Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-22T11:56:29.787Z Has data issue: false hasContentIssue false
  • English
  • Français

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: [email protected]
Get access Rights & Permissions [Opens in a new window]

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
Check for updates
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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

Bauser-Heaton, H, Borquez, A, Han, B, et al. Programmatic approach to management of tetralogy of fallot with major aortopulmonary collateral arteries: a 15-year experience with 458 patients. Circ Cardiovasc Interv. 2017; 10: e004952.10.1161/CIRCINTERVENTIONS.116.004952CrossRefGoogle ScholarPubMed
Savla, JJ, Faerber, JA, Huang, Y-SV, et al. 2-year outcomes after complete or staged procedure for tetralogy of fallot in neonates. J Am Coll Cardiol. 2019: 74: 1570–9.10.1016/j.jacc.2019.05.057CrossRefGoogle ScholarPubMed
Ghimire, LV, Chou, F-S, Devoe, C, Moon-Grady, A. Comparison of in-hospital outcomes when repair of tetralogy of fallot is in the neonatal period versus in the post-neonatal period. Am J Cardiol. 2020; 125: 140–5.10.1016/j.amjcard.2019.09.025CrossRefGoogle ScholarPubMed
Kreutzer, J, Perry, SB, Jonas, RA, Mayer, JE, Castañeda, AR, Lock, JE Tetralogy of Fallot with diminutive pulmonary arteries: preoperative pulmonary valve dilation and transcatheter rehabilitation of pulmonary arteries. J Am Coll Cardiol. 1996; 27: 1741–7.10.1016/0735-1097(96)00044-7CrossRefGoogle ScholarPubMed
Mainwaring, RD, Patrick, WL, Roth, SJ, et al. Surgical algorithm and results for repair of pulmonary atresia with ventricular septal defect and major aortopulmonary collaterals. J Thorac Cardiovasc Surg. 2018; 156: 1194–204.10.1016/j.jtcvs.2018.03.153CrossRefGoogle ScholarPubMed
Mainwaring, RD, Punn, R, Reddy, VM, Hanley, FL. Surgical reconstruction of pulmonary stenosis with ventricular septal defect and major aortopulmonary collaterals. Ann Thorac Surg. 2013; 95: 1417–21.10.1016/j.athoracsur.2013.01.007CrossRefGoogle ScholarPubMed
Liava’a, M, Brizard, CP, Konstantinov, IE, et al. Pulmonary atresia, ventricular septal defect, and major aortopulmonary collaterals: neonatal pulmonary artery rehabilitation without unifocalization. Ann Thorac Surg. 2012; 93: 185–91.10.1016/j.athoracsur.2011.08.082CrossRefGoogle ScholarPubMed
Gladman, G, McCrindle, BW, Williams, WG, Freedom, RM, Benson, LN. The modified blalock-taussig shunt: clinical impact and morbidity in fallot’s tetralogy in the current era. J Thorac Cardiovasc Surg. 1997; 114: 25–30.CrossRefGoogle ScholarPubMed
Quandt, D, Ramchandani, B, Stickley, J, et al. Stenting of the right ventricular outflow tract promotes better pulmonary arterial growth compared with modified blalock-taussig shunt palliation in tetralogy of fallot–type lesions. JACC Cardiovasc Interv. 2017; 10: 1774–84.10.1016/j.jcin.2017.06.023CrossRefGoogle ScholarPubMed
Lopez, L, Colan, S, Stylianou, M, et al. Relationship of echocardiographic Z scores adjusted for body surface area to age, sex, race, and ethnicity: the pediatric heart network normal echocardiogram database. Circ Cardiovasc Imag. 2017; 10:e006979.10.1161/CIRCIMAGING.117.006979CrossRefGoogle Scholar
Nakata, S, Imai, Y, Takanashi, Y, et al. A new method for the quantitative standardization of cross-sectional areas of the pulmonary arteries in congenital heart diseases with decreased pulmonary blood flow. J Thorac Cardiovasc Surg. 1984; 88: 610–9.10.1016/S0022-5223(19)38300-XCrossRefGoogle ScholarPubMed
Quandt, D, Penford, G, Ramchandani, B, Bhole, V, Mehta, C, Stumper, O. Stenting of the right ventricular outflow tract as primary palliation for Fallot-type lesions. J Congenit Cardiol. 2017; 1: 3.10.1186/s40949-017-0005-7CrossRefGoogle Scholar
Petrucci, O, O’Brien, SM, Jacobs, ML, Jacobs, JP, Manning, PB, Eghtesady, P. Risk factors for mortality and morbidity after the neonatal blalock-taussig shunt procedure. Ann Thorac Surg. 2011; 92: 642–52.10.1016/j.athoracsur.2011.02.030CrossRefGoogle ScholarPubMed
Guzzetta, NA, Foster, GS, Mruthinti, N, Kilgore, PD, Miller, BE, Kanter, KR. In-hospital shunt occlusion in infants undergoing a modified blalock-taussig shunt. Ann Thorac Surg. 2013; 96: 176–82.10.1016/j.athoracsur.2013.03.026CrossRefGoogle ScholarPubMed
Stumper, O, Ramchandani, B, Noonan, P, et al. Stenting of the right ventricular outflow tract. Heart. 2013: 99: 1603–8.10.1136/heartjnl-2013-304155CrossRefGoogle ScholarPubMed
Quandt, D, Ramchandani, B, Penford, G, et al. Right ventricular outflow tract stent versus BT shunt palliation in Tetralogy of Fallot. Heart. 2017; 103: 1985–1991.Google ScholarPubMed
Sandoval, JP, Chaturvedi, RR, Benson, L, et al. Right ventricular outflow tract stenting in tetralogy of fallot infants with risk factors for early primary repair. Circ Cardiovasc Interv 2016; 9:e003979.10.1161/CIRCINTERVENTIONS.116.003979CrossRefGoogle ScholarPubMed