Figure - available from: Pediatric Cardiology
This content is subject to copyright. Terms and conditions apply.
![Perimembranous VSD closure device. a Amplatzer membranous occluder with asymmetric disks for RV and LV placement. b Eccentric rims on the LV side to minimize damage to the aortic valve. c Concentric rims for anatomy with sufficient rims.
Permission to use pending (Mallula et al. [20])](publication/340069512/figure/fig1/AS:960053410549815@1605905978790/Perimembranous-VSD-closure-device-a-Amplatzer-membranous-occluder-with-asymmetric-disks.jpg)
Perimembranous VSD closure device. a Amplatzer membranous occluder with asymmetric disks for RV and LV placement. b Eccentric rims on the LV side to minimize damage to the aortic valve. c Concentric rims for anatomy with sufficient rims. Permission to use pending (Mallula et al. [20])
Source publication
Interventional cardiology has made extraordinary advances over recent years, but most are still limited to addressing single intracardiac or valvular lesions. This debate considers whether complete interventional repair of more complex congenital defects might become achievable. Tetralogy of Fallot (ToF) is probably the first candidate where comple...
Citations
... Stent stenosis from neointimal proliferation, stent fracture, stent migration and size discrepancies secondary to somatic growth are factors limiting the durability of RVOT stents [52]. ...
Newborns with congenital heart disease often require interventions linked to high morbidity and mortality rates. In the last few decades, many transcatheter interventions have become the first-line treatments for some critical conditions in the neonatal period. A catheter-based approach provides several advantages in terms of procedural time, length of hospitalization, repeatability and neurodevelopmental issues (usually related to cardiopulmonary bypass). The main transcatheter procedures will be reviewed, as they are now valid alternatives to conventional surgical management.
... To the editor, I read with interest a recent review on the feasibility of complete transcatheter correction of tetralogy of Fallot (TOF) with the aid of three-dimensional (3D) modeling and a combination of covered stents and ventricular septal defect (VSD) occluder devices [1]; these authors anticipate development of such technology in the coming two decades. A concomitant surgical perspective supported these ideas [2]. The authors are to be complimented on their perspective and insight. ...
... 5 For such patients, different therapeutic options have been employed to improve procedural outcome including the insertion of aortopulmonary shunt, arterial duct stenting, or percutaneous RVOT augmentation. 6 Especially in patients with major comorbidities such as severe cyanotic condition, small pulmonary arteries, Atrio Ventricular Septal Defect, or complex anatomical variants of TOF, these options are significantly limited. In this high risk group, some palliative options such as a surgical systemic to pulmonary shunt (Blalock-Taussig or BT shunt) is frequently employed, however, this procedure may be accompanied with some potential complications such as pulmonary over-circulation or even pulmonary artery stenosis. ...
Aim: Several studies assessed the effectiveness of different therapeutic procedures for repairing right ventricular outflow tract (RVOT) in tetralogy of Fallot (TOF) patients reporting contradictory results. What has been systematically summarized in the present study was to assess the outcome of RVOT stenting in TOF patients and also to compare its outcome with Blalock-Taussig (BT) shunt procedure.
Methods and Results: This study was performed according to established methods and in compliance with PRISMA-P (Preferred Reporting Items for Systematic review and Meta-Analysis) Protocols. Two investigators searched the manuscript databases including Medline, Web of knowledge, Google scholar, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library for all eligible studies in accordance with the considered keywords. In final, 10 articles were eligible for the final analysis.
The pooled success rate of RVOT stenting was found to be 93.6% (95%CI: 89.6% to96.2%). The overall improvement in arterial oxygen saturation following RVOT stenting was also shown to be 20.1%% (95%CI: 15.8% to 25.3%). The procedural-related death was also 3.7% (95%CI: 1.9% to7.3%). The assessment of the outcome of RVOT stenting and BT shunt showed no significant difference in improvement rate of arterial O2 saturation (OR = 1.419, 95%CI: 0.645 to 3.123, p = 0.384) and death rate (RR = 0.341, 95%CI: 0.057 to 2.024, p = 0.236).
Conclusion: RVOT stenting leads to appropriate clinical outcome in children suffering TOF Comparing RVOT stenting and BT shunt shows comparable results with respect to clinical sequels.
Classifications: Right Ventricular Outflow Tract (RVOT), Tetralogy of Fallot(TOF), Blalock-Taussig (BT) shunt
Condensed Abstract:
Aim: present study was to assess the outcome of RVOT stenting in TOF patients and also to compare its outcome with Blalock-Taussig (BT) shunt procedure.
Methods and Results: This study was performed according to established methods and in compliance with PRISMA-P (Preferred Reporting Items for Systematic review and Meta-Analysis) Protocols. In final, 10 articles were eligible for the final analysis. The assessment of the outcome of RVOT stenting and BT shunt showed no significant difference in improvement rate of arterial O2 saturation and death rate.
Conclusion: RVOT stenting leads to appropriate clinical outcome in children suffering TOF Comparing RVOT stenting and BT shunt shows comparable results with respect to clinical sequels.
This case report describes a 25-year-old woman with Tetralogy of Fallot (TOF) who underwent surgical repair at age 15. Eight years later, she presented with recurrent chest pain and was found to have residual severe pulmonary stenosis and regurgitation. This is a complication of TOF repair, particularly when the pulmonary valve is not preserved. The paper discusses the management of TOF, including initial palliative procedures and complete repair surgery. It highlights the long-term complications such as pulmonary valve regurgitation and residual stenosis, both of which may require re-intervention. The importance of long-term follow-up for TOF patients is emphasized.
Surgical repair of Tetralogy of Fallot has excellent outcomes, with over 90% of patients alive at 30 years. The ideal time for surgical repair is between 3 and 11 months of age. However, the symptomatic neonate with Tetralogy of Fallot may require earlier intervention: either a palliative intervention (right ventricular outflow tract stent, ductal stent, balloon pulmonary valvuloplasty, or Blalock-Taussig shunt) followed by a surgical repair later on, or a complete surgical repair in the neonatal period. Indications for palliation include prematurity, complex anatomy, small pulmonary artery size, and comorbidities. Given that outcomes after right ventricular outflow tract stent palliation are particularly promising – there is low mortality and morbidity, and consistently increased oxygen saturations and increased pulmonary artery z-scores – it is now considered the first-line palliative option. Disadvantages of right ventricular outflow tract stenting include increased cardiopulmonary bypass time at later repair and the stent preventing pulmonary valve preservation. However, neonatal surgical repair is associated with increased short-term complications and hospital length of stay compared to staged repair. Both staged repair and primary repair appear to have similar long-term mortality and morbidity, but more evidence is needed assessing long-term outcomes for right ventricular outflow tract stent palliation patients.
