Work

Role of balloon pulmonary valvuloplasty in symptomatic infants with tetralogy of Fallot awaiting intracardiac repair

Year: 2025

Type: article

Abstract: Background and aim: Mortality risk in tetralogy of Fallot (TOF) is highest in infancy, predominantly due to hypercyanotic spells. Timing of corrective surgery is centre/expertise dependent and surgical shunt procedures carry high mortality risk. We aimed to study the efficacy and feasibility of balloon pulmonary valvuloplasty (BPV) in TOF physiology children, as an alternative to surgical shunt, in those infants who were severely cyanosed (saturation <75 %) or having recurrent spells and who were still awaiting intracardiac repair (ICR). The primary objective was to assess the following parameters pre and post BPV: resting saturation, Z score of pulmonary annuli by 2D Echocardiography, right ventricular outflow tract (RVOT) gradient, hypercyanotic spell frequency. Secondarily we looked at the modified Nakata index (MNI), any procedural complications, requirement of early shunt or ICR (within study period). Materials and methods: test. The children were followed up for a period of 6 months post procedure. Results: After enrolling 10 infants, data could be studied in 9 of them. 1 child was lost to follow up. Significant improvement was noted in saturation, size of PA annulus, RVOT gradient, MNI (p value < 0.05 each). 2 patients had access site thrombosis which resolved with heparin. 1 had transient complete heart block which resolved within 24 h but required temporary pacing. There was no mortality and none had more than mild pulmonary regurgitation. Out of 5 children who presented with recurrent spells, 2 were completely free of spells after BPV, 2 had spells with reduced frequency/duration, 1 continued to have spells needing surgical intervention. (p = 0.36). Apart from this child who needed surgery, one other patient remained severely cyanotic and had to undergo a shunt procedure. Conclusion: To conclude, BPV seems like a safe and cost-effective alternative to high-risk surgical shunt palliation in symptomatic TOF infants, in resource constrained regions.

Source: International Journal of Cardiology Congenital Heart Disease

DOI: 10.1016/j.ijcchd.2025.100621

Authors: Sanjeev Hanumantacharya Naganur, Abhishek Mallick, Manoj Kumar Rohit, Parag Barwad, Vinothkumar S.P.

Institution: Post Graduate Institute of Medical Education and Research

Language: English

Topic: Congenital Heart Disease Studies

Subfield: Epidemiology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,120