Stenting of the Right Ventricular Outflow Tract in the High-risk Infant with Cyanotic Teratology of Fallot

Overview

Journal Pediatr Cardiol

Specialties Cardiology & Vascular Diseases
Pediatrics

Date 2013 Oct 8

PMID 24096718

Citations 9

Authors

Chesney D Castleberry

Todd M Gudausky

Stuart Berger

James S Tweddell

Andrew N Pelech

Affiliations

Soon will be listed here.

Abstract

Neonatal tetralogy of Fallot (TOF) repair carries an increased risk of low birthweight or premature infants. Studies are investigating stents in the right ventricular outflow tract (RVOT) as an alternative to aortopulmonary shunts. The authors review their institutional experience with RVOT stenting in the high-risk infant with TOF. Data on sequential patients who received RVOT stents were reviewed, with collection of their surgical, echocardiographic, and catheterization data. Size-matched control subjects were identified and outcomes compared. Six infants went to the catheterization lab for RVOT stenting from 2008 to 2010. Five of these patients had placement of an RVOT stent after balloon dilation. The median saturations were 71% on 48% fraction of inspired oxygen (FiO2), with improvement to 94% (p < 0.001) on 39% FiO2 24 h after stent placement. As shown by echocardiography, the diameter of the median right pulmonary artery (RPA) was 2.6 mm (z-score, -3.3), and the diameter of the left pulmonary artery (LPA) was 2.0 mm (z-score, -4.5). Repeat echocardiography before surgery showed a statistically significant increase in RPA and LPA size as well as a modified McGoon ratio (p < 0.05). Four of the five patients subsequently underwent TOF repair. No stent fractures occurred. One patient had repair 10 days after stent placement secondary to stent malposition and tricuspid valve injury. The authors' experience with stents in the RVOT of TOF patients has yielded good results, with significant improvement in oxygen saturations. Patients had successful elective surgical repair and stent removal without longer cardiopulmonary bypass times or recognizable complications compared with shunted patients.

Citing Articles

Right ventricular outflow tract stenting for late presenter unrepaired Fallot physiology: a single-center experience.

Prakoso R, Kurniawati Y, Siagian S, Sembiring A, Sakti D, Mendel B Front Cardiovasc Med. 2024; 11:1340570.

PMID: 38361582 PMC: 10867157. DOI: 10.3389/fcvm.2024.1340570.

Evaluation of Right Ventricular Outflow Tract Stenting as Palliative Treatment in Severely Cyanotic Tetralogy of Fallot: A Systematic Review and Meta-Analysis of Observational Studies.

Laurentius A, Wiyono L, Subali A, Siagian S J Tehran Heart Cent. 2022; 16(4):135-146.

PMID: 35935554 PMC: 9308887. DOI: 10.18502/jthc.v16i4.8599.

Fetal cardiac parameters for predicting postnatal operation type of fetuses with tetralogy of Fallot.

Park S, Won H, Kim R, Kim M, Yu J, Park C Cardiovasc Ultrasound. 2022; 20(1):4.

PMID: 35189903 PMC: 8859889. DOI: 10.1186/s12947-022-00274-5.

Right ventricular outflow tract stenting during neonatal and infancy periods: A multi-center, retrospective study.

Cansaran Tanidir I, Bulut M, Kamali H, Ozturk E, Yucel I, Guzeltas A Turk Gogus Kalp Damar Cerrahisi Derg. 2020; 28(3):442-449.

PMID: 32953206 PMC: 7493615. DOI: 10.5606/tgkdc.dergisi.2020.18970.

Surgical repair of Tetralogy of Fallot following primary palliation: Right ventricular outflow track stenting versus modified Blalock-Taussig shunt.

Bigdelian H, Ghaderian M, Sedighi M Indian Heart J. 2019; 70 Suppl 3:S394-S398.

PMID: 30595296 PMC: 6309724. DOI: 10.1016/j.ihj.2018.06.020.

References

Dohlen G, Chaturvedi R, Benson L, Ozawa A, Van Arsdell G, Fruitman D . Stenting of the right ventricular outflow tract in the symptomatic infant with tetralogy of Fallot. Heart. 2008; 95(2):142-7. DOI: 10.1136/hrt.2007.135723. View

Pigula F, Khalil P, Mayer J, Del Nido P, Jonas R . Repair of tetralogy of Fallot in neonates and young infants. Circulation. 1999; 100(19 Suppl):II157-61. DOI: 10.1161/01.cir.100.suppl_2.ii-157. View

Dryzek P, Mazurek-Kula A, Moszura T, Sysa A . Right ventricle outflow tract stenting as a method of palliative treatment of severe tetralogy of Fallot. Cardiol J. 2008; 15(4):376-9. View

