Long-term outcome of the right ventricular outflow tract palliation procedure in children with cyanotic congenital heart disease: A case-series study

Abstract

Background: The right ventricular outflow tract (RVOT) palliation has been shown to be a proper interventional procedure for lowering risk of mortality and improving clinical condition in cyanotic congenital heart disease (CHD) patients. Objectives: The present study aimed to assess the consequences of RVOT palliation in patients with TOF. Patients and Methods: This prospective case series was performed on 17 children who suffered from cyanotic CHD. The study endpoints were assessed by pulse oximetry, echocardiography, and electrocardiography immediately and also 12 months after RVOT palliation procedure. Results: The mean age of patients was 24.76 (median 10 months). Comparing laboratory and respiratory parameters 12 months after RVOT palliation showed a significant increase in arterial oxygen saturation (from 69.34 ± 13.07 to 86.29 ± 6.64, P = 0.001), RPA index of right pulmonary artery (from 5.49 ± 1.67 mm to 7.59 ± 1.79 mm, P < 0.001), Z score of right pulmonary artery (from-1.56 ± 2.34 to 0.53 ± 2.55, P < 0.001), LPA of left pulmonary artery (from 5.64 ± 1.88 mm to 8.06 ± 2.72 mm, P < 0.001), and also in Z score of left pulmonary artery (from-1.56 ± 2.33 to 0.78 ± 2.15, P = 0.001). Also, a significant decrease in the spell rate (from 88.2% to 17.6%, P < 0.001), and in the rate of tricuspid regurgitation (from 23.5% to 11.8%, P = 0.023) was shown. Cardiac arrhythmia occurred in only one patient that was transient. Stent fracture was found in none of the patients. Stent stenosis was also found in one patient. One-year death occurred only in one child. Conclusions: The right ventricular outflow tract palliation in children with cyanotic CHD leads to long-term favorable outcome regarding improvement in oxygen saturation, increase in Z score of both left and right pulmonary arteries and also considerable decrease in spell. Also, death and complications are rare following RVOT palliation.

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

“…Our findings are consistent with those of others studies that report remarkable growth of both PAs after either palliative approach (p < 0.05), which was valuable in high-risk cases, especially those with tet spells [3,5,8,17]. Despite the advantages of RVOT stenting over mBTS, early palliation in symptomatic infants increases the chance of requiring TAP at repair time.…”

“…(MAPCA) are candidates for primary palliation as a first step to avert hypoxia, improvement of oxygen saturation and PAs development until the complete repair [2,7, 8, 9].…”

Comparison and Validity of Fragmented QRS (fQRS) Against Cardiac Magnetic Resonance (CMR) in Predicting Right Heart Function in Tetralogy of Fallot Patients After Reconstructive Surgery

“…Mortezaeian et al showed the importance of repair surgery in improving oxygen saturation, low occurrence spell, and increased z-score of right and left pulmonary arteries (15). Therefore, they need PVR surgery at an older age compared to others.…”

Two‐stage approach for surgical treatment of tetralogy of Fallot in underweight children: Clinical and morphological outcomes

“…Right ventricular outflow tract (RVOT) stenting is suggested as a promising yet underestimated alternative to aortopulmonary shunt in patients with low body weight. Furthermore, data on tissue response to RVOT stenting, particularly stent endothelialization in such patients are lacking …”

“…Furthermore, data on tissue response to RVOT stenting, particularly stent endothelialization in such patients are lacking. [9][10][11][12] Here, we evaluated clinical results of RVOT stenting in underweight, 1-to 3-month-old children with ToF and carried out a histological examination of the stented arterial segments upon TSG.…”