Initial palliation in symptomatic patients with complex Tetralogy of Fallot

  • Dr Zdenka Reinhardt, Birmingham Children’s Hospital-NHS Trust, UK, United Kingdom
  • Dr Oliver Stumper, Birmingham Children’s Hospital-NHS Trust,, United Kingdom
  • Dr Paul Miler, Birmingham Children’s Hospital-NHS Trust,, United Kingdom
  • Dr Vinay Bhole, Birmingham Children’s Hospital-NHS Trust,, United Kingdom
  • John Stickley, Birmingham Children’s Hospital-NHS Trust,, United Kingdom
  • Mr Douglas Wall, Birmingham Children’s Hospital-NHS Trust,, United Kingdom
  • Dr John Wright, Birmingham Children’s Hospital-NHS Trust,, United Kingdom
  • Dr Joseph De Giovanni, Birmingham Children’s Hospital-NHS Trust,, United Kingdom

    • Objective
    To evaluate the effectiveness of RVOT stenting in symptomatic neonates and infants with complex TOF physiology.
    Method
    Retrospective data analysis of RVOT stent implantation as a primary procedure between 2005 and 2008.
    Results
    Eight patients underwent primary RVOT stenting over the 3.7 year period. Four had 2 stents implanted during the first procedure due to instability or inadequate cover of the entire length of the infundibulum. A further 2 required repeat stenting subsequently.
    Indications for stenting were severe cyanosis and spells (n=6), TOF with cAVSD (n=2). Four patients suffered from an associated genetic syndrome.
    Patient’s median age at stenting was 66 days (23-373), median weight 3.8 kg (1.75-8 kg). Pulmonary vasculature was hypoplastic in all with a mean pulmonary valve diameter of 4.5 mm, RPA diameter of 3.2 mm and LPA of 3 mm.
    Stents implanted were premounted Liberte coronary balloon expandable stents (Boston Scientific) in all (n=8), peripheral vascular Jomed (Abbott) in 1 and Genesis (Cordis) in 1.
    RVOT stenting improved systemic oxygen saturations from a median of 75% (40-82) to 90% (81-97) [p < 0.05].
    There were two major complications: 1 perforation and tamponade requiring emergency RVOT patch surgery, 1 transient pulmonary oedema. There were no deaths. Three patients required re-intervention, 2 catheter, 1 surgery. One patient had subsequent complete repair, with the others awaiting further management.
    Conclusion
    Stenting of the RVOT is a feasible and effective palliation and offers a promising new treatment option in the initial management of patients with complex Tetralogy of Fallot.