Palliative balloon valvoplasty of the pulmonary valve in tetralogy of Fallot

Massoud, Ikram; Imam, Adel; Mabrouk, Ahmed; Boutros, Nader; Kassem, A. S.; Daouod, Ahmed; Abd, Mahmoud; Hakem, El

doi:10.1017/s1047951100007344

Cited by 12 publications

(8 citation statements)

References 26 publications

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“…Like many of the earlier series,[19–22] we observed significant growth of the branch pulmonary arteries and pulmonary annulus following BPV. Growth can be explained by the symmetric increase in antegrade flow after BPV.…”

Section: Discussionsupporting

confidence: 86%

Balloon pulmonary valvotomy as interim palliation for symptomatic young infants with tetralogy of Fallot

et al. 2008

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Objectives:To describe the case selection, technique and immediate and short-term results of balloon pulmonary valvotomy (BPV) in young infants with tetralogy of Fallot (TOF).Background:Symptomatic young infants with TOF can either undergo corrective surgery or Blalock-Taussig (BT) shunt. Corrective surgery in early infancy is associated with significant morbidity and is not a realistic option in many centers. BT shunt carries the risk of branch pulmonary artery distortion and shunt occlusion.Methods:Infants less than three months with a significant valvar pulmonary stenosis (with or without associated infundibular and annular component) and oxygen saturation ≤80% were offered BPV. The right ventricular outflow tract (RVOT) was crossed with 4F Judkin's right coronary catheter and the valve was crossed with 0.014” coronary guide wire. Serial balloon dilatations were done with over the wire coronary balloons (3-4 mm) and Mini Tyshak balloons up to a balloon annulus ratio of 2:1, depending upon the improvement in saturation and formation of annular waist.Results:Seventeen infants less than three months of age with tetralogy of Fallot (median age: 33 days, range: 10-90 days, weight: 3.47 ± 0.87 kg, pulmonary annulus Z score: -5.59 ± 1.04) including eight neonates underwent palliative BPV between May 2004 and March 2007. The mean balloon annulus ratio was 1.4 ± 0.28 and fluoroscopy time was 26.18 ± 20.2 minutes. The mean oxygen saturation increased significantly from 73 ± 7% to 90 ± 3.68% following BPV (p = 0.0001). The only major complication was RVOT perforation and pericardial tamponade in one infant. The mean follow-up period was 23 ± 12 months. Two babies developed significant desaturation requiring surgery in the six months following BPV. There was a significant increase in pulmonary annulus. The z score for the pulmonary annulus improved from -5.59 ±1.04 before BPV to - 4.31 ± 1.9 at the time of last follow-up (p = 0.018). The mean Z score of hilar right pulmonary artery (RPA) increased significantly from -1.19 ± 1.78 before BPV to 0.7 ± 0.91 after BPV (p = 0.001). The mean Z score of hilar left pulmonary artery (LPA) increased significantly from -1.28 ± 1.41 to 0.03 ± 1.29 after BPV (p = 0.005). Eight patients underwent corrective surgery.Conclusions:Balloon pulmonary valvotomy is safe and effective. It significantly improves the growth of pulmonary annulus and branch pulmonary arteries. Thus it can be considered as an interim palliative procedure for symptomatic young infants with TOF and predominant valvar pulmonary stenosis.

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Section: Discussionsupporting

confidence: 86%

Balloon pulmonary valvotomy as interim palliation for symptomatic young infants with tetralogy of Fallot

et al. 2008

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“…Sluymans and colleagues, 14 however, were able to demonstrate significant growth of the pulmonary valve, and also a reduced requirement for transannular patching. Both Heusch et al, 12 and Massoud and colleagues, 11 were able to demonstrate growth of the major pulmonary arteries, and that has been a more consistent finding in previous reports. Improved flow, and hence equal growth of both pulmonary arteries, should be a further potential advantage of balloon dilation, since surgical shunts tend to favour the ipsilateral pulmonary artery.…”

supporting

confidence: 76%

“…11 " 13 It was hoped that the increased flow following dilation would stimulate growth of the pulmonary valve. It is disappointing, therefore, that of the three current papers, only Massoud et al 11 are able to support this contention. Sluymans and colleagues, 14 however, were able to demonstrate significant growth of the pulmonary valve, and also a reduced requirement for transannular patching.…”

mentioning

confidence: 93%

Is balloon dilation a reasonable option for the palliation of Fallot's tetralogy?

Arnold

1999

Cardiol Young

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P RIMARY CORRECTION, WITH LOW EARLY ANDlate mortality, is now the aim of many, if not most, leading centres for the management of Fallot's Tetralogy. The presence of a variety of risk factors, such as hypoplastic pulmonary arteries and coronary arterial abnormalities, makes this difficult to achieve. Yet other neonates, some with low weight at birth, present with severe hypoxia, making them poor candidates for open heart surgery. Most surgeons would agree that the presence of some of these risk factors is an indication for initial palliation rather than primary corrective surgery. Centres where the development of early primary open heart surgery in the first year is less well advanced will choose to palliate a higher proportion of patients.Until 1969, when Erickson and his associates 1 demonstrated long term improvement and relief of cyanotic spells in selected patients following the administration of propranolol, the only reliable means of palliation was the surgical construction of an arterio-pulmonary anastomosis. Such palliative surgery carries low risk, and encourages growth of the pulmonary valve and pulmonary arteries. Arciniegas and colleagues 2 were able to demonstrate that, in patients of comparable age, repair following a Blalock shunt carried a mortality not significantly higher than primary repair. Palliative operations, however, are not free of risk and complications. A recent report from Toronto 3 demonstrated that pulmonary arterial hypoplasia and distortion are common after palliation by modified Blalock Taussig shunts. Even after excluding noncardiac causes of death, survival was only 90% in

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“…Some studies related the size of the pulmonary annulus to the aorta, but this is less well validated. Several investigators described improved growth of the annulus by 2 SD or more, [40][41][42][43][44][45][46] and Kreutzer et al 47 found that z increased from −4.0 to −3.3.…”

Section: Balloon Dilatation and Stentingmentioning

confidence: 99%

At what age should tetralogy of Fallot be corrected?

Hoffman

2017

Cardiol Young

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Tetralogy of Fallot can be corrected with very low mortality at any age, even in neonates, but this does not necessarily mean that it should be corrected in the neonatal period. Although there are many advantages to early correction, a high proportion of these neonates have residual stenosis or pulmonary regurgitation that impairs ventricular function and may require further surgery or implantation of a pulmonary valve. Before we had the ability to correct this anomaly with low mortality in small children, a variety of palliative procedures had to be performed. Today, with better understanding of the anatomy of tetralogy of Fallot, we should consider what forms of palliation will increase growth of the right ventricular outflow tract in order to reduce the complications of very early surgery.

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Palliative balloon valvoplasty of the pulmonary valve in tetralogy of Fallot

Cited by 12 publications

References 26 publications

Balloon pulmonary valvotomy as interim palliation for symptomatic young infants with tetralogy of Fallot

Balloon pulmonary valvotomy as interim palliation for symptomatic young infants with tetralogy of Fallot

Is balloon dilation a reasonable option for the palliation of Fallot's tetralogy?

At what age should tetralogy of Fallot be corrected?

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