Two‐stage approach for surgical treatment of tetralogy of Fallot in underweight children: Clinical and morphological outcomes

Abstract

Background Two‐stage surgery including right ventricular outflow tract (RVOT) stenting with subsequent total surgical repair (TSG) has been suggested as a promising curative option in infants with tetralogy of Fallot (ToF) having comorbidities such as low body weight. However, data on clinical outcomes of such approach and tissue response to RVOT stenting in underweight infants are scarce. Methods We recruited 16 underweight (<3 kg; average weight, 2.2 ± 0.4 and 4.7 ± 0.9 kg at the time of RVOT stenting and TSG, respectively) infants (1‐3 months of age, average 28.2 ± 4.3 and 100.2 ± 22.3 days at the time of RVOT stenting and TSG, respectively) with ToF and performed RVOT stenting with the subsequent TSG. Excised stents were embedded into epoxy resin and stained by toluidine blue and basic fuchsin. Results Fifteen infants had a favorable clinical outcome, probably due to the rapid increase in the body weight, blood oxygen saturation, and left ventricular end‐diastolic volume to body surface area ratio indicative of improved pulmonary perfusion. Histological analysis revealed an endothelial cell monolayer at the stent surface with notable neovascularization of stented tissues, which could potentially explain the abovementioned clinical and echocardiography improvements. The only death occurred immediately after RVOT stenting and was caused by a massive subdural hematoma, possibly provoked by grade 2 intraventricular hemorrhage 12 days before the stenting. Conclusions We confirm RVOT stenting with the subsequent TSG as a safe and efficient surgical approach for the treatment of underweight children with ToF.

Assessment of the pulmonary arterial growth and results of two-stage repair in infants with severe form of tetralogy of Fallot

“…Стентирование выходного отдела правого желудочка является потенциально достойной альтернативой формированию модифицированного шунта Блэлок-Тауссиг, обладая такими преимуществами как: антеградный пульсирующий ток венозной крови в легочное русло с большим насыщением артериальной крови кислородом; быстрая стабилизация гемодинамики и перфузии органов за счет отсутствия снижения диастолического артериального давления [2,4,[21][22][23][24].…”

Stenting of the right ventricular outflow tract with subsequent radical correction in a child with a tetralogy of Fallot: results of six-year follow-up

“…стентирование ВОПЖ с последующей радикальной коррекцией ТФ было выполнено в 22 случаях. Помимо обнадеживающих клинических результатов были получены данные гистологических исследований, свидетельствующих об эффективном формировании неососуда в области ВОПЖ посредством эндотелизации имплантированного коронарного стента [3].…”

“…На настоящий момент перспективной альтернативой паллиативному хирургическому вмешательству является эндоваскулярный метод в виде стентирования ВОПЖ, позволяющий добиться уменьшения выраженности гипоксического синдрома, нормализовать легочный кровоток и состояние ветвей легочной артерии (ЛА), подготовить левый желудочек к радикальной коррекции порока [1,3].…”

Right ventricular outflow tract stenting promotes pulmonary artery development in tetralogy of fallot

“…For some patients with tetralogy of Fallot who have appropriate size of pulmonary artery, acceptable cardiac function, and no extracardiac complications, can be candidates for primary surgical repair within 3-9 months after birth, and the postoperative outcome was excellent in these infants. Current improvements in cardiac surgery reduced the patient mortality rate to 0.5%-2.5% throughout time (2)(3)(4). However, surgical repair of certain TOF types is challenging.…”

“…Two-stage surgical therapy with growth of pulmonary artery was suggested as an appropriate option (8)(9)(10)(11). The indicators for twostage repair and primary palliation were active cyanosis, low body weight and pulmonary arteries of small size (Mc Goon ratio <1.2 (4). The purpose of primary palliation is to promote the development of pulmonary arteries, increase pulmonary blood flow and improve arterial oxygen saturations, so as to attain the standard of final surgical repair.…”