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Palliative balloon valvoplasty of the pulmonary valve in tetralogy of Fallot

Published online by Cambridge University Press:  19 August 2008

Ikram Massoud ,
Adel Imam ,
Ahmed Mabrouk ,
Nader Boutros ,
Ashraf Kassem ,
Ahmed Daouod ,
Mahmoud Abd  and
El Hakem
Ikram Massoud*
Affiliation:
Department of Pediatric Cardiology, National Heart Institute, Imbaba, Giza, Egypt
Adel Imam
Affiliation:
Department of Pediatric Cardiology, National Heart Institute, Imbaba, Giza, Egypt
Ahmed Mabrouk
Affiliation:
Department of Pediatric Cardiology, National Heart Institute, Imbaba, Giza, Egypt
Nader Boutros
Affiliation:
Department of Pediatric Cardiology, National Heart Institute, Imbaba, Giza, Egypt
Ashraf Kassem
Affiliation:
Department of Pediatric Cardiology, National Heart Institute, Imbaba, Giza, Egypt
Ahmed Daouod
Affiliation:
Department of Pediatric Cardiology, National Heart Institute, Imbaba, Giza, Egypt
Mahmoud Abd
Affiliation:
Department of Pediatric Cardiology, National Heart Institute, Imbaba, Giza, Egypt
El Hakem
Affiliation:
Department of Pediatric Cardiology, National Heart Institute, Imbaba, Giza, Egypt
*
Dr Ikram Massoud, Head, Department of Pediatric Cardiology, National Heart Institute, Imbaba, Giza, Egypt. Tel./Fax: 202–3479893
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Abstract

Balloon dilation of the pulmonary valve was performed in 54 patients with tetralogy of Fallot with severe cyanosis, high haematocrit and severe valvar pulmonary stenosis. Clinical, echocardiographic, angiographic, and haemodynamic data were analyzed before and after the procedure. After balloon dilation, the systemic oxygen saturation increased from a mean value of 66% to 85<%. The mean value of the haematocrit before dilation was 55 + 13, and decreased to 47 after dilation (p < 0.002) in 2 months follow-up. Balloon dilation increased the size of the pulmonary valvar orifice from a mean value of 9 + 5mm to 11.5 + 2mm (p < 0.005). The mean Z score of the pulmonary valves, which was -3 + 1.3 before dilation, increased to -1.1 + 1.1 immediately after the procedure (p < 0.05).

The size of the right and left pulmonary arteries increased after dilation from 9mm to 10 mm, and from 8.7 + 2.4mm to 9.8 + 2.3mm, respectively (p <0.05). The comparable mean Z scores increased from -2.8 + 1.9 SD to -1.8 + 1.4 SD, and from -2.4 + 1.9 SD to -1.5 + 1.6 SD for the right and left branches, respectively (p < 0.05).

In patients with stenosis at the bifurcation of the pulmonary trunk and hypoplasia of the left artery, successful dilation of the pulmonary valve lead to an increase of flow and improvement in size of the hypoplas-tic segment.

In conclusion, initial balloon dilation of the pulmonary valve in tetralogy of Fallot resulted in increase of the Z score for the pulmonary valve and improved antegrade pulmonary blood flow, inducing growth of the pulmonary arteries and ameliorating the anatomic and physiologic preoperative condition.

Keywords

Balloon valvoplastyPallet‘s tetralogycardiac catheterization
Type
Original Articles
Information
Cardiology in the Young , Volume 9 , Issue 1 , January 1999 , pp. 24 - 36
Copyright
Copyright © Cambridge University Press 1999

