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Transventricular balloon dilation and stenting of the RVOT in small infants with tetralogy of fallot with pulmonary atresia
Author(s) -
Cools Bjorn,
Boshoff Derize,
Heying Ruth,
Rega Filip,
Meyns Bart,
Gewillig Marc
Publication year - 2013
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.24548
Subject(s) - medicine , tetralogy of fallot , pulmonary atresia , balloon dilation , ventricular outflow tract , surgery , cardiology , balloon , percutaneous , pulmonary valve , stenosis , stent , double outlet right ventricle , hypoplastic left heart syndrome , angioplasty , ventricle , heart disease
The management of small infants with tetralogy of Fallot (TOF) with pulmonary atresia (PA) and hypoplastic pulmonary arteries can be very challenging. Methods In three small infants (weight range 2,200–3,600 g, pulmonary trunk 2.0–3.2 mm), initial palliation consisted of sternotomy, transventricular puncture of the right ventricular outflow tract and atretic pulmonary valve, followed by balloon dilation ( n = 1) or stent deployment ( n = 2) from the right ventricle into the pulmonary trunk (stent diameter 5–6 mm, length 16 mm). Results The procedure resulted in adequate palliation with good anterograde flow to the pulmonary arteries and near normal saturations in all three patients (>92%); there was no associated morbidity. Additional transvenous stenting was required in all patients because of progressive muscular infundibular stenosis after a median of 3 months. Two patients evolved to full repair at the age of 5 months and one patient with multiple hilar stenoses requires additional percutaneous procedures through the stented RV outflow tract. Conclusion Transventricular balloon dilation and stenting of the RVOT through medial sternotomy as initial palliation strategy appears a safe and well tolerated alternative treatment in small infants with TOF with PA and a hypoplastic pulmonary trunk. © 2013 Wiley Periodicals, Inc.