Aims. Pulmonary atresia with intact ventricular septum (PA/IVS) can be treated by catheter-based interventions and complemented by various surgical procedures. We aim to determine a long-term treatment strategy to enable patients to be surgery free, depending solely on percutaneous interventions. Methods and Results. We selected five patients from among a cohort of patients with PA/IVS treated at birth with radiofrequency perforation and dilatation of the pulmonary valve. Patients had reached a pulmonary valve annulus of 20 mm or larger on their biannual echocardiographic follow-up, with right ventricular dilatation. The findings, together with the right ventricular outflow tract and pulmonary arterial tree, were confirmed by multislice computerised tomography. Based on the angiographic size of the pulmonary valve annulus, all patients were successfully implanted with either Melody® or Edwards® pulmonary valves percutaneously, regardless of their small weights and ages. No complications were encountered. Conclusion. We managed to stretch the age and weight limitations for performing percutaneous pulmonary valve implantation (PPVI): interventions were attempted whenever a pulmonary annulus size of >20 mm was reached, which was rationalised by the prevention of progressive right ventricular outflow tract dilatation and accommodating valves between 24 and 26 mm, which is enough to sustain a normal pulmonary flow in adulthood.

中文翻译：

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肺动脉闭锁和完整室间隔的分期经皮处理：突破极限

目的。室间隔完整的肺动脉闭锁 (PA/IVS) 可以通过导管介入治疗，并辅以各种外科手术。我们的目标是确定一种长期治疗策略，使患者无需手术，仅依靠经皮介入治疗。方法和结果. 我们从出生时接受射频穿孔和肺动脉瓣扩张治疗的 PA/IVS 患者队列中选择了 5 名患者。患者在每两年一次的超声心动图随访中达到 20 毫米或更大的肺动脉瓣环，并伴有右心室扩张。这些发现连同右心室流出道和肺动脉树，通过多层计算机断层扫描得到证实。根据肺动脉瓣环的血管造影尺寸，所有患者都成功地经皮植入了 Melody® 或 Edwards® 肺动脉瓣，无论他们的体重和年龄如何。没有遇到并发症。结论. 我们设法延长了进行经皮肺动脉瓣植入术 (PPVI) 的年龄和体重限制：每当肺动脉瓣环尺寸达到 >20 mm 时就尝试进行干预，通过预防进行性右心室流出道扩张和调节瓣膜使其合理化在 24 到 26 毫米之间，足以维持成年期的正常肺流量。