RF Perforation and balloon valvuloplasty in PA-VSD as palliation

Catheter Cardiovasc Interv 2007;69:1015-20
Walsh,M. et al. (Toronto)

A report of 8 cases (5 newborns) between 2000-2006.
RF was successful in 6 of 8 babies.
RF perforation was to be the first of 2 interventions. Second being surgical repair.
Procedure: 4 or 5 Fr sheath. JR 2 or 2.5 catheter placed perpendicular to pulmonary valve plane (LAO, cranial 10 deg & Straight lateral).
RF wire: First 3 cases - 0.018 wire (PA 120, Opsyka), last 5 (0.024 Baylis wire)
Energy applied: 3-10 W x 2-5 sec.
Once through, RF wire is exchanged to 0.038 Baylis coaxial catheter, 0.014 Wisdom coronary wire was placed.
Balloons: 2.5 - 3.5 coronary balloons. Then, upto 5 or 6 mm coronary balloons (20% more than diameter of RVOT)
RVgram...further balloon or stent performed depending on result. Stent placed in 1.
Complication: Inadvertent RVOT perforation (4 out of 8)!

Other references:
1. Kuhn MA et al. Valve perforation and balloon pulmonary valvuloplasty in an infant with TOF-PA. Catheter Cardiovasc Diagn 1997;40:403-6.
2. Housdorf, G. et al. RF-assisted "reconstruction of the RVOT in muscular PA-VSD. Br Heart J 1993;69:343-6.
3. Hausdorf, G. et al. Catheter creation of an open outflow tract in previously atretic RVOT associated with VSD. Am J Cardiol 1993;72:354-6.
4. Pagani FD, Cheatham JP, Beekman RH III, et al. Management strategy of TOF-PA and dimunitive pulmonary arteries. JTCVS 1995;110:1521-32.
5. Kreutzer J, Perry SB, Jonas RA, et al. TOF with dimunitive pulmonary arteries: Preoperative pulmonary valve dilation and transcatheter rehabilitation of pulmonary arteries. JACC 1996;27:1741-7.