Transcatheter Approach for Critical Pulmonary Stenosis or Pulmonary Atresia with Intact Ventricular Septum in Young Infants Using the Simmons Catheter

Abstract

Objectives and Background. The conventional process of percutaneous balloon pulmonary valvuloplasty for critical pulmonary stenosis (CPS) and pulmonary atresia with intact ventricular septum (PA/IVS) is challenging because of the difficulty in positioning the catheter stably into the right ventricular outflow tract (RVOT), especially in young infants with a hypertrophic right ventricle. In this study, we introduced a novel transcatheter approach with the Simmons catheter to reach the RVOT and compared its efficacy and safety with those of the approaches using a floating catheter and the Judkins right coronary catheter. Methods and Results. We retrospectively reviewed 52 young infants, 41 of whom had CPS and 11 had PA/IVS, in a single center from June 2009 to October 2017. Patients were divided into three groups according to the type of catheter used to enter through the RVOT. The unique structure of the Simmons catheter allowed it to be maneuvered directly into the RVOT within a few minutes. Compared with the other two groups, the Simmons catheter group had a significantly shorter fluoroscopy time entering through the RVOT (P<0.001) and a shorter total X-ray exposure time (P<0.001). Furthermore, compared with the floating catheter group, the success rate of surgery was much higher in the Simmons catheter group (P<0.001). Conclusions. The Simmons catheter is a safe and effective method to enter through the RVOT in infants with CPS or PA/IVS. Therefore, the Simmons catheter could be an alternative catheter when entering through the RVOT in young infants, especially neonates with low birth weight.