Balloon Dilation of the Pulmonary Valve in Premature Infants with Tetralogy of Fallot

Abstract

Infants with tetralogy of Fallot (ToF) presenting with desaturation may require augmentation of the pulmonary blood flow, usually in the form of a Blalock-Taussig shunt. Shunts may result in a preferential increase in blood flow to one lung. They also may be associated with significant morbidity and possibly mortality of premature infants. Balloon dilation of the pulmonary valve is reported to improve saturation in early infancy. This report describes two premature infants (weighing, respectively, 1.8 and 1.6 kg) with ToF and desaturation for whom balloon dilation of the pulmonary valve showed good results. Neither infant required palliative surgery. At this writing, one infant has already undergone complete repair.

Effects of Balloon Pulmonary Valvuloplasty as Preoperative Palliation for Tetralogy of Fallot

“…1,[10][11][12][13][14][15][16][17] There is controversy about the outcomes of BPV, and some reports have shown favorable outcomes of palliative BPV in patients with TOF. 13,16,17 Remadevi et al reported a statistically significant improvement in saturation and a high success rate of 87.5%, 17 which is similar to the value of 90.3% (BPV was successful in 28 of 31 patients) obtained in our center. However, there are some reports of poor outcomes such as sustained hypoxemia followed by the need for another palliation surgery or procedural complications, particularly in young infants and neonates.…”

Tetralogy of Fallot: Everything you wanted to know but were afraid to ask

“…Knowledge of an aberrant left coronary artery from the right coronary artery plays an important part in the surgical approach. In these patients, a Rastelli procedure (RV to PA conduit) is preferred as opposed to a transventricular repair …”

“…An aortic root injection will define the coronary and arch anatomy with selective injection in the presence of MAPCAs. Therapeutic interventions in selected cases of unrepaired TOF can include balloon pulmonary valvuloplasty and occasionally RVOT stenting . Regardless, transcatheter approaches may incur the risk of initiating a hypercyanotic spell and be considered with caution in these patients.…”

“…In these patients, a Rastelli procedure (RV to PA conduit) is preferred as opposed to a transventricular repair. [15][16][17] Right ventricle outflow obstruction can occur at multiple levels: subvalvar, valvar, and/or supravalvar. Subvalvar obstruction can result from hypertrophy of the muscular bands in the subpulmonic region and/or from the anterior and cephalad deviation of the VSD.…”

Transesophageal Echocardiography in Tetralogy of Fallot

“…The use of catheter-based interventions, consisting primarily of balloon pulmonary valvuloplasty, has been reported in selected infants as a form of early palliation. 24,25 Although it is well recognized that tetralogy represents a surgical disease, the optimal strategy, specifically in regard to the nature and timing of the procedure, remains a subject of interest and ongoing discussion in the field. [26][27][28][29] Potential options are either (1) initial palliation of symptomatic infants with a systemic to pulmonary artery shunt followed by definitive repair at a later time (2-stage approach) or (2) a single-stage primary repair.…”