Early and late results and the effects on pulmonary arteries of balloon dilatation of the right ventricular outflow tract in tetralogy of Fallot.
نویسندگان
چکیده
BACKGROUND Balloon dilatation of the pulmonary valve remains controversial as a palliative procedure in tetralogy of Fallot. AIMS To determine the clinical outcome, growth of the pulmonary vascular tree and findings at surgery of balloon dilatation of the pulmonary valve performed as a palliation in infants with tetralogy of Fallot. METHODS AND RESULTS Thirty-three severely cyanosed infants (mean age of 3 months for the whole population, including seven neonates) underwent this procedure from June 1990 to January 1997. After balloon dilatation, systemic oxygen saturation increased from a mean value of 76 +/- 9% to 88 +/- 7% (P < 0.001). The procedure was accomplished without complications. Four patients had recurrent hypoxic spells after dilatation leading to surgical repair within 30 days of dilatation (three modified Blalock-Taussig shunts and one complete repair). A control study was performed at a mean of 6.1 +/- 4.5 months after dilatation in 16 patients to establish growth of the pulmonary vascular tree (repeat catheterization in nine patients and surgical pulmonary annulus calibration in seven). The pulmonary annulus increased from a mean Z score of -4.1 +/- 0.9 SD to -2.5 +/- 1.1 SD (P < 0.001). Z score for the right pulmonary artery from -3.0 +/- 0.6 SD to -1.9 +/- 1.2 SD (P = 0.007) and the Z score for the left pulmonary artery from -2.7 +/- 0.7 SD to -1.6 +/- 1.3 SD (P = 0.021). At late follow-up (mean of 9 months after dilatation, range 3 to 54 months), 28 patients underwent complete repair. Trans-annular patching was required in 43% of patients. Four post-operative deaths were observed, none dilatation related. CONCLUSION Balloon dilatation of the pulmonary valve is an effective and safe palliation in tetralogy of Fallot. It promotes growth of the pulmonary vascular tree, reducing the need for trans-annular patching and is recommended in symptomatic infants of very young age, with a small pulmonary annulus (Z value below -4 SD) and associated cardiac anomaly.
منابع مشابه
Main indications and long-term outcomes of reoperation after initial repair of tetralogy of Fallot
Background and Objective: The aim of this study was to analyze our indications, surgical procedures, and clinical outcomes of patients undergoing reoperation after surgical correction of tetralogy of Fallot (TOF). Methods: Thirty seven consecutive patients who underwent reoperation late after intra-cardiac repair of TOF within a period of 10 years were assessed. Results: The most co...
متن کاملGrowth of the pulmonary artery after neonatal balloon dilatation of the right ventricular outflow tract in an infant with the tetralogy of Fallot and atrioventricular septal defect.
A two week old girl with tetralogy of Fallot and atrioventricular septal defect underwent palliation, for severe hypoxaemia, by balloon dilatation to the right ventricular outflow tract. This procedure was repeated once over the next eight months without complications. Serial right ventricular angiograms showed growth of the hypoplastic pulmonary ring ("annulus"), trunk, and arteries. Balloon d...
متن کاملRight ventricular Hemodynamic Alteration after Pulmonary Valve Replacement in Children with Congenital Heart Disease
Introduction: In patients who underwent surgery to repair Tetralogy of Fallot, right ventricular dilation from pulmonary regurgitation may be result in right ventricular failure, arrhythmias and cardiac arrest. Hence, pulmonary valve replacement may be necessary to reduce right ventricular volume overload. The aim of present study was to assess the effects of pulmonary valve replacement on rig...
متن کاملBalloon dilatation of the pulmonary valve in the first year of life in patients with tetralogy of Fallot: a preliminary study.
Fifteen infants with tetralogy of Fallot, who would otherwise have required a palliative operation, underwent balloon dilatation of the right ventricular outflow tract. The mean period of palliation was 8.5 months (range 0-26 months). The procedure was performed without serious complications on 88% of occasions. This preliminary study suggests that balloon dilatation may be useful in the manage...
متن کاملبررسی عملکرد بطنها با اکوکاردیوگرافی در نارسایی دریچه ریوی پس از جراحی تترالوژی فالوت
Background: Tetralogy of Fallot is the most common cyanotic congenital heart disease. The systolic and diastolic function in both ventricles is altered even after successful corrective surgery for this defect with a transannular patch. Pulmonary regurgitation, a common complication after this treatment, is usually well tolerated in childhood. The aim of this study was to assess the combined dia...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- European heart journal
دوره 19 4 شماره
صفحات -
تاریخ انتشار 1998