Petrucci O, OBrien S, Jacobs M, Jacobs J, Manning P, Eghtesady P . Risk factors for mortality and morbidity after the neonatal Blalock-Taussig shunt procedure. Ann Thorac Surg. 2011; 92(2):642-51. DOI: 10.1016/j.athoracsur.2011.02.030. View

Pettersen M, Du W, Skeens M, Humes R . Regression equations for calculation of z scores of cardiac structures in a large cohort of healthy infants, children, and adolescents: an echocardiographic study. J Am Soc Echocardiogr. 2008; 21(8):922-34. DOI: 10.1016/j.echo.2008.02.006. View

Casaccia G, Crescenzi F, Dotta A, Capolupo I, Braguglia A, Danhaive O . Birth weight and McGoon Index predict mortality in newborn infants with congenital diaphragmatic hernia. J Pediatr Surg. 2006; 41(1):25-8. DOI: 10.1016/j.jpedsurg.2005.10.002. View

Chang A, Hanley F, Lock J, Castaneda A, Wessel D . Management and outcome of low birth weight neonates with congenital heart disease. J Pediatr. 1994; 124(3):461-6. DOI: 10.1016/s0022-3476(94)70376-0. View

KIRKLIN J, Blackstone E, PACIFICO A, Brown R, Bargeron Jr L . Routine primary repair vs two-stage repair of tetralogy of Fallot. Circulation. 1979; 60(2):373-86. DOI: 10.1161/01.cir.60.2.373. View

Ahmad U, Fatimi S, Naqvi I, Atiq M, Moizuddin S, Sheikh K . Modified Blalock-Taussig shunt: immediate and short-term follow-up results in neonates. Heart Lung Circ. 2007; 17(1):54-8. DOI: 10.1016/j.hlc.2007.06.003. View

10.

Alwi M, Choo K, Abdul Latiff H, Kandavello G, Samion H, Mulyadi M . Initial results and medium-term follow-up of stent implantation of patent ductus arteriosus in duct-dependent pulmonary circulation. J Am Coll Cardiol. 2004; 44(2):438-45. DOI: 10.1016/j.jacc.2004.03.066. View

11.

Tamesberger M, Lechner E, Mair R, Hofer A, Sames-Dolzer E, Tulzer G . Early primary repair of tetralogy of fallot in neonates and infants less than four months of age. Ann Thorac Surg. 2008; 86(6):1928-35. DOI: 10.1016/j.athoracsur.2008.07.019. View

12.

Kolcz J, Pizarro C . Neonatal repair of tetralogy of Fallot results in improved pulmonary artery development without increased need for reintervention. Eur J Cardiothorac Surg. 2005; 28(3):394-9. DOI: 10.1016/j.ejcts.2005.05.014. View

13.

Fraisse A . Stenting the paediatric heart. Heart. 2008; 95(2):100-1. DOI: 10.1136/hrt.2008.142794. View

14.

Gedicke M, Morgan G, Parry A, Martin R, Tulloh R . Risk factors for acute shunt blockage in children after modified Blalock-Taussig shunt operations. Heart Vessels. 2010; 25(5):405-9. DOI: 10.1007/s00380-009-1219-1. View

15.

PACIFICO A, Bargeron Jr L, KIRKLIN J . Primary total correction of tetralogy of Fallot in children less than four years of age. Circulation. 1973; 48(5):1085-91. DOI: 10.1161/01.cir.48.5.1085. View

16.

Korbmacher B, Heusch A, Sunderdiek U, Gams E, Rammos S, Langenbach M . Evidence for palliative enlargement of the right ventricular outflow tract in severe tetralogy of Fallot. Eur J Cardiothorac Surg. 2005; 27(6):945-8. DOI: 10.1016/j.ejcts.2005.02.010. View

17.

Fraser Jr C, McKenzie E, Cooley D . Tetralogy of Fallot: surgical management individualized to the patient. Ann Thorac Surg. 2001; 71(5):1556-61; discussion 1561-3. DOI: 10.1016/s0003-4975(01)02475-4. View

18.

Fiore A, Tobin C, Jureidini S, Rahimi M, Kim E, Schowengerdt K . A comparison of the modified Blalock-Taussig shunt with the right ventricle-to-pulmonary artery conduit. Ann Thorac Surg. 2011; 91(5):1479-84. DOI: 10.1016/j.athoracsur.2010.11.062. View

19.

Lee C, Lee C, Kim S, Lim C, Chang Y, Kang C . Outcome after one-stage repair of tetralogy of Fallot. J Cardiovasc Surg (Torino). 2006; 47(1):65-70. View

20.

McMahon C, Walsh K . Transcatheter right ventricular outflow tract stent implantation in a child with pentalogy of Cantrell, double outlet right ventricle, and severe pulmonary stenosis. Catheter Cardiovasc Interv. 2013; 82(7):1164-7. DOI: 10.1002/ccd.24852. View