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Ann Thorac Surg 2009;88:688-689. doi:10.1016/j.athoracsur.2008.11.063
© 2009 The Society of Thoracic Surgeons
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How To Do It

Hybrid Ventricular Decompression in Pulmonary Atresia With Intact Septum

Redmond P. Burke, MDa,*, Robert L. Hannan, MDa, Jennifer A. Zabinsky, MEnga, Christopher F. Tirotta, MDb, Evan M. Zahn, MDc

a Department of Cardiovascular Surgery, Miami Children's Hospital, The Congenital Heart Institute at Miami Children's Hospital, Miami, Florida
b Department of Anesthesiology, Miami Children's Hospital, The Congenital Heart Institute at Miami Children's Hospital, Miami, Florida
c Department of Cardiology, Miami Children's Hospital, The Congenital Heart Institute at Miami Children's Hospital, Miami, and Arnold Palmer Hospital for Children, Orlando, Florida

Accepted for publication November 26, 2008.

* Address correspondence to Dr Burke, Miami Children's Hospital, Division of Cardiovascular Surgery, 3100 SW 62nd Ave, Miami, FL 33155 (Email: redmond111{at}aol.com).

Initial palliation for pulmonary atresia with intact ventricular septum continues to evolve in the face of significant early and late morbidity. In patients with suitable anatomy, decompression of the right ventricle may be the first step in treatment. A hybrid approach to right ventricular decompression, combining surgery and interventional catheterization techniques is described. Direct access to the right ventricle through a subxiphoid incision with transventricular sheath placement is used to provide optimum catheter position for radiofrequency perforation of membranous pulmonary atresia followed by balloon dilation. The technique may address key limitations of the traditional surgical and interventional approaches.






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