Pulmonary Valve Perforation

What is it? 

The  pulmonary valve is sometimes replaced by a membrane obstructing (stopping) the flow from the Right Ventricle (RV) to the pulmonary artery (PA). For these babies a source of pulmonary blood flow needs to be established. This requires one of the following:

 

• A shunt between the aortic branches and the pulmonary artery (example BT shunt).

• Stenting of the patent duct. 

• Perforation (making a hole) of the pulmonary valve in the cath lab followed by balloon dilation.

 

Pulmonary valve perforation is a relatively high risk procedure. A wire is used to make a hole and cross the membrane between the right ventricle and the pulmonary artery.  This needs to be very precise and the procedure requires expertise and experience.  Often the duct is stented in the same sitting.

 

Complications:

The procedure carries a risk of complications in the form of perforation (making a hole) of other nearby structures with the possibility of emergency cardiac surgery.

 

What happens next?

The baby is kept in the ICU post operatively, and is regularly monitored. When a satisfactory forward blood flow is documented with a good oxygen saturation which indicates a good pulmonary blood flow with good gas exchange, discharge may be planned with regular follow-up OPD visits. Eventually, there may be a need for additional surgical procedures in some patients.