The balloon dilation of the pulmonary valve during early repair of tetralogy of Fallot

Abstract

The integrity of the PV annulus and PV function can be preserved in selected patients during early repair of TOF when using concomitant balloon dilation. The PV preservation will hopefully prevent long-standing RV dysfunction.

Technical Performance Score as Predictor for Post-discharge Reintervention in Valve-Sparing Tetralogy of Fallot Repair

“…24 In other small studies, freedom from RI at 1-year follow-up has been 0%-7%. 13,14 The overall RI for our cohort of 157 patients was 17%. On comparing PV Z scores between those who did and did not need RI, it appears that a median preoperative PV Z score of À2 would favor freedom from RI.…”

“…2,3 Although initial repair strategies predominantly involved transannular incisions, recognition of late problems following repair of TOF with a transannular patch has stimulated modifications to preserve pulmonary valve (PV) function in TOF with pulmonary stenosis (PS) including transatrial approach, 4,5 and transatrial transpulmonary approach. 6,7 In the recent era, valve-sparing techniques, [8][9][10][11][12][13][14] including intraoperative balloon dilation of the PV, have been developed as a means to preserve the PV in patients with moderate hypoplasia of the pulmonary annulus. Valve-sparing approaches potentially risk higher reintervention (RI) rates.…”

Combined Surgical and Interventional Approaches for Treating Patients with Congenital Heart Disease

“…Moreover, the involvement of the hemodynamic expertise in the operating room led to the development of new strategies aimed to improve both early and long‐term outcomes (i.e., the preservation of the PV integrity and function during early repair of TOF). In such patients, a balloon PV annuls dilation during standard early trans‐atrial/transpulmonary repair proved to be effective in preserving both PV integrity and RV function, in the mid‐term, in this way improving the results of “conventional” TOF repair by means of a transannular valved patch . Furthermore, during our more recent experience with this innovative technique we have been able to preserve the PV function even in more severe forms of TOF (with PV Z‐score <−3) by adding complex PV surgical reconstruction maneuvres, following effective annular dilation .…”

“…For such procedures, the use of fluoroscopy is often necessary in the catheterization laboratory or in more sophisticated hybrid surgical operating rooms . During the last decade, following the technological advancements and the development of new surgical therapeutic options, the cooperation between surgeons and cardiologists has further expanded, by combining surgical and interventional techniques which are performed in the operating room without the use of fluoroscopy. These procedures represent an emerging field, which combines skills and techniques that are part of the armamentarium of pediatric cardiac surgeons and interventional pediatric cardiologists, with the aim of overcoming the technical limits of each single specialty and therefore widening the spectrum of treatable CHDs.…”

Surgical repair of tetralogy of Fallot: the quest for the ‘ideal’ repair

“…The debate becomes interesting for the pulmonary annulus with a z-score of −1 or −2. Transannular patching is still the most reliable option, although intra-operative balloon dilation of the pulmonary annulus has been forwarded as a promising additional tool (7,8). When the pulmonary annulus is nearly of the appropriate size, carrying a z-value of −1 to 0, preservation of the pulmonary valve should be pursued.…”