Skip to main content
SpringerLink
Log in

Effect of Balloon Pulmonary Valvuloplasty on Growth of Pulmonary Annulus in Infants with Tetralogy of Fallot

  • Research
  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

Abstract

Percutaneous balloon pulmonary valvuloplasty (PBPV) is an alternative intervention in infants with Tetralogy of Fallot (TOF). It can not only improve hypoxia but also promote pulmonary annulus (PA) growth. In this study, we evaluated the effect of PBPV on PA growth in infants with TOF. To eliminate the effect of the systemic to pulmonary shunt (SPS) that may promote PA growth, we divided TOF infants into 2 groups: group A, patients who underwent PBPV with or without other SPS, and group B, patients who attempted SPS but without PBPV. Sixty patients were included, 28 patients in group A and 32 patients in group B. Age at the time of intervention in group A (range, 0.4–5.4; median 1.4 months) was lower than that in group B (range, 2.3–7.7; median 4.8 months), p-value 0.02. The body weight in group A (range, 3–5.5; median 3.7 kg) was also lower than that in group B (range 4.1–6.4; median 5.9 kg), p-value 0.02. Echocardiographic data at the mean follow-up period of 37.2 months (3–88 months) in group A and 39.6 months (6–95 months) in group B demonstrated an increase in mean PA diameter from 5.0 ± 1.3 mm to 10.2 ± 2.9 mm, p-value < 0.001 in group A; and from 6.2 ± 2 mm to 9.5 ± 2.9 mm, p-value < 0.001 in group B. The median PA z-score increased from − 3.4SD (− 3.9 to − 2.6SD) to − 1.8SD (− 2.5 to − 0.8SD), with the p-value of 0.002 in group A; and increased from − 2.9SD (− 4.5 to − 1.3SD) to − 2.7SD (− 3.6 to − 1.4SD), with the p-value of 0.73 in group B. By using the PA z-score as the absolute value, there was a statistically significant increase in the PA z-score during follow-up in group A, but not in group B. Balloon pulmonary valvuloplasty in infants with TOF can facilitate the growth of the pulmonic annulus even after eliminating the effect of the systemic to pulmonary shunt.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Benjamin EJMP, Alonso A, Bittencourt MS, Callaway CW, Carson AP et al (2019) Heart disease and stroke statistics - 2019 update: a report from the American heart association. Circulation 139(10):e56–e528

    Article  PubMed  Google Scholar 

  2. Van Arsdell GS, Maharaj GS, Tom J, Rao VK, Coles JG, Freedom RM et al (2000) What is the optimal age for repair of tetralogy of Fallot? Circulation 102:Iii123–Iii129

    PubMed  Google Scholar 

  3. Steiner MB, Tang X, Gossett JM, Malik S, Prodhan P (2014) Timing of complete repair of non-ductal-dependent tetralogy of Fallot and short-term postoperative outcomes, a multicenter analysis. J Thorac Cardiovasc Surg 147:1299–1305

    Article  PubMed  Google Scholar 

  4. Martins IF, Doles IC, Bravo-Valenzuela NJM, Santos A, Varella MSP (2018) When is the best time for corrective surgery in patients with tetralogy of Fallot between 0 and 12 months of age? Braz J Cardiovasc Surg 33:505–510

    Article  PubMed  PubMed Central  Google Scholar 

  5. Peck D, Tretter J, Possner M, Yutzey K, Zafar F, Morales D et al (2021) Timing of repair in tetralogy of Fallot: effects on outcomes and myocardial health. Cardiol Rev 29:62–67

    Article  PubMed  Google Scholar 

  6. Wilder TJ, Van Arsdell GS, Benson L, Pham-Hung E, Gritti M, Page A et al (2017) Young infants with severe tetralogy of Fallot: early primary surgery versus transcatheter palliation. J Thorac Cardiovasc Surg 154(1692–700):e2

    Google Scholar 

  7. Bailey J, Elci OU, Mascio CE, Mercer-Rosa L, Goldmuntz E (2020) Staged versus complete repair in the symptomatic neonate with tetralogy of Fallot. Ann Thorac Surg 109:802–808

    Article  PubMed  Google Scholar 

  8. Loomba RS, Buelow MW, Woods RK (2017) Complete repair of tetralogy of Fallot in the neonatal versus non-neonatal period: a meta-analysis. Pediatr Cardiol 38:893–901

    Article  PubMed  Google Scholar 

  9. Vetter HORB, Seidel P, Kleinhans E, Büll U, Klinner W (1990) Non-invasive assessment of right and left ventricular volumes 11 to 24 years after corrective surgery on patients with tetralogy of Fallot. Eur J Cardiothorac Surg 4(1):24–28

    Article  CAS  PubMed  Google Scholar 

  10. Ylitalo P, Nieminen H, Pitkanen OM, Jokinen E, Sairanen H (2015) Need of transannular patch in tetralogy of Fallot surgery carries a higher risk of reoperation but has no impact on late survival: results of Fallot repair in Finland. Eur J Cardiothorac Surg 48:91–97

