Sterile vegetations in children with severe tetralogy of Fallot

1998 ◽  
Vol 8 (4) ◽  
pp. 440-442
Author(s):  
Antoinette M. Cilliers ◽  
Kathy M. Vanderdonck ◽  
Jan P. du Plessis ◽  
Stefanus L. Cronje ◽  
Solomon E. Levin
Keyword(s):  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Cardiac Catheterization ◽  
Surgical Repair ◽  
Infundibular Stenosis

AbstractThe finding of bland, sterile vegetations in children with severe tetralogy of Fallot is unexpected, and to our knowledge, has not been reported previously. Eight patients diagnosed with tetralogy between January 1993 and July 1997 had sterile vegetations proven by histological and microbiological evaluation, in their right ventricular outflow tracts. Four of these patients were experiencing severe hyper-cyanotic spells, and four had severely reduced effort tolerance at presentation. They all underwent cardiac catheterization and were submitted for surgical repair. At surgery, the vegetations were thought to be causing further narrowing of the already tight fibrotic infundibular stenosis. Two of these patients had evidence of damaged valves, without evidence of active endocarditis. Although initially sterile, these vegetations, may in some instances, become infected.

Tetralogy of Fallot: stent palliation or neonatal repair?

2021 ◽  
pp. 1-9
Author(s):  
Adeolu Banjoko ◽  
Golnoush Seyedzenouzi ◽  
James Ashton ◽  
Fatemeh Hedayat ◽  
Natalia N. Smith ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Surgical Repair ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Outflow Tract ◽  
Hospital Length Of Stay ◽  
Mortality And Morbidity

Abstract Surgical repair of Tetralogy of Fallot has excellent outcomes, with over 90% of patients alive at 30 years. The ideal time for surgical repair is between 3 and 11 months of age. However, the symptomatic neonate with Tetralogy of Fallot may require earlier intervention: either a palliative intervention (right ventricular outflow tract stent, ductal stent, balloon pulmonary valvuloplasty, or Blalock-Taussig shunt) followed by a surgical repair later on, or a complete surgical repair in the neonatal period. Indications for palliation include prematurity, complex anatomy, small pulmonary artery size, and comorbidities. Given that outcomes after right ventricular outflow tract stent palliation are particularly promising – there is low mortality and morbidity, and consistently increased oxygen saturations and increased pulmonary artery z-scores – it is now considered the first-line palliative option. Disadvantages of right ventricular outflow tract stenting include increased cardiopulmonary bypass time at later repair and the stent preventing pulmonary valve preservation. However, neonatal surgical repair is associated with increased short-term complications and hospital length of stay compared to staged repair. Both staged repair and primary repair appear to have similar long-term mortality and morbidity, but more evidence is needed assessing long-term outcomes for right ventricular outflow tract stent palliation patients.

scholarly journals The right ventricular myocardial systolic-to-diastolic duration ratio in children after surgical repair of Tetralogy of Fallot

2020 ◽  
Vol 128 (6) ◽  
pp. 1677-1683
Author(s):  
Wei Hui ◽  
Cameron Slorach ◽  
Susan Iori ◽  
Andreea Dragulescu ◽  
Luc Mertens ◽  
...  
Keyword(s):  
Oxygen Consumption ◽  
Cardiac Magnetic Resonance ◽  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Surgical Repair ◽  
Peak Oxygen Consumption ◽  
Myocardial Performance ◽  
Repaired Tetralogy Of Fallot ◽  
2D Strain ◽  
The Right

This is the first study to assess right ventricular myocardial performance using the systolic-to-diastolic duration ratio derived from 2D strain. Seventy-six children with repaired Tetralogy of Fallot were evaluated. Echocardiographic data were correlated with cardiac magnetic resonance and peak oxygen consumption during exercise. The results show the right ventricular myocardial systolic-to-diastolic duration ratio incorporates systolic and diastolic performance, electromechanical dyssynchrony, and postsystolic shortening and is associated with exercise capacity in repaired Tetralogy of Fallot.

scholarly journals Ventricular Tachycardia and Right Ventricular Fibrosis After Tetralogy of Fallot Surgical Repair

Circulation ◽  
2013 ◽  
Vol 128 (2) ◽  
pp. 185-187 ◽  
Author(s):  
Anisa Chaudhry ◽  
Robert W. Biederman ◽  
Roberto Candia ◽  
Sahadev Reddy ◽  
Ronald W. Williams ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Surgical Repair ◽  
Ventricular Fibrosis

Abstract 2345: Improving Outcomes in High Risk Tetralogy of Fallot Patients with Right Ventricular Outflow Tract Stenting

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Gaute Dohlen ◽  
Rajiv Chaturvedi ◽  
Lee N Benson ◽  
Deborah Fruitman ◽  
Akira Osawa ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Stent Implantation ◽  
Surgical Repair ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Outflow Tract ◽  
Group I ◽  
Surgical Data ◽  
Group Ii

Background: Symptomatic infants with tetralogy of Fallot (TOF) and hypoplastic pulmonary arteries have higher risk for primary surgical repair. In our institution, palliation with only balloon angioplasty of the right ventricular outflow tract (RVOT) and pulmonary valve has been inconsistent and short-lived. Objectives: To evaluate our experience with percutaneous transcatheter stent implantation in the RVOT in symptomatic TOF patients. Methods: Retrospective review at the Hospital for Sick Children in Toronto, Canada from 1994 until 2007 (Group I). Outcomes were compared with our institutional primary surgical repair patients (n = 44, Group II). Results: Ten stent procedures performed in 8 patients. Median age at first intervention was 22 days (range, 3 to 119). Median weight was 3.2 kg (2.1 to 4.1). Indication for intervention was desaturation below 70% or prostaglandin dependency. Two patients required a second stenting procedure for progressive RVOT obstruction at 67 and 122 days of life. There were no major procedural complications. Discharge post stent implantation occurred at a median of 4 days (1 to 12). Median number of days from initial stent implantation to next intervention was 108 days (44 to 315). Left and right pulmonary artery diameter Z-score increased from a median of −4.3 and −3.5 to −0.9 and −0.8 respectively before surgery. For Group I and II respectively, surgical data were: repair at median age of 142 days (44 to 413) compared to 24 days (5 to 112) (P<0.001), median weight at surgery 5.3 kg (4.0 to 9.3) and 3.2 kg (2.0 to 5.9) (P<0.001), median bypass time 99 minutes (66 to 127) and 118 minutes (54 to 264) (P=0.03), median ventilator days 4 (0 to 11) and 6 (1 to 97) (P=0.08), median days in intensive care unit was 5 (2 to 12) versus 8 (2 to 161) (P=0.09), time to discharge was 16 days (5 to 29) and 16 days (6 to 230) (P=0.35). There was no mortality in Group I and 2 late hospital deaths in Group II. Conclusion: Stenting of the RVOT in TOF patients safely and effectively palliated symptomatic patients. This promoted development of more favourable pre-operative conditions and translated to excellent surgical outcomes. This approach represents a powerful adjunct to the management armamentarium for this challenging patient population.

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