Peratrial Balloon Pulmonary Valvotomy in Infants: Right Ventricular Wall None-Touch Technique.

Peratrial balloon pulmonary valvotomy, an alternative technique for severe pulmonary valve stenosis (PVS) in infants, performed exclusively under transesophageal echocardiographic guidance, is hereby described. The technique is performed using a hollow probe through a right minithoracotomy in the fourth intercostal space. The hollow probe introduces a guidewire through the PVS without touching the right ventricular wall, therefore avoiding eliciting ventricular arrhythmias, spasm of the right ventricular outflow tract, and subsequent hemodynamic instability. Unlike conventional approaches, the peratrial technique permits quicker orientation and dilatation and allows quick conversion to open heart surgery when needed.