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.

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.

The current strategy of repair of tetralogy of Fallot in children and adults

2008 ◽  
Vol 18 (6) ◽  
pp. 608-614 ◽  
Author(s):  
Guo-Wei He ◽  
Xiao-Cheng Liu ◽  
Xiang-Rong Kong ◽  
Li-Xin Liu ◽  
Ying-Qun Yan ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Right Ventricular Function ◽  
Right Atrium ◽  
Pulmonary Valve ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Outflow Tract ◽  
Pulmonary Insufficiency ◽  
The Right

AbstractObjectivesThe strategies of repair of tetralogy of Fallot change with the age of patients. In children older than 4 years and adults, the optimal strategy may be to use different method of reconstruction of the right ventricular outflow tract from those followed in younger children, so as to avoid, or reduce, the pulmonary insufficiency that is increasingly known to compromise right ventricular function.MethodsFrom April, 2001, through May, 2008, we undertook complete repair in 312 patients, 180 male and 132 female, with a mean age of 11.3 years ±0.4 years, and a range from 4 to 48 years, with typical clinical and morphological features of tetralogy of Fallot, including 42 patients with the ventriculo-arterial connection of double outlet right ventricle. The operation was performed under moderate hypothermia using blood cardioplegia. The ventricular septal defect was closed with a Dacron patch. When it was considered necessary to resect the musculature within the right ventricular outflow tract, or perform pulmonary valvotomy, we sought to preserve the function of the pulmonary valve by protecting as far as possible the native leaflets, or creating a folded monocusp of autologous pericardium.ResultsThe repair was achieved completely through right atrium in 192, through the right ventricular outflow tract in 83, and through the right atrium, the outflow tract, and the pulmonary trunk in 36 patients. A transjunctional patch was inserted in 169 patients, non-valved in all but 9. There were no differences regarding the periods of aortic cross-clamping or cardiopulmonary bypass. Of the patients, 5 died (1.6%), with no influence noted for the transjunctional patch. Of those having a non-valved patch inserted, three-tenths had pulmonary regurgitation of various degree, while those having a valved patch had minimal pulmonary insufficiency and good right ventricular function postoperatively, this being maintained after follow-up of 8 to 24-months.ConclusionsBased on our experience, we suggest that the current strategy of repair of tetralogy of Fallot in older children and adults should be based on minimizing the insertion of transjunctional patches, this being indicated only in those with very small ventriculo-pulmonary junctions. If such a patch is necessary, then steps should be taken to preserve the function of the pulmonary valve.

Late replacement of the pulmonary valve: when and what type of valve?

2005 ◽  
Vol 15 (S1) ◽  
pp. 58-63 ◽  
Author(s):  
James A. Quintessenza ◽  
Jeffrey P. Jacobs ◽  
Paul J. Chai ◽  
Victor O. Morell ◽  
Jorge M. Giroud ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Pulmonary Valve ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Outflow Tract ◽  
Pulmonary Insufficiency ◽  
Operative Strategy ◽  
Surgical Options ◽  
The Right

After repair of tetralogy of Fallot, many patients present in need of reoperative surgical reconstruction of the right ventricular outflow tract. The predominant physiologic lesion is pulmonary insufficiency, but there may also be varying degrees of obstruction of the right ventricular outflow tract. In the past, it has been felt that patients tolerate pulmonary insufficiency reasonably well. In some patients, however, the long-term effects of pulmonary insufficiency and subsequent right ventricular dilation and dysfunction are associated with poor exercise tolerance and increased incidence of arrhythmias and sudden death.1,2 Numerous studies support replacement of the pulmonary valve as treatment for pulmonary insufficiency in order to improve performance, optimize hemodynamics, and better control arrhythmias.3–10 The indications for reconstruction of the right ventricular outflow tract in this setting, nonetheless, as well as the operative strategy, continue to evolve. There are multiple surgical options for replacement of the pulmonary valve for these patients, including aortic and pulmonary homografts, stented and stentless porcine valves, porcine valved conduits, bovine jugular venous conduits, and even mechanical valves and mechanical valved conduits.11–32 It was a less than ideal experience with these currently available options that stimulated our interest into employing alternative materials and techniques. Favorable experimental and clinical experience with valves made of a polytetrafluoroethylene monoleaflet33–36 encouraged us to consider a new method of reconstruction with this material, using a bifoliate polytetrafluoroethylene valve. In this work, we review our indications for replacement of the pulmonary valve after repair of tetralogy of Fallot, the surgical options available, and our experience reconstructing the right ventricular outflow tract with a new surgically created bifoliate polytetrafluoroethylene valve.

OXIMETER STUDIES IN NEWBORN INFANTS DURING CRYING

PEDIATRICS ◽  
1952 ◽  
Vol 9 (6) ◽  
pp. 756-763 ◽  
Author(s):  
KLARA J. PREC ◽  
DONALD E. CASSELS
Keyword(s):  
Oxygen Saturation ◽  
Arterial Oxygen Saturation ◽  
Pulmonary Ventilation ◽  
Newborn Infants ◽  
Arterial Oxygen ◽  
Direct Reading ◽  
Single Scale ◽  
The Mean ◽  
Alveolar Oxygen ◽  
The Right

The arterial oxygen saturation was determined in 135 healthy newborn infants during sleep and while crying with a direct reading single scale oximeter. In the first group, consisting of infants from one hour and 30 minutes to 3 days of age, 66% showed a decrease of oxygen saturation with crying, 27% an increase and 6.8% no change. In the second group, which includes all infants between 4 and 9 days of age, 59% showed an increase in saturation with crying, 21% a decrease and 22.4% no change. In comparison, the mean results in these two groups are in the opposite direction. These changes are statistically significant. Twenty-eight infants were studied also while breathing oxygen (73%-98.5%), and the results compared with those in room air were found to show an identical trend. It is concluded that increases in arterial oxygen saturation with crying, which occur most frequently in older infants, are probably due to an increase in alveolar oxygen tension secondary to improved pulmonary ventilation during crying. The paradoxic decrease in saturation during crying, which was found in a large percentage of infants of the younger group, is suggestive of the presence of a transitory venous-arterial shunt. This shunt could be either through atelectatic areas of the lung or through the foramen ovale, which is only functionally closed and can open whenever the pressure in the right auricle exceeds the left auricular pressure. There is some available evidence to support the latter possibility.

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.

Sign in / Sign up

Export Citation Format

Share Document