Faculty Collaboration Database

Stenting of the right ventricular outflow tract in the high-risk infant with cyanotic teratology of Fallot. Pediatr Cardiol 2014 Mar;35(3):423-30

Date

10/08/2013

Pubmed ID

24096718

DOI

10.1007/s00246-013-0796-z

Scopus ID

2-s2.0-84897599274 (requires institutional sign-in at Scopus site)   29 Citations

Abstract

Neonatal tetralogy of Fallot (TOF) repair carries an increased risk of low birthweight or premature infants. Studies are investigating stents in the right ventricular outflow tract (RVOT) as an alternative to aortopulmonary shunts. The authors review their institutional experience with RVOT stenting in the high-risk infant with TOF. Data on sequential patients who received RVOT stents were reviewed, with collection of their surgical, echocardiographic, and catheterization data. Size-matched control subjects were identified and outcomes compared. Six infants went to the catheterization lab for RVOT stenting from 2008 to 2010. Five of these patients had placement of an RVOT stent after balloon dilation. The median saturations were 71% on 48% fraction of inspired oxygen (FiO2), with improvement to 94% (p < 0.001) on 39% FiO2 24 h after stent placement. As shown by echocardiography, the diameter of the median right pulmonary artery (RPA) was 2.6 mm (z-score, -3.3), and the diameter of the left pulmonary artery (LPA) was 2.0 mm (z-score, -4.5). Repeat echocardiography before surgery showed a statistically significant increase in RPA and LPA size as well as a modified McGoon ratio (p < 0.05). Four of the five patients subsequently underwent TOF repair. No stent fractures occurred. One patient had repair 10 days after stent placement secondary to stent malposition and tricuspid valve injury. The authors' experience with stents in the RVOT of TOF patients has yielded good results, with significant improvement in oxygen saturations. Patients had successful elective surgical repair and stent removal without longer cardiopulmonary bypass times or recognizable complications compared with shunted patients.

Author List

Castleberry CD, Gudausky TM, Berger S, Tweddell JS, Pelech AN

Author

Todd M. Gudausky MD Associate Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Cardiac Catheterization
Cyanosis
Echocardiography
Female
Humans
Infant
Infant, Newborn
Male
Stents
Tetralogy of Fallot
Treatment Outcome
Ventricular Outflow Obstruction