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Efficacy and safety of balloon dilation as palliative treatment for tetralogy of Fallot

  • Gurleen K. Sharland (a1), Shakeel A. Qureshi (a1), Edmund J. Ladusans (a1), Jonathon M. Parsons (a1), Edward J. Baker (a1), Philip B. Deverall (a1) and Michael Tynan (a1)...

Abstract

Twenty-six patients requiring palliation for the tetralogy of Fallot were treated by balloon dilation. The mean age at dilation was 8.5 months (range 0.5−20.6) and the mean weight 6.7 kg (range 2.6−10.7). Successful dilation was achieved in 25 patients. The mean ratio of the balloon to the diameter of the pulmonary outflow tract was 1.6 (range 1.2−2.0). The aortic oxygen saturation increased from mean±SD of 80±12.4% before to 91±4.3% after dilation (p<0.05). The pulmonary arterial oxygen saturation rose from 64±10.7% to 80±7.7% (p<0.05). Transient hypotension and arterial desaturation were noted in 19 patients during inflation of the balloon. One patient had a cardiac arrest prior to dilation and died afterwards. Seven patients had cyanotic spells related to the procedure. Attempts to cross the pulmonary valve resulted in infundibular perforation by the guide wire in one patient. Of the 24 survivors who initially had successful dilation procedures, three have needed a Blalock-Taussig shunt. Palliation without a shunt was achieved in the remaining 21 patients. In 12 patients, repeat angiography, 2.5−20 months (mean 9.1) after dilation, showed an increase in the diameter of the outflow tract from 7.1±2.1 mm before to 9.5±2.0 mm after dilation (p<0.05). Diameters of the pulmonary arteries increased from 6.3±2.2 mm on the right and 6.8±1.9 mm on the left before to 9.2±2.2 mm and 9.3±2.5 mm respectively after dilation (p<0.05 for both branches). Surgical correction has been achieved in 22 patients, 21 of these 2−22 months after balloon dilation and the other patient 20 months after construction of a shunt. At operation, the leaflets of the pulmonary valve were noted to be torn in five patients. In 12 patients, there was extensive scarring of the infundibulum. Balloon dilation of the right ventricular outflow tract achieves adequate palliation and may result in an increase in the diameter of the pulmonary valve and branches of the pulmonary trunk. It should be considered as an alternative to shunt procedures in children with tetralogy of Fallot.

Copyright

Corresponding author

Dr. Shakeel A. Qureshi, Department of Paediatric Cardiology, 11th Floor Guy's Tower, Guy's Hospital, St. Thomas Street, London SE1 9RT, United Kingdom. Tel. 071-955-4616.

