Hostname: page-component-586b7cd67f-gb8f7 Total loading time: 0 Render date: 2024-11-26T21:55:36.421Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  19 August 2008

Gurleen K. Sharland ,
Shakeel A. Qureshi ,
Edmund J. Ladusans ,
Jonathon M. Parsons ,
Edward J. Baker ,
Philip B. Deverall  and
Michael Tynan
Gurleen K. Sharland
Affiliation:
From the Department of Paediatric Cardiology, Guy's Hospital, London
Shakeel A. Qureshi*
Affiliation:
From the Department of Paediatric Cardiology, Guy's Hospital, London
Edmund J. Ladusans
Affiliation:
From the Department of Paediatric Cardiology, Guy's Hospital, London
Jonathon M. Parsons
Affiliation:
From the Department of Paediatric Cardiology, Guy's Hospital, London
Edward J. Baker
Affiliation:
From the Department of Paediatric Cardiology, Guy's Hospital, London
Philip B. Deverall
Affiliation:
From the Department of Paediatric Cardiology, Guy's Hospital, London
Michael Tynan
Affiliation:
From the Department of Paediatric Cardiology, Guy's Hospital, London
*
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.
Get access Rights & Permissions [Opens in a new window]

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.

Keywords

Balloon dilationtetralogy of Fallotinterventional cardiac catheterization
Type
Original Articles
Information
Cardiology in the Young , Volume 4 , Issue 3 , July 1994 , pp. 255 - 261
Copyright
Copyright © Cambridge University Press 1994

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

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: 232–235.CrossRefGoogle ScholarPubMed
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: 159–165.CrossRefGoogle ScholarPubMed
Boucek, MM, Webster, HE, Orsmond, GS, Ruttenburg, HD.Balloon pulmonary valvotomy: palliation for cyanotic heart disease. Am Heart J 1988; 115: 318–322.CrossRefGoogle ScholarPubMed
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: 362–367.CrossRefGoogle Scholar
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: 542–552.CrossRefGoogle Scholar
Rao, PS, Brais, M.Balloon pulmonary valvuloplasty for congenital cyanotic heart defects. Am Heart J 1988; 115: 1105–1110.Google ScholarPubMed
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: 117–119.Google ScholarPubMed
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: 359–363.CrossRefGoogle Scholar
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: 917–922.CrossRefGoogle Scholar
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: 117–121.CrossRefGoogle ScholarPubMed
Alfieri, O, Locatelli, G, Bianchi, T, Vanini, V, Parenzan, L.Repair of tetralogy of Fallot after Waterston anastomosis. J Thorac Cardiovasc Surg 1979; 77: 826–831.CrossRefGoogle ScholarPubMed
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: 715–720.CrossRefGoogle ScholarPubMed
Smith, VC, Caggiano, AV, Knauf, DG, Alexander, JA.The Blalock-Taussig shunt in the newborn infant. J Thorac Cardiovasc Surg 1991; 102: 602–605.CrossRefGoogle ScholarPubMed
Kirklin, JW, Bargeron, LM Jr, Pacifico, AD.The enlargement of small pulmonary arteries by preliminary palliative operations. Circulation 1977; 56: 612–617.CrossRefGoogle ScholarPubMed
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: 459–465.CrossRefGoogle Scholar
Alfieri, O, Blackstone, EH, Parenzan, L.Growth of the pulmonary annulus and pulmonary arteries after the Waterston anastomosis. J Thorac Cardiovasc Surg 1979; 78: 440–444.CrossRefGoogle Scholar
Gill, CC, Moodie, DS, McGoon, DC.Staged surgical management of pulmonary atresia with diminutive pulmonary arteries. J Thorac Cardiovasc Surg 1977; 73: 436–442.CrossRefGoogle ScholarPubMed
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: 494–501.CrossRefGoogle Scholar
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: 402–410.CrossRefGoogle ScholarPubMed
Hamilton, JRL, Wilson, N, Dickinson, DF, Walker, DR.Waterston shunt revisited. Br Heart J 1988; 59: 121–122. [Abstract]Google Scholar
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: 268–272.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Brock, RC.Late results of palliative operations for Fallot's tetralogy. J Thorac Cardiovasc Surg 1974; 67: 511–518.CrossRefGoogle ScholarPubMed
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: 552–567.CrossRefGoogle ScholarPubMed
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: 175–185.CrossRefGoogle ScholarPubMed
Kirklin, JW, Barratt-Boyes, BG.Cardiac Surgery. Wiley Medical, New York, 1986, pp 765–778.Google Scholar
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: 65–68.CrossRefGoogle Scholar
Castanñeda, AR, Freed, MD, Williams, RG, Norwood, WI.Repair of the tetralogy of Fallot in infancy. J Thorac Cardiovasc Surg 1977; 74: 372–381.CrossRefGoogle Scholar
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 206–III 212.Google ScholarPubMed
Gustafson, RA, Murray, GF, Warden, HE, Hill, RC, Rozar, GE Jr. Early primary repair of tetralogy of Fallot. Ann Thorac Surg 1988; 45: 235–241.CrossRefGoogle ScholarPubMed
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: 396–402.CrossRefGoogle ScholarPubMed
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: 126–137.CrossRefGoogle ScholarPubMed
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: 706–723.CrossRefGoogle ScholarPubMed
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: 775–779.CrossRefGoogle ScholarPubMed
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: 783–791.CrossRefGoogle ScholarPubMed
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: 321–324.CrossRefGoogle Scholar
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: 136–140.CrossRefGoogle Scholar
Lamb, RK, Qureshi, SA, Arnold, R.Pulmonary artery tear following balloon valvuloplasty in Fallot's tetralogy. Int J Cardiol 1987; 15: 347–349.CrossRefGoogle Scholar