Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-24T02:11:00.788Z Has data issue: false hasContentIssue false
  • English
  • Français

Balloon valvoplasty in infants with tetralogy of Fallot: effects on oxygen saturation and growth of the pulmonary arteries

Published online by Cambridge University Press:  19 August 2008

A. Heusch ,
A. Tannous ,
O. N. Krogmann  and
M. Bourgeois
A. Heusch*
Affiliation:
Department of Paediatric Cardiology, Heinrich-Heine-University, Diisseldorf, Germany
A. Tannous
Affiliation:
Department of Paediatric Cardiology, Heinrich-Heine-University, Diisseldorf, Germany
O. N. Krogmann
Affiliation:
Department of Paediatric Cardiology, Heinrich-Heine-University, Diisseldorf, Germany
M. Bourgeois
Affiliation:
Department of Paediatric Cardiology, Heinrich-Heine-University, Diisseldorf, Germany
*
Andreas Heusch, MD. Department of Paediatric Cardiology, Heinrich-Heine-University, Moorenstrasse 5, D-40001 Dusseldorf PB 101007, Germany. Tel: 211-8117713; Fax: 211-8116287
Get access Rights & Permissions [Opens in a new window]

Abstract

Balloon valvoplasty was undertaken in 27 patients with tetralogy of Fallot for first-stage palli-ation. Indications were arterial saturation of oxygen <80%, hypoxic spells and duct-dependant pulmonary perfusion. The dilation was performed following diagnostic heart catheterization. Saturations improved from 75% ± 8.5 before valvoplasty to 85% ± 8.4 after the procedure, and worsened little to 83% ± 9.6 at follow-up after 3.4 months. The pulmonary valvar orifice was hypoplastic in most patients (Z = — 3.3 ± 1.2), and did not change after the procedure. The cross-sectional area of the pulmonary arteries was diminished initially, reflected by a Nakata index of 186 ± 95 mm2/rn2. After valvoplasty, we found widening of the vessels (Nakata index 225 ± 100 mm2/m2). At follow-up no further growth of the arteries was observed (Nakata index 209 ±109 mm2/m2). The procedure was complicated by hypoxic spells in three patients which were controlled by intravenous propranolol, and deep venous thrombosis in four patients. Our data demonstrate that balloon valvoplasty is feasible for initial palliation in patients with tetralogy of Fallot. It does not, however, produce growth of the pulmonary arteries or of the pulmonary valve.

Keywords

Tetralogy of Fallotpulmonary arteriesoxygen saturationvalvoplasty
Type
Original Articles
Information
Cardiology in the Young , Volume 9 , Issue 1 , January 1999 , pp. 17 - 23
Copyright
Copyright © Cambridge University Press 1999

