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Stenting of the right ventricular outflow tract in symptomatic neonatal tetralogy of Fallot

  • Nikolaus A. Haas (a1), Thorsten K. Laser (a1), Axel Moysich (a1), Ute Blanz (a2) and Eugen Sandica (a2)...

Abstract

There is ongoing debate regarding the initial management of symptomatic neonates with tetralogy of Fallot. Although neonatal repair can be performed with low mortality, it is associated with increased morbidity and long-term impact on right ventricular performance. Traditionally, the modified Blalock–Taussig shunt remains the palliative procedure of choice. Differential pulmonary artery flow may occur and subsequently result in underdevelopment and distortion of pulmonary vessels. Transcatheter therapy was previously limited to balloon valvulotomy when the obstruction is predominantly at the pulmonary valve level. Stenting of the right ventricular outflow tract can enable adequate forward flow; however, pulmonary regurgitation may impact on right ventricular performance and cardiac output. Stenting of the right ventricular outflow tract with valve sparing placement of the stent thus treating the underlying pathophysiology of the hypercyanotic spells provides a safe and effective management strategy, improving arterial oxygen saturation, avoiding pulmonary regurgitation and encouraging pulmonary artery growth.

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Corresponding author

Correspondence to: Dr N. A. Haas, MD, PhD, Department for Pediatric Cardiology/Congenital Heart Defects, Centre for Congenital Heart Defects Heart and Diabetes Centre North-Rhine, Westfalia Georgstrasse, 11 D-32545 Bad Oeynhausen, Germany. Tel: +49 0 5731 97 3620; Fax: +49 0 5731 97 2131; E-mail: nikhaas@hdz-nrw.de

References

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