency-assisted valvotomy and balloon dilation versus surgical valvotomy and blalock taussig shunt. J Am Coll Cardiol 35:468–476

    Article  CAS  Google Scholar 

  23. Rathgeber S, Auld B, Duncombe S, Hosking MC, Harris KC (2017) Outcomes of radiofrequency perforation for pulmonary atresia and intact ventricular septum: a single-centre experience. Pediatr Cardiol 38(1):170–175

    Article  Google Scholar 

  24. Bakhru S, Marathe S, Saxena M, Verma S, Saileela R, Dash TK, Koneti NR (2017) Transcatheter pulmonary valve perforation using chronic total occlusion wire in pulmonary atresia with intact ventricular septum. Ann Pediatr Cardiol 10(1):5–10

    Article  Google Scholar 

  25. Patil NC, Saxena A, Gupta SK, Juneja R, Mıshra S, Ramakrishnan S, Kotharı SS (2016) Perforating the atretic pulmonary valve with CTO hardware: technical aspects. Catheter Cardiovasc Interv 88(5):E145–E150

    Article  Google Scholar 

  26. Petit CJ, Qureshi AM, Glatz AC, Kelleman MS, McCracken CE, Ligon RA, Mozumdar N, Whiteside W, Khan A, Goldstein BH (2018) Technical factors are associated with complications and repeat intervention in neonates undergoing transcatheter right ventricular decompression for pulmonary atresia and intact ventricular septum: results from the congenital catheterisation research collaborative. Cardiol Young 28(8):1042–1049

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Hacer Kamalı.

Ethics declarations

Conflict of interest

There is no conflıct of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kamalı, H., Tanıdır, İ.C., Erdem, A. et al. The Use of Chronic Total Occlusion (CTO) Wires for Perforation of Atretic Pulmonary Valve; Two Centers Experience. Pediatr Cardiol 42, 1041–1048 (2021). https://doi.org/10.1007/s00246-021-02578-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00246-021-02578-1

Keywords

Navigation