Excimer laser ablation for valvular angioplasty in pulmonary atresia and intact ventricular septum.

Background And Objectives: The prognosis for infants with pulmonary atresia and intact ventricular septum (PA/IVS) is poor and they present a major management challenge. Mechanical penetration of the atretic pulmonary valve is an applicable option for decompression of the right ventricle and optimization of left ventricular function. The utilization of laser energy for debulking and vaporization of the atretic valve tissue is a relevant approach due to the potential for controlled, precise mode of energy distribution.

Study Design/patients And Methods: A 4-month-old female with PA/IVS whose failure to thrive was accompanied by critical hemodynamic abnormalities received successful percutaneous pulmonary valve plate ablation by a 0.9 mm pulsed-wave ultraviolet excimer laser catheter (308 nm wavelength, fluence 50 mJ/mm(2); 30 Hz). A "step-by-step" lasing technique was applied whereby the tip of the emitting laser catheter is advanced ahead of a guide wire that serves mainly as support for positioning of that catheter.

Results: Adequate penetration of the atretic tissue enabled introduction of balloon dilations resulting in patency of the atretic valve, decompression of the right ventricle, improved right and left ventricular hemodynamics, and oxygenation. To further investigate the effect of excimer laser energy on atretic valvular tissue this laser was applied in a specimen of heart from an infant who died because of PA/IVS. Histopathologic examination of the irradiated tissue revealed no laser-induced injury to the pulmonary valve.

Conclusions: Thus, laser ablation and penetration of an atretic pulmonary valve is feasible and safe. The penetration of the atretic valve with the laser catheter enables subsequent introduction of various sizes balloon dilations. The application of available laser sources for treatment of congenital heart diseases is reviewed.