Trans-Collateral Retrograde Perforation of the RVOT in Pulmonary Atresia/Ventricular Septal Defect: A Feasible
Sherien Abdelsalam1, Osama Abdelaziz1,2, Hosam Ibrahim1,2
1Pediatric Cardiology Department, Al Nas Hospital, Cairo, Egypt (S.A., O.A., H.I., A.Y., E.A., N.E.-F., A.L.).
Circulation. Cardiovascular Interventions
|February 5, 2026
Summary
This study shows that retrograde trans-collateral right ventricular outflow tract perforation is a safe and effective treatment for pulmonary atresia with ventricular septal defect. This minimally invasive approach improves pulmonary artery growth and oxygen saturation in patients with major aortopulmonary collateral arteries.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Interventional Cardiology
Background:
- Pulmonary atresia with ventricular septal defect (PA/VSD) is a complex congenital heart defect.
- Major aortopulmonary collateral arteries (MAPCAs) often supply pulmonary blood flow exclusively in PA/VSD.
- Traditional surgical repair can be challenging in MAPCAs-dependent PA/VSD, especially in resource-limited settings.
Purpose of the Study:
- To evaluate the feasibility, safety, and outcomes of retrograde trans-collateral right ventricular outflow tract (RVOT) perforation.
- To assess the effectiveness of this approach in patients with PA/VSD and MAPCAs-dependent pulmonary circulation.
Main Methods:
- A cohort of 10 patients with PA/VSD and MAPCAs-dependent pulmonary circulation underwent attempted retrograde trans-collateral RVOT perforation.
- The procedure involved accessing the RVOT via MAPCAs using a retrograde approach.
- One procedure was unsuccessful, and data were collected from October 2021 to February 2025.
Main Results:
- Systemic oxygen saturation significantly improved post-procedure (P<0.01).
- Significant growth of central pulmonary arteries was observed, with improved right and left pulmonary artery Z-scores (P<0.01).
- The Nakata index significantly increased from a median of 49 to 111.7 mm²/m² (P<0.01).
Conclusions:
- Retrograde trans-collateral RVOT perforation is a feasible and safe catheter-based strategy for selected PA/VSD patients.
- This technique promotes central pulmonary artery growth.
- It serves as a potential bridge to future surgical repair in complex PA/VSD cases.
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