Radiofrequency Perforation of the Pulmonary Valve in Patients with Pulmonary Atresia and Intact Ventricular Septum

Even though patients with the diagnosis of pulmonary atresia with intact ventricular septum (PA/IVS) and a single-ventricle pathway usually have a very poor longterm outcome, the outlook for those patients with a biventricular or a ‘one-and-a-half ventricle’ circulation is much better. Achieving antegrade pulmonary flow through perforation of the atretic pulmonary valve plate is an important treatment modality, not only to decompress the right ventricle (RV), but more importantly to serve as an incentive to facilitate further growth of an initially hypoplastic right ventricle.1 A variety of sharp instruments as well as laser-guided techniques have been used to perforate the atretic pulmonary valve. However, these techniques are often poorly controlled and associated with a risk of creating inadvertent injury to surrounding structures, often with disastrous results.As a result, the use of radio frequency (RF) energy was introduced into therapeutic cardiac catheterization in the early 1990s as an alternative to laser-guided perforation of the pulmonary valve plate.2Not all patients with PA/IVS are suitable candidates to be taken to the cardiac catheterization laboratory. A thorough echocardiographic assessment is required prior to the procedure and minimal requirements in most cases include the presence of a tripartite RV as well as a membranous atretic pulmonary valve with a well formed infundibulum.3