RT Journal Article
SR Electronic
T1 Stenting of the right ventricular outflow tract in the symptomatic infant with tetralogy of Fallot
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 142
OP 147
DO 10.1136/hrt.2007.135723
VO 95
IS 2
A1 G Dohlen
A1 R R Chaturvedi
A1 L N Benson
A1 A Ozawa
A1 G S Van Arsdell
A1 D S Fruitman
A1 K-J Lee
YR 2009
UL http://heart.bmj.com/content/95/2/142.abstract
AB Background: Repair of neonatal tetralogy of Fallot (TOF) has low mortality. Debate continues regarding the initial management of cyanotic or duct-dependent infants with TOF and adverse risk factors. While 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 TOF. Methods: Clinical, echocardiographic, angiographic and haemodynamic data were reviewed for nine 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 (range 2.7–4.2), Z-score −6.7 (range −9.7 to −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 to −2.4) before stent implantation to −1.5 (−4.2 to −0.2) (p = 0.02) before surgical repair. Median Z-score for the right pulmonary artery increased from −3.7 (−6.8 to −1.9) to −0.8 (−2.5 to 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 were no deaths. 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.