References

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Qureshi, SA, Kirk, CR, Lamb, RK, Arnold, R, Wilkinson, JL.Balloon dilatation of the pulmonary valve in the first year of life in patients with tetralogy of Fallot: a preliminary study. Br Heart J 1988; 60: 232235.
Sreeram, N, Saleem, M, Jackson, M, Peart, I, McKay, R, Arnold, R, Walsh, K.Results of balloon pulmonary valvuloplasty as a palliative procedure in tetralogy of Fallot. J Am Coll Cardiol 1991; 18: 159165.
Boucek, MM, Webster, HE, Orsmond, GS, Ruttenburg, HD.Balloon pulmonary valvotomy: palliation for cyanotic heart disease. Am Heart J 1988; 115: 318322.
Ladusans, EJ, Qureshi, SA, Parsons, JM, Arab, S, Baker, EJ, Tynan, M.Balloon dilatation for neonatal critical pulmonary valve stenosis. Br Heart J 1990; 63: 362367.
Blackstone, EH, Kirklin, JW, Bertranou, EG, Labrosse, CJ, Soto, B, Bargeron, LM Jr. Preoperative prediction from cineangio-grams of post repair right ventricular pressure in tetralogy of Fallot. J Thorac Cardiovasc Surg 1979; 78: 542552.
Rao, PS, Brais, M.Balloon pulmonary valvuloplasty for congenital cyanotic heart defects. Am Heart J 1988; 115: 11051110.
de Geeter, B, Weisburd, P, Dillenseger, P, Willard, D.Palliative percutaneous pulmonary valvuloplasty in neonatal forms of tetralogy of Fallot. Arch Fr Pediatr 1989; 46: 117119.
Kay, PH, Capuani, A, Franks, R, Lincoln, C.Experience with the modified Blalock-Taussig operation using polytetrafluoro-ethylene (Impra) grafts. Br Heart J 1983; 49: 359363.
Guyton, RA, Owens, JE, Waumett, JD, Dooley, KJ, Hatcher, CR, Williams, WH.The Blalock-Taussig shunt: low risk, effective palliation, and pulmonary artery growth. J Thorac Cardiovasc Surg 1983; 85: 917922.
Stewart, S, Alexson, C, Manning, J, Oakes, D, Eberly, SW.Long-term palliation with the classic Blalock-Taussig shunt. J Thorac Cardiovasc Surg 1988; 96: 117121.
Alfieri, O, Locatelli, G, Bianchi, T, Vanini, V, Parenzan, L.Repair of tetralogy of Fallot after Waterston anastomosis. J Thorac Cardiovasc Surg 1979; 77: 826831.
Newfeld, EA, Waldmann, JD, Paul, MH, Muster, AJ, Cole, RB, Idriss, F, Riker, W.Pulmonary vascular disease after systemic-pulmonary arterial shunt operations. Am J Cardiol 1977; 39: 715720.
Smith, VC, Caggiano, AV, Knauf, DG, Alexander, JA.The Blalock-Taussig shunt in the newborn infant. J Thorac Cardiovasc Surg 1991; 102: 602605.
Kirklin, JW, Bargeron, LM Jr, Pacifico, AD.The enlargement of small pulmonary arteries by preliminary palliative operations. Circulation 1977; 56: 612617.
Gale, AW, Arciniegas, E, Green, EW, Blackstone, EH, Kirklin, JW.Growth of the pulmonary annulus and pulmonary arteries after the Blalock-Taussig shunt. J Thorac Cardiovasc Surg 1979; 77: 459465.
Alfieri, O, Blackstone, EH, Parenzan, L.Growth of the pulmonary annulus and pulmonary arteries after the Waterston anastomosis. J Thorac Cardiovasc Surg 1979; 78: 440444.
Gill, CC, Moodie, DS, McGoon, DC.Staged surgical management of pulmonary atresia with diminutive pulmonary arteries. J Thorac Cardiovasc Surg 1977; 73: 436442.
Tucker, WY, Turley, K, Ullyot, DJ, Ebert, PA.Management of symptomatic tetralogy of Fallot in the first year of life. J Thorac Cardiovasc Surg 1979; 78: 494501.
Gay, WA Jr, Ebert, PA.Aorta to right pulmonary artery anastomosis causing obstruction of the right pulmonary artery. Management during correction of tetralogy of Fallot. Ann Thorac Surg 1973; 16: 402410.
Hamilton, JRL, Wilson, N, Dickinson, DF, Walker, DR.Waterston shunt revisited. Br Heart J 1988; 59: 121122. [Abstract]
