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Hypercyanotic spells caused by antegrade catheterization of the pulmonary arteries in tetralogy of Fallot: fact or fiction?

Published online by Cambridge University Press:  19 August 2008

Ian A. Murdoch ,
Shakeel A. Qureshi ,
Rue Dos Anjos ,
Jonathan M. Parsons ,
Edward J. Baker  and
Michael J. Tynan
Ian A. Murdoch
Affiliation:
Department of Paediatric Cardiology, Guy's Hospital, London
Shakeel A. Qureshi*
Affiliation:
Department of Paediatric Cardiology, Guy's Hospital, London
Rue Dos Anjos
Affiliation:
Department of Paediatric Cardiology, Guy's Hospital, London
Jonathan M. Parsons
Affiliation:
Department of Paediatric Cardiology, Guy's Hospital, London
Edward J. Baker
Affiliation:
Department of Paediatric Cardiology, Guy's Hospital, London
Michael J. Tynan
Affiliation:
Department of Paediatric Cardiology, Guy's Hospital, London
*
Dr. S.A. Qureshi, Department of Paediatric Cardiology, Guy's Hospital, St. Thomas's Street. London SEI 9RT, United Kingdom
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Summary

Between January 1985 and March 1990, 66 children with the tetralogy of Fallot underwent 85 cardiac catheterization procedures. The mean age at first procedure was 2.5 years (range 0.1–;14.4 years) and the mean weight was 10.4 kg ( range 2.4–36.0 kg). Diagnostic cardiac catheterization was performed in 60 procedures and balloon dilatation in 25. Hypercyanotic spells had occurred prior to 24 (28%) of the procedures (all the patients being on propranolol) and a systemic-to-pulmonary arterial shunt had been constructed before 28 (33%) procedures. Of the procedures, 54 (64%) were performed under local and 31(36%) under general anesthesia. The pulmonary trunk was entered antegradely in 52 procedures, retrogradely through a shunt in 6 and not entered in 27. Balloon dilatation was performed under general anesthesia on 25 occasions. No procedure was abandoned because of a cyanotic spell. Nine (11%) spells occurred during 86 procedures, one of the procedures being postponed because ofa spell occurring after premedication, the procedure and not, therefore, continuing to catheterization. Five spells occurred before the catheter was positioned in the heart, 2 spells occurred during catheterization. Of the spells, eight occurred during procedures in children who had not had previous shunts. Antegrade entry into the pulmonary trunk in the group with shunts was associated with no spells compared with 6/38 (18%) in the group not having undergone surgery (p<0.l). In the group not undergoing surgery, when the pulmonary trunk was not entered, 1 (5%) spell occurred during 19 procedures compared with 6/38 (18%) when the pulmonary trunk was entered (p<0.4). The only clinically important factor which significantly influenced the incidence of spells was the use of general anesthesia, which was associated with 6/31 (19%) spells compared with local anesthesia which was associated with 2/54 (4%) spells (p<0.026).

Type
Original Articles
Information
Cardiology in the Young , Volume 1 , Issue 2 , April 1991 , pp. 136 - 140
Copyright
Copyright © Cambridge University Press 1991

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References

1.Qureshi, SA, Kirk, CR, 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
2.Wood, P. Symposium on Congenital Heart Disease-Attacks of Deeper Cyanosis and Loss of Consciousness (Syncope) in Fallot's Tetralogy. Br Heart J 1958; 20: 282–286.Google Scholar
3.Braudo, JL, Zion, MM. Cyanotic spells and loss of conscious ness induced by cardiac catheterization in patients with Fallot's Tetralogy. Am Heart J 1960; 59: 10–18.CrossRefGoogle Scholar
4.Anderson, RH, Macartney, FJ, Shinebourne, EA, Tynan, M. In Paediatric Cardiology. 1st ed. Churchill Livingstone, Edin burgh, 1987, pp 765–98.Google Scholar
5.Guntheroth, WG, Kawabori, I. “Tetrad of Fallot”. In: Moss, AJ, Adams, FH and Emmanuouilides, GC (eds). Heart Disease in Infants, Children and Adolescents. 2nd ed., Williams & Wilkins, Baltimore, 1979, pp 276–289.Google Scholar
6.Honey, M, Chamberlain, DA, Howard, H. The effect of betasympathetic blockade on arterial oxygen saturation in Fallot's tetralogy. Circulation 1964; 30: 501–510.Google Scholar
7.Greely, WJ, Stanley, TE, Ungerleider, RM, Kisslo, JA. Inrraoperative hypoxemic spells in the tetralogy of Fallot. An echocardiographic analysis ofdiagnosis and treatment. Anesth Analg 1989; 69: 815–819.Google Scholar
8.Shaddy, RE, Viney, J, Judd, yE, McGough, EC. Continuous intravenous phenylephrine infusion for the treatment of hypoxemic spells in tetralogy of Fallot. J Pediatr 1989; 114: 468–470.Google Scholar
9.Ponce, FE, Williams, LC, Webb, HM et al. Propranolol palliation of the tetralogy of Fallot: experience with longterm drug treatment in paediatric patients. Pediatrics 1973; 52: 100–108.Google Scholar
10.Garson, A, Gillette, PC, McNamara, DG. Propranolol the preferred palliation for tetralogy of Fallot. Am J Cardiol 1981; 47: 1099–1104.Google Scholar
11.Hickey, PR, Hansen, DD, Cramolini, GM, Vincent, RN, Lang, P. Pulmonary and systemic haemodynamic responses to keramine in infants with normal and elevated pulmonary vascular resistance. Anesthesiology 1985; 62: 287–292.CrossRefGoogle ScholarPubMed
12.Hickey, PR, Hansen, DD, Strafford, M. Pulmonary and systemic haemodynamic effects of nitrous oxide in infants with normal and elevated pulmonary vascular resistance. Anesthe siology 1986; 65: 374–378.Google Scholar