Year : 2017  |  Volume : 10  |  Issue : 3  |  Page : 304--305

Central perforation of atretic pulmonary valve using coronary microcatheter


Saurabh Kumar Gupta, Rajnish Juneja, Anita Saxena 
 Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India

Correspondence Address:
Rajnish Juneja
Cardio-Thoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi - 110 029
India

Abstract

Percutaneous perforation of pulmonary valve, using 0.014” guidewires meant for coronary artery chronic total occlusion (CTO), is increasingly being performed for select cases of pulmonary atresia with intact ventricular septum (PA-IVS). Despite growing experience, procedural failures and complications are not uncommon. Even in infants treated successfully, the orifice created in the atretic pulmonary valve is eccentric. In this report, we present usefulness of coronary microcatheter in alignment of perforating coronary guidewire to the center of atretic pulmonary valve resulting in central perforation.



How to cite this article:
Gupta SK, Juneja R, Saxena A. Central perforation of atretic pulmonary valve using coronary microcatheter.Ann Pediatr Card 2017;10:304-305


How to cite this URL:
Gupta SK, Juneja R, Saxena A. Central perforation of atretic pulmonary valve using coronary microcatheter. Ann Pediatr Card [serial online] 2017 [cited 2022 May 21 ];10:304-305
Available from: https://www.annalspc.com/text.asp?2017/10/3/304/213372


Full Text



 Case Summary



Percutaneous perforation of pulmonary valve, using 0.014” guidewires meant for coronary artery chronic total occlusion (CTO), is increasingly being performed for select cases of pulmonary atresia with intact ventricular septum (PA-IVS).[1],[2],[3] Technically, owing to a short segment of atresia, well-defined atretic pulmonary valve, a predictable distal vascular bed, pulmonary arteries, and a patent ductus arteriosus, PA-IVS is equivalent to a “simple CTO.” In the majority, however, the catheter remains noncoaxial and uncomfortably away from pulmonary valve resulting in failures [1],[2] and complications.[3] Movement of coronary guidewire further destabilizes the catheter and even when the perforation is successful, the orifice created is eccentric.[4]

A 5-month-old male infant with membranous PA-IVS was scheduled for percutaneous perforation of pulmonary valve. Multiple catheters failed to achieve coaxial position [Figure 1]a and prohibited attempt to perforate pulmonary valve. A 2.6 Fr Finecross MG coronary microcatheter (Terumo Corporation, Japan) was then used to bridge the gap between 5 Fr Judkins right coronary catheter and pulmonary valve [Figure 1]b and Online [Video 1]. The radiopaque marker at the tip of microcatheter allowed its manipulation and positioning to the center of pulmonary valve. An otherwise well-formed pulmonary valve with clear center helped in positioning of microcatheter [Figure 1]b. After ascertaining central engagement of microcatheter by test angiograms through the catheter, Conquest Pro (Asahi Intecc, Japan) guidewire was advanced within the microcatheter and pulmonary valve was perforated exactly at the center [Figure 1]c, [Figure 1]d and Online [Video 2], [Video 3]. The microcatheter was then kept in the left pulmonary artery, and guidewire was changed to a nonpenetrating coronary guidewire. Subsequently, successful pulmonary valve balloon dilatation was achieved as per standard technique [Online [Video 4]. Echocardiography showed flow through the center of pulmonary valve with normal leaflet motion and trivial pulmonary regurgitation.{Figure 1}

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This report highlights the usefulness of microcatheter in perforating an atretic pulmonary valve. We hypothesize that the microcatheter allows engagement to the center of pulmonary valve, possibly the weakest area, and facilitates central perforation by 0.014” coronary guidewire. Arguably, this central perforation of valve is expected to preserve valve function with much lower risk of progressive pulmonary regurgitation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Alwi M, Budi RR, Mood MC, Leong MC, Samion H. Pulmonary atresia with intact septum: The use of Conquest Pro coronary guidewire for perforation of atretic valve and subsequent interventions. Cardiol Young 2013;23:197-202.
2Patil NC, Saxena A, Gupta SK, Juneja R, Mishra S, Ramakrishnan S, et al. Perforating the atretic pulmonary valve with CTO hardware: Technical aspects. Catheter Cardiovasc Interv 2016;88:E145-50.
3Bakhru S, Marathe S, Saxena M, Verma S, Saileela R, Dash TK, et al. Transcatheter pulmonary valve perforation using chronic total occlusion wire in pulmonary atresia with intact ventricular septum. Ann Pediatr Cardiol 2017;10:5-10.
4Abrams DJ, Rigby ML, Daubeney PE. Images in cardiovascular medicine. Membranous pulmonary atresia treated by radiofrequency-assisted balloon pulmonary valvotomy. Circulation 2003;107:e98-9.