Balloon dilation of the right ventricular outflow tract in tetralogy of Fallot: a palliative procedure

1999 ◽  
Vol 9 (1) ◽  
pp. 11-16 ◽  
Author(s):  
Sameh M. Arab ◽  
Abdel-Fattah E. Kholeif ◽  
Salah R. Zaher ◽  
Aly M. Abdel-Mohsen ◽  
A. Samir Kassem ◽  
...  
Keyword(s):  
Tetralogy Of Fallot ◽  
Arterial Oxygen Saturation ◽  
Pulmonary Arteries ◽  
Balloon Dilation ◽  
Right Ventricular Outflow Tract ◽  
Outflow Tract ◽  
Arterial Oxygen ◽  
Palliative Procedure ◽  
The Mean ◽  
The Right

AbstractFifteen patients requiring palliation for tetralogy of Fallot were treated by balloon dilation because of hypercyanotic spells. The mean age at dilation was 1.9 ± 0.7 years (range 0.5 – 3), and the mean weight 9.8 ± 2.1kg (range 6.0 –13.5). Dilation of the outflow tract was combined with dilation of the left and/or right pulmonary arteries in 5 patients. Successful dilation was achieved in 12 patients (80%), but failed in 3 patients with hypoplastic pulmonary arteries. In one patient, the stenosis of the right pulmonary artery could not be dilated because of a very sharp angle at the site of the stenosis. Two of the 3 patients in whom the procedure failed died of severe cyanotic spells within 24 hours of the unsuccessful procedure. No major complications occurred during or after the procedure in the cases undergoing successful dilation. The arterial oxygen saturation increased significantly, from 71 ± 5.7% to 89 ± 3.9%, immediately after the procedure (p < 0.005). During a period of follow up of 6 ± 3.7 months (range 1 – 13), the procedure was repeated on 3 occasions, and successfully accomplished in 2 of these. In conclusion, balloon dilation is a satisfactory palliative procedure for tetralogy of Fallot in those units in which total correction is not performed under 2 to 3 years of age.

Efficacy and safety of balloon dilation as palliative treatment for tetralogy of Fallot

1994 ◽  
Vol 4 (3) ◽  
pp. 255-261 ◽  
Author(s):  
Gurleen K. Sharland ◽  
Shakeel A. Qureshi ◽  
Edmund J. Ladusans ◽  
Jonathon M. Parsons ◽  
Edward J. Baker ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
Tetralogy Of Fallot ◽  
Pulmonary Valve ◽  
Arterial Oxygen Saturation ◽  
Balloon Dilation ◽  
Right Ventricular Outflow Tract ◽  
Outflow Tract ◽  
Arterial Oxygen ◽  
The Mean ◽  
The Right

AbstractTwenty-six patients requiring palliation for the tetralogy of Fallot were treated by balloon dilation. The mean age at dilation was 8.5 months (range 0.5−20.6) and the mean weight 6.7 kg (range 2.6−10.7). Successful dilation was achieved in 25 patients. The mean ratio of the balloon to the diameter of the pulmonary outflow tract was 1.6 (range 1.2−2.0). The aortic oxygen saturation increased from mean±SD of 80±12.4% before to 91±4.3% after dilation (p<0.05). The pulmonary arterial oxygen saturation rose from 64±10.7% to 80±7.7% (p<0.05). Transient hypotension and arterial desaturation were noted in 19 patients during inflation of the balloon. One patient had a cardiac arrest prior to dilation and died afterwards. Seven patients had cyanotic spells related to the procedure. Attempts to cross the pulmonary valve resulted in infundibular perforation by the guide wire in one patient. Of the 24 survivors who initially had successful dilation procedures, three have needed a Blalock-Taussig shunt. Palliation without a shunt was achieved in the remaining 21 patients. In 12 patients, repeat angiography, 2.5−20 months (mean 9.1) after dilation, showed an increase in the diameter of the outflow tract from 7.1±2.1 mm before to 9.5±2.0 mm after dilation (p<0.05). Diameters of the pulmonary arteries increased from 6.3±2.2 mm on the right and 6.8±1.9 mm on the left before to 9.2±2.2 mm and 9.3±2.5 mm respectively after dilation (p<0.05 for both branches). Surgical correction has been achieved in 22 patients, 21 of these 2−22 months after balloon dilation and the other patient 20 months after construction of a shunt. At operation, the leaflets of the pulmonary valve were noted to be torn in five patients. In 12 patients, there was extensive scarring of the infundibulum. Balloon dilation of the right ventricular outflow tract achieves adequate palliation and may result in an increase in the diameter of the pulmonary valve and branches of the pulmonary trunk. It should be considered as an alternative to shunt procedures in children with tetralogy of Fallot.

