[Interventional high frequency perforation and enlargement of the outflow tract of pulmonary atresia].

In 18 patients with pulmonary atresia interventional perforation of the atresia was attempted using radiofrequency. All patients were referred for palliative surgery. The age ranged from 4 days to 19 years. After angiographic delineation of the relations between the right ventricular outflow tract and main pulmonary artery the tip of a radiofrequency perforation catheter (Cerablate-catheter, 2F, Osypka) was brought into contact with the atresia. The radiofrequency was applied in the unipolar fashion (radiofrequency-generator HAT 200, Osypka). Radiofrequency perforation was successfully performed in 14/18 patients, subsequent balloon dilatation was performed in 12 of these patients. In six patients with muscular atresia a Palmaz-stent was implanted into the right ventricular outflow tract. An inadvertent perforation of the right ventricular outflow tract occurred in three patients, of the pulmonary artery in two patients. However, these were tolerated without sequelae or clinical symptoms. The arterial oxygen saturation increased by 21%; in none of the patients was cardiac failure or pulmonary edema observed. Using the Cerablate-catheter even muscular atresias could be perforated. Implantation of a stent into the newly created right ventricular outflow tract results in a predictable communication between the right ventricle and the pulmonary artery. Although this interventional right ventricular outflow tract creation seems to be a promising new technique, experience is limited and there are no long-term results.