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

Published online by Cambridge University Press:  27 March 2013

Nikolaus A. Haas*
Affiliation:
Department for Pediatric Cardiology/Congenital Heart Defects, Centre for Congenital Heart Defects, 11 D-32545 Bad Oeynhausen, Germany
Thorsten K. Laser
Affiliation:
Department for Pediatric Cardiology/Congenital Heart Defects, Centre for Congenital Heart Defects, 11 D-32545 Bad Oeynhausen, Germany
Axel Moysich
Affiliation:
Department for Pediatric Cardiology/Congenital Heart Defects, Centre for Congenital Heart Defects, 11 D-32545 Bad Oeynhausen, Germany
Ute Blanz
Affiliation:
Department of Surgery for Congenital Heart Defects, Heart and Diabetes Centre North-Rhine-Westfalia, Ruhr University Bochum, Georgstrasse, 11 D-32545 Bad Oeynhausen, Germany
Eugen Sandica
Affiliation:
Department of Surgery for Congenital Heart Defects, Heart and Diabetes Centre North-Rhine-Westfalia, Ruhr University Bochum, Georgstrasse, 11 D-32545 Bad Oeynhausen, Germany
*
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

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.

Type
Brief Reports
Copyright
Copyright © Cambridge University Press 2013 

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