Balloon valvuloplasty as an initial palliation in the treatment of newborns and young infants with severely symptomatic tetralogy of Fallot.
BACKGROUND
Balloon valvuloplasty in infants with symptomatic tetralogy of Fallot (TOF) may increase the pulmonary flow and prompt the growth of pulmonary arteries.


METHODS
From 1994 to 2002, percutaneous transluminal balloon valvuloplasty (PTPV) was performed in 22 consecutive newborns and young infants (<3 months of age) with TOF. The indication included severe hypoxemia (systemic oxygen saturation below 75%, 10 cases) and repeated hypoxic spells (12 cases). The age at PTPV was 8-88 days (38 +/- 34, median 27) and the body weight 2-5 kg (3.45 +/- 1.15, median 3). A balloon catheter (4- 7 mm in diameter and 2 cm in length) was used to dilate the pulmonary valve.


RESULTS
No major procedure-related complications occurred. The systemic oxygen saturation increased significantly (14 +/- 9%). A subsequent palliative shunt operation was avoided in 12 patients (54.5%), but 10 still needed operation (median 11 days after the PTPV). The presence of recurrent hypoxic spells before PTPV was the most important indicator for PTPV failure (p = 0.02).


CONCLUSIONS
PTPV was safe and effective for symptomatic newborns and young infants with TOF, but a palliative shunt operation was still needed due to short effect, especially in those with recurrent spells before the dilation.
Wu
En-Ting
ET
Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan, ROC.
Wang
Jou-Kou
JK
Lee
Wen-Lee
WL
Chang
Chien-Chih
CC
Wu
Mei-Hwan
MH
D002404:Catheterization; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007229:Infant Welfare; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000209:etiology; D011651:Pulmonary Artery / Q000601:surgery; D011664:Pulmonary Valve / Q000601:surgery; D012720:Severity of Illness Index; D013771:Tetralogy of Fallot / Q000628:therapy*; D013995:Time; D016896:Treatment Outcome