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

Abstract

BackgroundTetralogy of Fallot (TOF) is a cyanotic disease requiring early intervention. We assessed the effect of right ventricular outflow tract (RVOT) stenting versus modified Blalock-Taussig shunt (mBTS) on outcomes of surgical repair of TOF.MethodsFifteen palliated TOF infants underwent complete repair surgery. RVOT stenting was performed in seven infants and mBTS was done in eight infants. Data on sequential patients who underwent surgery were collected and reviewed retrospectively.ResultsStenting group were significantly younger (1.62 ± 0.34 vs 2.80 ± 0.52, p = 0.001), had lower body weight (3.28 ± 0.48 vs 5.03 ± 0.67, p = 0.001) and lesser body surface area (0.20 ± 0.01 vs 0.26 ± 0.20, p = 0.001) than the mBTS group at palliation. Mean right pulmonary artery (RPA) diameter in stenting group at palliation was 2.9 ± 0.54 mm (z-score -3.08 ± 0.97) and increased at surgery to 4.6 ± 0.49 mm (z-score –0.79 ± 0.66) (p = 0.001). The mean left pulmonary artery (LPA) diameter was 2.5 ± 0.42 mm (z-score -3.3 ± 0.86), which increased to 3.3 ± 0.40 mm (z-score -2.2 ± 0.74) at surgery (p = 0.005). The mean RPA diameter in mBTS group at palliation was 3.2 ± 0.32 mm (z-score –2.9 ± 0.70) and increased at surgery to 4.3 ± 0.55 mm (z-score –1.1 ± 0.94) (p = 0.001). The mean LPA diameter was 2.8 ± 0.26 mm (z-score -3.3 ± 0.62), which increased to 3.2 ± 0.24 mm (z-score –2.4 ± 0.52) at surgery (p = 0.032). Repeat echocardiography showed significant increase in McGoon ratio and Nakata index in both groups (p = 0.001). No significant differences were seen between the two groups regarding surgical procedure and postoperative complications.ConclusionRVOT stenting is a safe and effective approach instead of mBTS in hazardous TOF infants with hypercyanotic spell, small PAs and complex anatomies.

Interventional Treatment of Cardiac Emergencies in Children with Congenital Heart Diseases

“…44,45 The major complications related to this procedure are perforation of the RVOT and hemopericardium, damage of the tricuspid valve apparatus, stent dislodgement into the right ventricle, stent embolization into the aortic arch followed by moderate to severe aortic valve regurgitation, or stent thrombosis. [44][45][46][47][48][49][50][51][52][53]…”

Comparative Outcomes of Primary Arterial Switch Operation for Transposition of Great Arteries within the First Month of Life

“…However, technical factors such as the insufficient mobilization of the pulmonary arteries and the inadequate size or form of the pericardial patch used to reconstruct the pulmonary trunk have been suggested to contribute to the development of RVOT obstruction. 13 …”

Stenting of the right ventricular outflow tract with subsequent radical correction in a child with a tetralogy of Fallot: results of six-year follow-up

“…Схожие положительные результаты после стентирования ВОПЖ у пациентов с ТФ также были продемонстрированы в ряде других зарубежных пилотных исследований [7]. Однако проспективные исследования являются единичными, при этом c небольшой выборкой пациентов.…”