Long-term results after palliative intra-cardiac repair for tetralogy of Fallot and diminutive pulmonary arteries

2019 ◽  
Vol 29 (8) ◽  
pp. 1036-1039
Author(s):  
Yoichi Kawahira ◽  
Kyoichi Nishigaki ◽  
Koji Kagisaki ◽  
Takuji Watanabe ◽  
Kazuki Tanimoto
Keyword(s):  
Right Ventricle ◽  
Tetralogy Of Fallot ◽  
Arterial Oxygen Saturation ◽  
Pulmonary Arteries ◽  
Systolic Pressure ◽  
Cardiac Repair ◽  
Long Term Results ◽  
Arterial Oxygen ◽  
The Right

AbstractBackground:In patients with tetralogy of Fallot with the diminutive pulmonary arteries, we sometimes have to give up the complete intra-cardiac repair due to insufficient growth of the pulmonary arteries. We have carried out palliative intra-cardiac repair using a fenestrated patch.Methods:Of all 202 patients with tetralogy of Fallot in our centre since 1996, five patients (2.5%) with the diminutive pulmonary arteries underwent palliative intra-cardiac repair using a fenestrated patch. Mean operative age was 1.8 years. Previous operation was Blalock–Taussig shunt in 4. At operation, the ventricular septal defect was closed using a fenestrated patch and the right ventricular outflow tract was enlarged. Follow-up period was 9.8 ± 2.6 years.Results:There were no operative and late deaths. Fenestration closed spontaneously on its own in four patients 2.7 ± 2.1 years after the intra-cardiac repair with a stable haemodynamics; however, the last patient with the smallest pulmonary artery index had supra-systemic pressure of the right ventricle post-operatively. The fenestration was emergently enlarged. Systemic arterial oxygen saturation was significantly and dramatically increased from 83.5 to 94% after the palliative intra-cardiac repair, and to 98% at the long term. A ratio of systolic pressure of the right ventricle to the left was significantly decreased to 0.76 ± 0.12 at the long term. Now all five patients were Ross classification class I.Conclusion:Although frequent catheter and surgical interventions were needed after the palliative intra-cardiac repair, this repair might be a choice improving quality of life with good results in patients with tetralogy of Fallot associated with the diminutive pulmonary arteries.

Single-stage correction, with extensive pulmonary arterial reconstruction, of a pulmonary arterial sling associated with tetralogy of Fallot

2009 ◽  
Vol 19 (5) ◽  
pp. 519-521 ◽  
Author(s):  
Onur S. Goksel ◽  
Emin Tireli ◽  
Ahmet Çelebi
Keyword(s):  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Pulmonary Arteries ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Outflow Tract ◽  
Single Stage ◽  
Arterial Reconstruction ◽  
Pulmonary Arterial ◽  
The Right

AbstractPulmonary arterial sling, rare in itself, is even rarer when associated with tetralogy of Fallot. Successful single-stage correction of this combination, with extensive pulmonary arterial reconstruction, has been reported only occasionally. We describe our experience with an 18 month-old girl, showing that extensive reconstruction of both the pulmonary arteries and the right ventricular outflow tract can permit single-stage correction in selected patients, resulting in favourable physiology and anatomy.