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Kan, J, White, R, Mitchell, S, Gardner, T.Percutaneous balloon valvoplasty: a new method for treating congenital pulmonary valve stenosis. N Engl J Med 1982; 307: 540–545.Google Scholar
2.Rammos, S, Kramer, H, Trampisch, HJ, Krogmann, O, Kozlik, R, Bourgeois, M.Normalwerte des Wachstums der Pulmonalarterien im Kindesalter. Herz 1989; 14: 348–357.Google Scholar
3.Kirklin, J, Barratt-Boyes, B (eds). Anatomy, dimensions and terminology. In: Cardiac Surgery. London: Churchill Livingstone, 1993, pp 3–60.Google ScholarPubMed
4.Nakata, S, Imai, Y, Takanashi Y A new method for the quantitative standardization of cross sectional areas of the pulmonary arteries in congenital heart disease with decreased pulmonary blood flow. J Thorac Cardiovasc Surg 1984; 88: 610–619.CrossRefGoogle ScholarPubMed
5.Groh, M, Meliones, J, Bove, E, Kirklin, JW, Blackstone, EH, Lupinatti, FM, Snider, AR, Rosenthal, A.Repair of tetralogy of Fallot in infancy. Circulation 1991; 84 (suppl. Ill): 206–212.Google ScholarPubMed
6.Reddy, V, Liddicoat, J, McElhinney, D, Brook, M, Stanger, P, Hanley, L.Routine primary repair of Tetralogy of Fallot in neonates and infants less than three months of age. Ann Thorac Surg 1995; 60: S592–596.CrossRefGoogle ScholarPubMed
7.Stellin, G, Milanesi, O, Rubino, M, Michelion, G, Bianco, R, Moreolo, GS, Boneva, R, Sorbara, C, Casarotto, D.Repair of tetralogy of Fallot in the first six months of live: transatrial versus transventricular approach. Ann Thorac Surg 1995; 60: S588–591.CrossRefGoogle Scholar
8.Kirklin, JW, Barratt-Boyes, B (eds). Ventricular septal defect and pulmonary stenosis or atresia, section 1: tetralogy of Fallot with pulmonary stenosis: results. In: Cardiac Surgery. Churchill Livingstone, New York, 1993, pp 919–942.Google Scholar
9.Kirklin, JW, Blackstone, E, Jonas, R, Shimazaki, Y, Kirklin, JK.Mayer, JE Jr, Pacifico, AD, Castañeda, AR.Morphologic and surgical determinations of outcome events after repair of tetralogy of Fallot and pulmonary stenosis: a two institution study. J Thorac Cardiovasc Surg 1992; 103: 706–723.CrossRefGoogle ScholarPubMed
10.Guyton, RA, Owens, JE, Waumett, JD, Dooley, KJ, Hatcher, CR Jr, Williams WH. The Blalock—Taussig shunt. J Cardiovasc Surg 1983; 85: 917–922.Google ScholarPubMed
11.Newfeld, EA, Waldman, D, Paul, MH, Muster, AJ, Cole, RB, Idriss, F, Riker, WPulmonary vascular disease after systemic- pulmonary arterial shunt operations. Am J Cardiol 1977; 39: 715–720.CrossRefGoogle ScholarPubMed
12.Hwang, B, Lu, J-H, Lee, B-H, Hsieng, J-H, Meng, L.Palliative treatment for tetralogy of Fallot with percutaneous balloon dilatation of right ventricular outflow tract. Jpn Heart J 1995; 36: 751–761.CrossRefGoogle ScholarPubMed
13.Matsuoko, S, Ushiroguchi, Y, Kubo, M, Tatara, K, Kitagawa, T, Katoh, I.Balloon pulmonary Valvoplasty for infants with severe tetralogy of Fallot. Jpn Heart J 1993; 34: 643–651.CrossRefGoogle Scholar
14.Sluysmans, T, Neven, B, Rubay, J, Lintermans, J, Ovaert, C, Mucumbitsi, J, Shango, P, Stijns, M, Vliers, A.Early balloon dilatation of the pulmonary valve in infants with tetralogy of Fallot. Circulation 1995; 91: 1506–1511.Google Scholar
15.Sreeram, N, Saleem, M, Jackson, M, Peart, I, McKay, R, Arnold, R, Walsh, K.Results of balloon pulmonary Valvoplasty as a palliative procedure in tetralogy of Fallot. J Am Col Cardiol 1991; 18: 159–165.Google Scholar
16.Stümper, O, Piéchaud, JF, Bonhoeffer, P, Bonnet, D, Aggoun, Y, Sidi, D, Kachaner, J.Pulmonary balloon Valvoplasty in the palliation of complex cyanotic congenital heart disease. Heart 1996; 76: 363–366.Google Scholar
17.Shimazaki, Y, Blackstone, E, Kirklin, J, Jonas, R, Mandell, V, Colvin, E.The dimension of the right ventricular outflow tract and pulmonary arteries in tetralogy of Fallot and pulmonary stenosis. J Thorac Cardiovasc Surg 1992; 103: 692–705.CrossRefGoogle ScholarPubMed
18.Kreutzer, J, Perry, S, Jonas, R, Mayer, J, Castaneda, A, Lock, J.Tetralogy of Fallot with diminutive arteries: preoperative pulmonary valve dilatation and transcatheter rehabilitation of pulmonary arteries. J Am Col Cardiol 1996; 27: 1741–1747.Google Scholar
19.Parsons, J, Ladusans, E, Qureshi, S.Growth of the pulmonary artery after neonatal balloon dilatation of the right ventricular outflow tract in an infant with tetralogy of Fallot and atri- oventricular septal defect. Br Heart J 1989; 62: 65–68.CrossRefGoogle Scholar
20.Alfieri, O, Blackstone, E, Parenzan, L.Growth of the pulmonary annulus and pulmonary arteries after the Waterston anastomosis. J Thorac Cardiovasc Surg 1979; 78: 440–444.Google Scholar
21.Rudolph, A, Heymann, M, Spitznas, U.Hemodynamic considerations in the development of narrowing of the aorta. Am J Cardiol 1972; 30: 514–525.Google Scholar
22.Hornberger, LK, Sanders, SP, Sahn, DJ, Rice, MJ, Spevak, PJ, Benacerraf, BR, McDonald, RW, Colan, SD.In utero pulmonary artery and aortic growth and potential for progression of pulmonary outflow tract obstruction in tetralogy of Fallot. J Am Coll Cardiol 1995; 25: 739–745.CrossRefGoogle ScholarPubMed
23.Battistessa, S, Robles, A, Jackson, M, Miyamato, S, Arnold, R, McKay, R.Operative findings after percutaneous pulmonary balloon dilatation of the right outflow tract in tetralogy of Fallot. Br Heart J 1990; 64: 321–324.CrossRefGoogle ScholarPubMed
24.Radtke, WInterventional pediatric cardiology: state of the art and future perspective. Eur J Pediatr 1994; 153: 542–547.CrossRefGoogle ScholarPubMed
25.Lamb, R, Qureshi, S, Arnold, R.Pulmonary artery tear following balloon valvoplasty in Pallet–s tetralogy. Int J Cardiol 1987; 15: 347–349.CrossRefGoogle Scholar