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Stenting of the right ventricular outflow tract in the symptomatic infant with tetralogy of Fallot
  1. Gaute Dohlen (gaute{at}online.no)
  1. The Hospital for Sick Children, Canada
    1. Rajiv R Chaturvedi (rajiv.chaturvedi{at}sickkids.ca)
    1. The Hospital for Sick Children, Canada
      1. Lee N Benson (lee.benson{at}sickkids.ca)
      1. The Hospital for Sick Children, Canada
        1. Akira Ozawa (akira.ozawa{at}sickkids.ca)
        1. The Hospital for Sick Children, Canada
          1. Glen S Van Arsdell (glen.vanarsdell{at}sickkids.ca)
          1. The Hospital for Sick Children, Canada
            1. Deborah S Fruitman (deborah.fruitman{at}sickkids.ca)
            1. The Hospital for Sick Children, Canada
              1. Kyong-Jin Lee (kyong-jin.lee{at}sickkids.ca)
              1. The Hospital for Sick Children, Canada

                Abstract

                Background Repair of neonatal TOF has low mortality. Debate continues regarding the initial management of cyanotic or duct-dependent infants with TOF and adverse risk factors. Whilst repair can and has been performed in these patients, it is associated with increased morbidity.

                Objective We review the effectiveness of right ventricular outflow tract (RVOT) stenting in the symptomatic young infant with tetralogy of Fallot (TOF).

                Methods Clinical, echocardiographic, angiographic and hemodynamic data were reviewed for 9 patients who underwent 11 RVOT stenting procedures from October 1994 to August 2007.

                Results The pulmonary valve was deemed unsalvageable in all patients (median valve diameter 3.7 mm (2.7, 4.2), Z score -6.7 (-9.7, -5.4). RVOT stenting improved arterial oxygen saturation from a median of 73% (60, 85) to 94% (90, 98) (p = 0.008). Median Z score for the left pulmonary artery increased from -4.9 (-7.8, -2.4) before stent implantation to -1.5 (-4.2, -0.2) (p = 0.02) before surgical repair. Median Z score for the right pulmonary artery increased from -3.7 (-6.8, -1.9) to -0.8 (-2.5, 0.1) (p = 0.008). Median Nakata index increased from 56 mm2/m2 (21, 77) to 150 mm2/m2 (123, 231) (p=0.008). There were no procedural complications. Six patients have undergone successful repair. There was no mortality.

                Conclusions In the symptomatic young infant with TOF, stenting of the RVOT provides a safe and effective management strategy, improving arterial oxygen saturation and encouraging pulmonary artery growth.

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