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Catheter-based palliation for infants with tetralogy of Fallot

Published online by Cambridge University Press:  10 August 2020

Dasana Lingaswamy ,
Louisa Koepcke ,
Mani Ram Krishna Open the ORCID record for Mani Ram Krishna [Opens in a new window] ,
Brijesh P. Kottayil ,
Gopalraj S. Sunil ,
Katie Moynihan ,
Balaji Seshadri  and
Raman Krishna Kumar Open the ORCID record for Raman Krishna Kumar [Opens in a new window]
Dasana Lingaswamy
Affiliation:
Department of Paediatric Cardiology, Amrita Institute of Medical Sciences, Kochi, India
Louisa Koepcke
Affiliation:
Paracelsus Medical School, Nuremberg, Germany
Mani Ram Krishna*
Affiliation:
Department of Paediatric Cardiology, Amrita Institute of Medical Sciences, Kochi, India
Brijesh P. Kottayil
Affiliation:
Department of Cardio-vascular and Thoracic Surgery, Amrita Institute of Medical Sciences, Kochi, India
Gopalraj S. Sunil
Affiliation:
Department of Cardio-vascular and Thoracic Surgery, Amrita Institute of Medical Sciences, Kochi, India
Katie Moynihan
Affiliation:
Department of Cardiology, Boston Children’s Hospital, Boston, MA, USA Department of Paediatrics, Harvard Medical School, Boston, MA, USA
Balaji Seshadri
Affiliation:
Department of Paediatrics (Cardiology), Oregon Health and Sciences University, Portland, OR, USA
Raman Krishna Kumar
Affiliation:
Department of Paediatric Cardiology, Amrita Institute of Medical Sciences, Kochi, India
*
Author for correspondence: Dr Mani Ram Krishna, Department of Paediatric Cardiology, Amrita Institute of Medical Sciences, AIMS, Ponekkara (P.O), Kochi 682041, India. Tel: +91 484 2853570. E-mail: mann_comp@hotmail.com
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Abstract

Background:

The optimal management of symptomatic tetralogy of Fallot in neonates and younger infants with unfavourable anatomy is unclear and is further constrained by resource limitations in low and middle income countries.

Methods:

Retrospective medical record review of infants with tetralogy of Fallot undergoing corrective or palliative procedures between January 2016 and June 2019.

Results:

The study included 120 infants; of whom 83 underwent primary complete repair, four underwent surgical palliation, and 33 underwent catheter-based palliation, including balloon pulmonary valvuloplasty (n = 18), right ventricular outflow tract stenting (n = 14), and stenting of the patent arterial duct (n = 1). Infants undergoing catheter-based procedures were younger in age (median 32 days; inter-quartile range (IQR) 7–144 versus 210 days; IQR 158–250), with lower baseline saturation (65 ± 12% versus 87 ± 7%) and had smaller pulmonary artery z-scores compared to the complete repair cohort. Follow-up was available for 31/33 (94%) infants (median 7 months [IQR 4–11]) who underwent trans-catheter palliation; 12 underwent complete repair, 10 are well, awaiting repair, eight required further palliation (catheter: 6; surgical: 2), and one died post-discharge from non-cardiac causes.

Conclusion:

Catheter-based palliation is a safe and effective alternative in infants with tetralogy of Fallot who are at high risk for primary surgical repair.

Keywords

Trans-catheter palliationintra-cardiac repairtetralogy of Fallot treatment
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 10 , October 2020 , pp. 1469 - 1472
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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