Retrograde Transcatheter Perforation in Adult with Pulmonary Atresia and Single Ventricle: A Unique Case of Ventricular Outflow Tract Opening

Radiofrequency-assisted perforation and subsequent balloon dilatation technique is accepted for treating pulmonary stenosis and pulmonary atresia in patients with intact interventricular septum, but its high cost limits the widespread use. Perforation of the atretic pulmonary valve using the stiff end of a coronary wire seems to be an effective alternative to the radiofrequency perforation. We report on a 47-year-old man with a complex cardiopathy including a pulmonary valve atresia, who underwent a partial surgical repair. Due to high surgical risk, a completion could not be foreseen and a percutaneous retrograde perforation of the pulmonary valve was proposed. The perforation was managed by means of BMW wires with stiff tip from the right internal jugular vein because the femoral vein access was not accesible. Following three Armada balloon inflations, an Express stent was properly introduced to keep the ventricular outflow tract (VOT) open. We describe a successful unusual technique of atretic pulmonary valve percutaneous retrograde perforation that can be an efficient alternative when surgery or anterograde percutaneous access are not possible.