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References

1.Lillehei, CS, Cohen, M, Warden, HE, Read, RC, Aust, JB, Dewall, RA, Varco, AR.Direct vision intracardiac surgical correction of tetralogy of Fallot, pentalogy of Fallot, and pulmonary atresia defects. Report of the first ten cases. Ann Surg 1995; 142: 418–455.CrossRefGoogle Scholar
2.Bove, EL, Byrum, CJ, Thomas, FD, Kavey, RE, Sondheimer, HM, Blackman, MS, Parker, FB Jr. The influence of pulmonary insufficiency on ventricular function following repair of tetralogy of Fallot. Evaluation using radionuclide ventriculography. J Thorac Cardio Vase Surg 1983; 85: 691–696.CrossRefGoogle ScholarPubMed
3.Lange, PE, Onnasch, DGW, Bernhand, , Heintzen, PH.Left ventricular and right ventricular adaptation to right ventricular over load before and after surgical repair of tetralogy of Fallot. AmJ Cardiol 1982; 50: 786.CrossRefGoogle Scholar
4.Lin, TK, Diehl, AM, Kiltte, CF.Hemodynamic complication in tetralogy of Fallot after pulmonary valvectomy or infundibulectomy (Brock procedure). Am Heart J 1958; 65: 288.CrossRefGoogle Scholar
5.Gale, AW, Arciniegas, E, Green, EW, Blackstone, EH, Kirklin, JWGrowth of the pulmonary annulus and pulmonary arteries after Blalock. Taussig shunt. J Thorac Cardiovasc Surg 1979; 77: 459–465.CrossRefGoogle Scholar
6.Kirklin, JW, Blackstone, EH, Pacifico, AD, Brown, RN, Bargeron, LM.Routine primary repair versus two stage repair of Fallot tetralogy. Circulation 1979; 60: 373–386.CrossRefGoogle Scholar
7.Kirklin, JW, Barratt-Boyes, BG.Cardiac Surgery. Wiley Medical, New York, 1986: 767–768.Google Scholar
8.Fabricius, J, Hansen, PF, Lindeneg, O.Pulmonary atresia developing after shunt operation for Pallet–s tetralogy. Br Heart J 1961; 23: 556–558.CrossRefGoogle Scholar
9.Roberts, WC, Foreisinger, GG, Cohen, LS, Mason, DT, Ross, RS. Acquired pulmonary atresia. Total obstruction to right ventricular outflow tract after systemic to pulmonary arterial anastomsis for cyanotic congenital cardiac disease. Am J Cardiol 1969; 24: 335.CrossRefGoogle Scholar
10.Kan, JS, White, RI, Mitchell, SE, Gardner, TJ.Percutaneous balloon valvuloplasty:a new method for treating congenital pulmonary valve stenosis. N Engl J Med 1982; 307: 540–542.CrossRefGoogle ScholarPubMed
11.Allen, H.D, Driscoll, DJ, Fricker, FJ.Guideline for pediatric therapeutic catheterization. Circulation 1991; 84: 2248–2258.CrossRefGoogle Scholar
12.Shimazaki, Y, Blackstone, EH, Kirklin, JW, Jonas, RA, Mandell, V, Colvin, EVThe dimensions of right ventricular outflow tract and pulmonary arteries in tetralogy of Fallot and pulmonary stenosis. J Thorac Cardiovasc Surg 1992; 103: 692–705.CrossRefGoogle ScholarPubMed
13.Sievers, HH, Onnasch, DG, Lange, PE, Bernhard, A, Heintzen, PH.Dimensions of great arteries, semilunar valve roots, and right ventricular outflow tract during growth:normative angiocardiographic data. Peditar Cardiol 1983; 4: 189–196.CrossRefGoogle ScholarPubMed
14.Bini, M, Naftel, DC, Blackstone, EH.Measurements of Cineagiograms of apparently normal children. In: Kirklin, JW, Barratt Boyes, BG, eds. Cardiac Surgery. Churchill Livingstone, New York, 1993: 3–57.Google Scholar
15.Murphy, JG, Gersch, BJ, Phil, CB, Mair, DD, Fuster, V, McGoon, MD, llstrup, DM, McGoon, dc, Kirklin, JW, Danielson, GK.Long term outcome in patients undergoing surgical repair of tetralogy of Fallot. N Engl J Med 1993; 329: 593–594.CrossRefGoogle ScholarPubMed