Repair of tetralogy of Fallot with pulmonary atresia in early infancy

1995 ◽  
Vol 5 (4) ◽  
pp. 326-330 ◽  
Author(s):  
Hideki Uemura ◽  
Toshikatsu Yagihara ◽  
Yasunaru Kawashima
Keyword(s):  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Primary Repair ◽  
Pulmonary Arteries ◽  
Pulmonary Atresia ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Outflow Tract ◽  
Early Infancy ◽  
The Right

AbstractBelieving early repair to offer major benefits, we have repaired tetralogy of Fallot with pulmonary atresia in five infants aged less than six months. The ventricular septal defect was closed via a right atriotomy. The right ventriculotomy was 30±3% of the right ventricular length. The posterior wall of the right ventricular outflow tract was created by anastomosing directly the pulmonary trunk to the right ventriculotomy, or either by interposition of the left atrial appendage or an autologous pericardia! flap. The pathway was then roofed over with an equine pericardia! patch. All patients survived and are now doing well from 18 to 41 (31±11) months after the repair, although one patient required reoperation for relief of stenosis at the site of an anastomosis between the pulmonary arteries and the interposed left appendage. In the other patients, postoperative sequential echocardiography has shown no obstruction in the right ventricular outflow tract, nor significant pulmonary or tricuspid regurgitation. We conclude that primary repair in early infancy is an excellent option for surgical treatment of tetralogy of Fallot with pulmonary atresia.

Palliative balloon valvoplasty of the pulmonary valve in tetralogy of Fallot

1999 ◽  
Vol 9 (1) ◽  
pp. 24-36 ◽  
Author(s):  
Ikram Massoud ◽  
Adel Imam ◽  
Ahmed Mabrouk ◽  
Nader Boutros ◽  
Ashraf Kassem ◽  
...  
Keyword(s):  
Tetralogy Of Fallot ◽  
Pulmonary Valve ◽  
Pulmonary Stenosis ◽  
Pulmonary Arteries ◽  
Balloon Dilation ◽  
Mean Value ◽  
Z Score ◽  
Before And After ◽  
The Mean ◽  
The Right

AbstractBalloon dilation of the pulmonary valve was performed in 54 patients with tetralogy of Fallot with severe cyanosis, high haematocrit and severe valvar pulmonary stenosis. Clinical, echocardiographic, angiographic, and haemodynamic data were analyzed before and after the procedure. After balloon dilation, the systemic oxygen saturation increased from a mean value of 66% to 85<%. The mean value of the haematocrit before dilation was 55 + 13, and decreased to 47 after dilation (p < 0.002) in 2 months follow-up. Balloon dilation increased the size of the pulmonary valvar orifice from a mean value of 9 + 5mm to 11.5 + 2mm (p < 0.005). The mean Z score of the pulmonary valves, which was -3 + 1.3 before dilation, increased to -1.1 + 1.1 immediately after the procedure (p < 0.05).The size of the right and left pulmonary arteries increased after dilation from 9mm to 10 mm, and from 8.7 + 2.4mm to 9.8 + 2.3mm, respectively (p <0.05). The comparable mean Z scores increased from -2.8 + 1.9 SD to -1.8 + 1.4 SD, and from -2.4 + 1.9 SD to -1.5 + 1.6 SD for the right and left branches, respectively (p < 0.05).In patients with stenosis at the bifurcation of the pulmonary trunk and hypoplasia of the left artery, successful dilation of the pulmonary valve lead to an increase of flow and improvement in size of the hypoplas-tic segment.In conclusion, initial balloon dilation of the pulmonary valve in tetralogy of Fallot resulted in increase of the Z score for the pulmonary valve and improved antegrade pulmonary blood flow, inducing growth of the pulmonary arteries and ameliorating the anatomic and physiologic preoperative condition.

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