[Perforation-dilatation of pulmonary atresia with intact interventricular septum in neonates and infants].

Sixteen children (14 neonates less than 1 week old and 2 infants aged 3 and 6 months) had a "favorable" type of pulmonary atresia with an intact interventricular septum in which the hypoplasia of the right ventricle was mild and the cavity tripartite with a well developed infundibulum arriving in contact with a good-sized pulmonary artery from which it was separated by a totally or almost totally imperforate dome. They underwent a procedure associating an infusion of prostaglandin. E1 and an attempted pulmonary valve disobliteration by interventional catheterisation: needle puncture followed by balloon dilatation. There were 4 failed procedures (impossible puncture or dilatation), only one of which in the last 10 cases. The outcome of the 12 primary successes was related to the rapidity of recovery of right ventricular diastolic function: 7 patients were cured within a few days or weeks with prostaglandin therapy: 5 children required surgical anastomosis with a longer recovery period--3 cures but 2 deaths. Overall, there were two myocardial effractions without serious complications and 1 enterocolitis which was long-lasting but eventually cured. Two mild residual stenoses were redilated. In conclusion, the puncture-dilatation technique may be used instead of surgical valvectomy in favorable forms of pulmonary atresia with intact septum in the neonate. With experience, it was possible to remove the obstruction in 9 out of 10 cases with a minimum of complications. It is the compulsory first stage to complete cure, the probability and rapidity of which depend on recovery of right ventricular compliance.