title: Transcatheter stenting of the right ventricular outflow tract augments pulmonary arterial growth in symptomatic infants with right ventricular outflow tract obstruction and hypercyanotic spells.
abstract: We retrospectively reviewed all the children with right ventricular outflow tract obstruction, hypoplastic pulmonary annulus, and pulmonary arteries who underwent stenting of the right ventricular outflow tract for hypercyanotic spells at our institution between January, 2008 and December, 2013; nine patients who underwent cardiac catheterisation at a median age of 39 days (range 12-60 days) and weight of 3.6 kg (range 2.6-4.3 kg) were identified. The median number of stents placed was one stent (range 1-4). The median oxygen saturation increased from 60% to 96%. The median right pulmonary artery size increased from 3.3 to 5.5 mm (-2.68 to -0.92 Z-score), and the median left pulmonary artery size increased from 3.4 to 5.5 mm (-1.93 to 0 Z-scores). Among all, one patient developed transient pulmonary haemorrhage, and one patient had pericardial tamponade requiring drainage. Complete repair of tetralogy of Fallot +/- atrioventricular septal defect or double-outlet right ventricle was achieved in all nine patients. Transcatheter stent alleviation of the right ventricular outflow tract obstruction resolves hypercyanotic spells and allows reasonable growth of the pulmonary arteries to facilitate successful surgical repair. This represents a viable alternative to placement of a systemic-to-pulmonary artery shunt, particularly in small neonates.
authors.affiliation: Department of Paediatric Cardiology,Our Lady's Children's Hospital,Crumlin,Dublin,Ireland.
authors.forename: Eimear
authors.initials: E
authors.lastname: McGovern
authors.affiliation: Department of Paediatric Cardiology,Our Lady's Children's Hospital,Crumlin,Dublin,Ireland.
authors.forename: Conall T
authors.initials: CT
authors.lastname: Morgan
authors.affiliation: Department of Paediatric Cardiology,Our Lady's Children's Hospital,Crumlin,Dublin,Ireland.
authors.forename: Paul
authors.initials: P
authors.lastname: Oslizlok
authors.affiliation: Department of Paediatric Cardiology,Our Lady's Children's Hospital,Crumlin,Dublin,Ireland.
authors.forename: Damien
authors.initials: D
authors.lastname: Kenny
authors.affiliation: Department of Paediatric Cardiology,Our Lady's Children's Hospital,Crumlin,Dublin,Ireland.
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Walsh
authors.affiliation: Department of Paediatric Cardiology,Our Lady's Children's Hospital,Crumlin,Dublin,Ireland.
authors.forename: Colin J
authors.initials: CJ
authors.lastname: McMahon
mesh_terms: D000792:Angiography; D006328:Cardiac Catheterization; D004310:Double Outlet Right Ventricle / Q000601:surgery*; D004452:Echocardiography; D005260:Female; D006343:Heart Septal Defects / Q000601:surgery*; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007494:Ireland; D008297:Male; D011651:Pulmonary Artery / Q000503:physiopathology*; D011664:Pulmonary Valve / Q000601:surgery; D012189:Retrospective Studies; D015607:Stents; D013771:Tetralogy of Fallot / Q000601:surgery*; D016896:Treatment Outcome
keywords: Hypercyanotic spell; right ventricular outflow tract; stent; tetralogy of Fallot