All issues > Volume 46(3); 2003

Original Article

J Korean Pediatr Soc. 2003;46(3):250-258. Published online March 15, 2003.

Medico-Surgical Cooperative Treatment of Pulmonary Atresia with Intact Ventricular Septum

Kyeong Sik KS Kim¹, Byeong Chul BC Kweon¹, Jong Kyun JK Lee¹, Jae Young JY Choi¹, Jun Hee JH Sul¹, Sung Kyu SK Lee¹, Young Whan YW Park², Bum Koo BK Cho²

¹Division of Pediatric Cardiology, Yonsei Cardiovascular Center, Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
²Division of Pediatric Cardiovascular Surgery, Yonsei Cardiovascular Center, Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea

Correspondence Jae Young JY Choi ,Email: cjy0122@yumc.yonsei.ac.kr

Abstract

Purpose
: The actual clinical examples of co-appliance of catheter intervention with surgical procedures in the treatment of pulmonary atresia with an intact ventricular septum(PA/IVS) which we have experienced in our institution are here shown, and the anatomical and hemodynamical profiles between each method is compared.
Methods
: Medical records of 33 patients with PA/IVS who underwent various treatment from January, 1995 to December, 2000 were reviewed for a retrograde study.
Results
: In three out of 10 patients who underwent percutaneous balloon pulmonary valvotomy (PPV), residual pulmonary stenosis were observed in their out patient department(OPD) follow-ups, eventually necessitatig balloon pulmonary valvuloplasty(BPV). One out of three patients exhibited deterioration of tricuspid regurgitation after BPV, requiring surgical tricuspid annuloplasty(TAP). Two out of the seven patients who received primarily surgical right ventricle outlet tract(RVOT) repair without any systemic-pulmonary shunt or intervention needed additional intervention employing cardiac catheterization after operation. Two patients received interventional catheterization before surgical RVOT repair. In five out of 11 cases of Fontan type operation, coil embolization of collateral circulation was done before total cavo-pulmonary connection(TCPC), and in three cases, interventional catheterization was needed after TCPC.
Conclusion
: Both medical and surgical treatment modalities are widely used in management of PA/IVS patients, and recent results prove that medico-surgical cooperative treatment is essential.

Keywords :Percutaneous pulmonary balloon valvotomy(PPV), Surgical RVOT repair, Total cavo- pulmonary connection(TCPC), Right ventricle dependent coronary circulation(RVDCC), Balloon pulmonary valvuloplasty(BPV)