Operative findings after percutaneous pulmonary balloon dilatation of the right ventricular outflow tract in tetralogy of Fallot.

Abstract

Since 1983 percutaneous balloon dilatation of the right ventricular outflow tract has been performed as an alternative to surgical palliation in selected cases of tetralogy of Fallot at the Royal Liverpool Children's Hospital. From 31 December 1984 to 31 December 1988, 27 of these patients underwent subsequent surgical correction. Age at operation ranged from 7 to 58 months (median 2-7 years). The mean interval between balloon dilatation and correction was 15-6 months (range 3-39 months). Two patients had a systemic pulmonary shunt operation performed before dilatation and a further five required one afterwards. Overall 20 (74%) patients had some anatomical alteration as the result of balloon dilatation, while in seven (26%) there was no discernible change in the right ventricular outflow tract. There was no consistent relation between the ratio of balloon size to pulmonary annulus diameter and the morphological findings.Balloon dilatation may obviate the need for systemic-pulmonary shunt at the expense of some structural damage, particularly to the posterior cusp. The present data suggest that dilatation does not bring about growth of the annulus to such an extent that transannular patch is no longer needed at intracardiac repair. The median age of the patients at operation was 33 months (range 7-58 months). Twenty one of them had one pulmonary dilatation, four had two procedures, and two patients had three and four balloon dilatations. The mean age at the first dilatation was 10-0 months (range 0-5-30); for all dilatations the median age was 14-6 months (range 0-5-56). Balloon sizes ranged from 5 to 15 mm (mean 13 mm). Surgical correction was undertaken 3 to 39 months (mean 15 6 months) after dilatation.At operation the surgeon classified the pulmonary valve leaflets as follows: (a) intact, when there was no observable effect of dilatation; (b) detached, when the leaflet was separated from its hinge-point for a variable length, starting from one of the commissures; (c) split, when a vertical tear was found, usually in mid-portion of the leaflet dividing it in two segments (in no case was a split identified at a commissure); (d) fused, when the leaflets were fused to the pulmonary artery wall, probably after initial detachment.The pulmonary ventriculo-arterial junction (pulmonary annulus) was described as: (a) intact, where there was no observable effect of dilatation; or (b) split, when there was a tear usually originating at the hinge-point of the leaflet and extending a variable distance into the main pulmonary artery and its right branch.The computerised records of all the other patients ( 1 13

Early and late results and the effects on pulmonary arteries of balloon dilatation of the right ventricular outflow tract in tetralogy of Fallot

“…The use of a right coronary Judkins or Cobra catheter with an appropriate curve, in combination with a flexible guidewire, should reduce this risk and facilitate the crossing of the right ventricular outflow tract. Damage to the pulmonary valve leaflet following balloon dilatation has also been reported in 50 to 75% of patients [1,32,33,42] . This may be the consequence of using a large balloon with a balloon size to pulmonary annulus ratio between 1•5 and 2.…”

“…Most of the patients showed marked clinical improvement with relief of cyanosis and the complete repair could be delayed. Some have questioned the efficacy of balloon dilatation of the pulmonary valve on the growth of the pulmonary vascular tree [1,32,33,35,40,42] . Many criteria have been proposed to describe such growth.…”

An evaluation of efficacy and utility of palliative pulmonary balloon valvuloplasty in symptomatic infants with tetralogy of Fallot

“…[7,18] Araştırmacılar daha önce yenidoğan kuzularda yaptıkları çalışmada, kullanılan balon çapının pulmoner arter çapının %50'sinin üzerinde olduğu durumda SVÇY'de ağır hasar meydana geldiğini göstermişlerdir. [22] Biz çalışmamızdaki düşük komplikasyon oranlarının hem pulmoner anülüs/balon oranını 2'nin altında tutmamıza hem de anülüse komşu normal pulmoner arter çapının %150'sini aşmamaya özen gösterdiğimiz için olabileceğini düşünmekteyiz.…”

Transcatheter recanalisation and stenting of a closed ductus arteriosus in duct dependent lung perfusion

“…In symptomatic newborns with tetralogy of Fallot, percutaneous balloon dilatation of the right ventricular outflow tract and the application of propranolol is used palliatively to provide ideal conditions for repair,2 although the dysplastic pulmonary valve may be damaged 3. Stenting of the patent arterial duct to maintain patency was first reported by Gibbs et al in patients with pulmonary atresia4 but required redilatation 5.…”