16.Walsh, EP, Rockenmacher, S, Keane, JF, Hougen, TJ, Lock, JE, Castaneda, AR.Late results in patients with tetralogy of Fallot repaired during infancy. Circulation 1988; 77: 1062–1067.CrossRefGoogle ScholarPubMed
17.Bove, El, Lupinetti, FM. Tetralogy of fallot. In: Mavroudis, C, Backer, CL, (eds). Pediatric cardiac Surgery. Mosby. Year Book Inc, St. Louis 1994, pp 276–291.Google Scholar
18.Kirklin, JW, Barratt-Boyes, BG. Ventricular Septal defect and pulmonary stenosis or atresia, section l:tetralogy of fallot with pulmonary stenosisiresults. In: Kirklin, JW, Barratt Boyes, BG, eds. Cardiac Surgery. Churchill Livingstone, New York, 1993: 919–942.Google ScholarPubMed
19.Kirklin, JW, Blackstone, EH, Jonas, RA, Shimazaki, Y, Kirklin, JK, Mayer, JE, Pacifico, AD, Castaneda, AR.Morphologic and surgical determinants of outcome events after repair of tetralogy of Fallot and pulmonary stenosis: a two institution study. J Thorac Cardiovascular Surg 1992; 103: 706–723.CrossRefGoogle ScholarPubMed
20.Mizuno, A, Satof, , Hasegawa, T. Acquired obsruction of right ventricular outflow tract in tetralogy of Fallot after Blalock. Taussig anastomosis. Jpn Heart J 1970; 11: 113.CrossRefGoogle ScholarPubMed
21.Nakata, S, Imai, Y, Takanashi, Y, Kurosawa, H, Tezuka, K, Nakazawa, M, Ando, M, Takao, A.A new method for the quantitative standardization of cross sectional area of the pulmonary arteries in congenital heart disease with decreased pulmonary blood flow. J Thorac Cardiovasc Surg 1984; 88: 610–619.CrossRefGoogle ScholarPubMed
22.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
23.Battistessa, 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. British Heart J 1990; 64: 321–324.CrossRefGoogle ScholarPubMed
24.Sreeram, N, Saleem, M, Jackson, M, Peart, J, Mckay, R, Arnold, R, Walsh, K.Results of balloon valvuloplasty as a palliative procedure in tetralogy of Fallot. J Am Coll Cardiol 1991; 18: 159–165.CrossRefGoogle ScholarPubMed
25.Guntheroth, WG.Balloon valvuloplasty as palliation in tetralogy of Fallot. J Am Coll Cardiol 1992; 19: 234–237.CrossRefGoogle Scholar
26.Matsuoka, S, Ushiroguchi, Y, Kubo, M, Tatara, K, Kitagawa, T, Katoh, I, Kuroda, Y.Balloon pulmonary valvuloplasty for infants with severe tetralogy of Fallot. Jpn Heart J 1993; 34: 643–651.CrossRefGoogle ScholarPubMed
27.Piechaud, JF, Delogu, AB, Iserin, L, Aggoun, Y, Cohen, L, Sidi, D, Kachaner, J. Palliative treatment of tetralogy of fallot by percutaneous dilatation of the right ventricular out flow tract. A study 40 cases. Arch Mai Coeur 1994; 87: 573–579.Google ScholarPubMed
28.Heusch, A, Tannous, A, Rammos, .S, Krogmann, ON, Bourgeois, M.Balloon valvuloplasty of pulmonary valve in tetralogy of Fallot: influence on pulmonary artery size and oxygen saturation. Cardiol Young 1994; 4 (Suppl 1):7a. (Abstract).Google Scholar
29.Sluysmans, T, Neven, B, Rubay, J, Lintermans, J, Ovaert, C, Mucumbitsi, JShango, P, Stijns, M, Vliers, A.Early Balloon dilatation of pulmonary valve in infants with tetralogy of Fallot. Circulation 1995; 91: 1506–1511.CrossRefGoogle ScholarPubMed
30.Godart, F, Key, C, Prat, A, Muilwijk, C, Francart, C, Vaksmann, G, Breviere, CM.Early and late results and the effects on pulmonary arteries of balloon dilatation of the right ventricular outflow tract in tettalogy of Fallot. Eur Heart J 1998 Apr; 19 (4): 595–600.CrossRefGoogle ScholarPubMed
31.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
32.Ring, JC, Kulik, TJ, Burke, BA, Lock, JE.Morphologic changes induced by dilation of the pulmonary valve annulus with over large balloons in normal newborn lambs. Am J Cardiol 1985; 55: 210–214.CrossRefGoogle Scholar