Fenchel, G, Steil, E, Sebold, TH, Quintenz, R, Apitz, J, Hoffmeister, HE.Early and late results of the modified Waterston shunt with PTFE grafts for palliation of complex congenital cyanotic heart disease in neonates. Thorac Cardiovasc Surg 1991; 39: 268272.
Roberts, WC, Freisinger, GC, Cohen, LS, Mason, DT, Ross, RS.Acquired pulmonary atresia. Total obstruction to right ventricular outflow after systemic to pulmonary arterial anastomoses for cyanotic congenital cardiac disease. Am J Cardiol 1969; 24: 335-45.
Brock, RC.Late results of palliative operations for Fallot's tetralogy. J Thorac Cardiovasc Surg 1974; 67: 511518.
Piehler, JM, Danielson, GK, McGoon, DC, Wallace, RB, Fulton, RE, Mair, DD.Management of pulmonary atresia with ventricular septal defect and hypoplastic pulmonary arteries by right ventricular outflow construction. J Thorac Cardiovasc Surg 1980; 80: 552567.
Lane, I, Treasure, T, Leijala, M, Shinebourne, E, Lincoln, C.Diminutive pulmonary artery growth following right ventricular outflow tract enlargement. Int J Cardiol 1983; 3: 175185.
Kirklin, JW, Barratt-Boyes, BG.Cardiac Surgery. Wiley Medical, New York, 1986, pp 765778.
Parsons, JM, Ladusans, EJ, Qureshi, SA.Growth 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. Br Heart J 1989; 62: 6568.
Castanñeda, AR, Freed, MD, Williams, RG, Norwood, WI.Repair of the tetralogy of Fallot in infancy. J Thorac Cardiovasc Surg 1977; 74: 372381.
Groh, MA, Meliones, JN, Bove, EL, Kirklin, JW, Blackstone, EH, Lupinetti, FM, Snider, AR, Rosenthal, A.Repair of tetralogy of Fallot in infancy. Effect of pulmonary artery size on outcome. Circulation 1991; 84(Suppl IIIyes): III 206III 212.
Gustafson, RA, Murray, GF, Warden, HE, Hill, RC, Rozar, GE Jr. Early primary repair of tetralogy of Fallot. Ann Thorac Surg 1988; 45: 235241.
Touati, GD, Vouhe, PR, Amodeo, A, Pouard, P, Mauriat, P, Leca, F, Neveux, JY.Primary repair of tetralogy of Fallot in infancy. J Thorac Cardiovasc Surg 1990; 99: 396402.
Di Donato, RM, Jonas, RA, Lang, P, Rome, JJ, Mayer, JE Jr, Castanñeda, AR.Neonatal repair of tetralogy of Fallot with and without pulmonary atresia. J Thorac Cardiovasc Surg 1991; 101: 126137.
Kirklin, JW, Blackstone, EH, Jonas, RA, Shimazaki, Y, Kirklin, JK, Mayer, JE Jr, Pacifico, AD, Castanñeda, AR.Morphologic and surgical determinants of outcome events after repair of tetralogy of Fallot and pulmonary stenosis. A two-institution study. J Thorac Cardiovasc Surg 1992; 103: 706723.
Okita, Y, Miki, S, Kusuhara, K, Ueda, Y, Tahata, T, Yamanaka, K, Tamura, T.Palliative reconstruction of right ventricular outflow tract in tetralogy with hypoplastic pulmonary arteries. Ann Thorac Surg 1990; 49: 775779.
Kirklin, JK, Kirklin, JW, Blackstone, EH, Milano, A, Pacifico, AD.Effect of transannular patching on outcome after repair of tetralogy of Fallot. Ann Thorac Surg 1989; 48: 783791.
Batistessa, SA, Robles, A, Jackson, M, Miyamoto, S, Arnold, R, McKay, R.Operative findings after percutaneous pulmonary balloon dilatation of the right ventricular outflow tract in tetralogy of Fallot. Br Heart J 1990; 64: 321324.
Murdoch, IA, Qureshi, SA, dos Anjos, R, Parsons, JM, Baker, EJ, Tynan, MJ.Hypercyanotic spells caused by antegrade catheterization of the pulmonary arteries in tetralogy of Fallot. Cardiol Young 1991; 1: 136140.
Lamb, RK, Qureshi, SA, Arnold, R.Pulmonary artery tear following balloon valvuloplasty in Fallot's tetralogy. Int J Cardiol 1987; 15: 347349.

Keywords

Efficacy and safety of balloon dilation as palliative treatment for tetralogy of Fallot

  • Gurleen K. Sharland (a1), Shakeel A. Qureshi (a1), Edmund J. Ladusans (a1), Jonathon M. Parsons (a1), Edward J. Baker (a1), Philip B. Deverall (a1) and Michael Tynan (a1)...

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