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Stenting of the right ventricular outflow tract as an initial intervention in Tetralogy of Fallot with pulmonary stenosis and major aortopulmonary collateral arteries

Published online by Cambridge University Press:  04 December 2020

Mohammad Abumehdi Open the ORCID record for Mohammad Abumehdi [Opens in a new window] ,
Deepa Sasikumar ,
Milind Chaudhari ,
Vinay Bhole ,
Phil Botha ,
Chetan Mehta  and
Oliver Stumper
Mohammad Abumehdi
Affiliation:
The Heart Unit, Department of Cardiology, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, UK
Deepa Sasikumar
Affiliation:
The Heart Unit, Department of Cardiology, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, UK
Milind Chaudhari
Affiliation:
The Heart Unit, Department of Cardiology, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, UK
Vinay Bhole
Affiliation:
The Heart Unit, Department of Cardiology, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, UK
Phil Botha
Affiliation:
The Heart Unit, Department of Cardiology, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, UK
Chetan Mehta
Affiliation:
The Heart Unit, Department of Cardiology, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, UK
Oliver Stumper*
Affiliation:
The Heart Unit, Department of Cardiology, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, UK
*
Author for correspondence: Dr Oliver Stumper, Department of Cardiology, Birmingham Children’s Hospital, Birmingham, UK. Tel: +44 121 333 9999. E-mail: oliver.stumper@nhs.net
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Abstract

Objectives:

To assess the role of right ventricular outflow tract stenting as the primary intervention in Tetralogy of Fallot with pulmonary stenosis and major aortopulmonary collateral arteries.

Background:

The management of a subset of infants with Tetralogy of Fallot with pulmonary stenosis and major aortopulmonary collateral arteries requires a staged approach including rehabilitation of diminutive native pulmonary arteries, conventionally using an aortopulmonary shunt. We share our experience of pulmonary artery rehabilitation with right ventricular outflow tract stenting.

Methods:

Retrospective review of all patients with Tetralogy of Fallot with pulmonary stenosis who underwent right ventricular outflow tract stenting as primary intervention over an 8-year period.

Results:

Ten patients underwent right ventricular outflow tract stent insertion at a median age of 61 days (interquartile range (IQR) 8.3–155 days). Median weight at stent deployment was 4.2 kg (IQR 3.2–5.7 kg). Oxygen saturations improved from a median of 79% (IQR 76–80%) to 92% (IQR 90–95%), p = 0.012. The median right and left pulmonary artery z score increased from −3.51 (IQR −4.59 to −2.80) and −2.07 (IQR −3.72 to 0.15) to a median of −1.17 (IQR −2.26 to 0.16) p < 0.05, and 0.24 (IQR −1.09 to 1.84) p < 0.05, respectively, at subsequent angiogram. Nine patients underwent further catheterisation. Four patients underwent complete anatomical repair. Only one patient required unifocalisation, as most patients had a native supply to all-important lung segments.

Conclusion:

Right ventricular outflow tract stenting is a useful procedure in the subset of patients with Tetralogy of Fallot with pulmonary stenosis and major aortopulmonary collateral arteries, where native pulmonary arterial growth is required to facilitate repair.

Keywords

congenitalinterventional cardiologyTetralogy of Fallotstenting
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 3 , March 2021 , pp. 452 - 459
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Copyright
© The Author(s), 2020. Published by Cambridge University Press

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