    Article  PubMed  Google Scholar 

  11. Ducas RA, Harris L, Labos C, Nair GKK, Wald RM, Hickey EJ et al (2021) Outcomes in young adults with tetralogy of Fallot and pulmonary annular preserving or transannular patch repairs. Can J Cardiol 37:206–214

    Article  PubMed  Google Scholar 

  12. Smith CA, McCracken C, Thomas AS, Spector LG, St Louis JD, Oster ME et al (2019) Long-term outcomes of tetralogy of Fallot: a study from the pediatric cardiac care consortium. JAMA Cardiol 4:34–41

    Article  PubMed  Google Scholar 

  13. Gatzoulis MA, Balaji S, Webber SA, Siu SC, Hokanson JS, Poile C et al (2000) Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot: a multicentre study. The Lancet 356:975–981

    Article  CAS  Google Scholar 

  14. Cholkraisuwat E, Lertsapcharoen P, Khongphatthanayothin A, La-orkhun V, Vithessonthi K, Benjacholamas V et al (2010) Balloon pulmonary valvuloplasty in tetralogy of Fallot: effects on growth of pulmonary annulus and transannular patch. J Med Assoc Thai 93:898–902

    PubMed  Google Scholar 

  15. Wu ET, Wang JK, Lee WL, Chang CC, Wu MH (2006) Balloon valvuloplasty as an initial palliation in the treatment of newborns and young infants with severely symptomatic tetralogy of Fallot. Cardiology 105:52–56

    Article  PubMed  Google Scholar 

  16. Remadevi KSVB, Francis E, Kannan BR, Kumar RK (2008) Balloon pulmonary valvotomy as interim palliation for symptomatic young infants with tetralogy of Fallot. Ann Pediatr Cardiol 1(1):2–7

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Kim G, Ban GH, Lee HD, Sung SC, Kim H, Choi KH (2016) Effects of balloon pulmonary valvuloplasty as preoperative palliation for tetralogy of Fallot. Congenit Heart Dis 11:315–322

    Article  PubMed  Google Scholar 

  18. Sluysmans TNB, Rubay J, Lintermans J, Ovaert C, Mucumbitsi J, Shango P, Stijns M, Vliers A (1995) Early balloon dilatation of the pulmonary valve in infants with tetralogy of Fallot. Risks and benefits. Circulation 91(5):1506–11

    CAS  PubMed  Google Scholar 

  19. Nakashima K, Itatani K, Oka N, Kitamura T, Horai T, Hari Y et al (2014) Pulmonary annulus growth after the modified Blalock-Taussig shunt in tetralogy of Fallot. Ann Thorac Surg 98:934–940

    Article  PubMed  Google Scholar 

  20. Chong BK, Baek JS, Im YM, Park CS, Park JJ, Yun TJ (2016) Systemic-pulmonary shunt facilitates the growth of the pulmonary valve annulus in patients with tetralogy of Fallot. Ann Thorac Surg 102:1322–1328

    Article  PubMed  Google Scholar 

  21. Pettersen MD, Du W, Skeens ME, Humes RA (2008) Regression equations for calculation of z scores of cardiac structures in a large cohort of healthy infants, children, and adolescents: an echocardiographic study. J Am Soc Echocardiogr 21:922–934

    Article  PubMed  Google Scholar 

  22. Narayanswami Sreeram M, Moin Saleem MRCP, Mark Jackson PHD, Ian Peart MRCP, Roxane McKAY MD, Robert Arnold FRCP, Kevin WM (1990) Results of balloon pulmonary valvuloplasty as a palliative procedure in tetralogy of Fallot. J Am Coll CardioI 18:159–165

    Article  Google Scholar 

  23. Qureshi SAKC, Lamb RK, Arnold R, Wilkinson JL (1988) Balloon dilatation of the pulmonary valve in the first year of life in patients with tetralogy of Fallot: a preliminary study. Br Heart J 60(3):232–5

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Kim GBG, Lee HD, Sung SC, Kim H, Choi KH (2016) Effects of balloon pulmonary valvuloplasty as preoperative palliation for tetralogy of Fallot. Congenit Heart Dis 11(4):315–322

    Article  PubMed  Google Scholar 

  25. Tseng SY, Truong YT, Peck D, Kandi S, Brayer S, Jason DP et al (2022) Patent ductus arteriosus stent versus surgical aortopulmonary shunt for initial palliation of cyanotic congenital heart disease with ductal-dependent pulmonary blood flow: a systematic review and meta-analysis. J Am Heart Assoc 11:e024721

    Article  PubMed  PubMed Central  Google Scholar 

  26. Kasturi S, Balaji S, Sudhakar A, Sunil GS, Kottayil BP, Bayya PR et al (2019) Accuracy of a new echocardiographic index to predict need for trans-annular patch in tetralogy of Fallot. Pediatr Cardiol 40:161–167

    Article  PubMed  Google Scholar 

  27. Awori MN, Leong W, Artrip JH, O’Donnell C (2013) Tetralogy of Fallot repair: optimal z-score use for transannular patch insertion. Eur J Cardiothorac Surg 43:483–486

    Article  PubMed  Google Scholar 

  28. Awori MN, Mehta NP, Mitema FO, Kebba N (2018) Optimal use of z-scores to preserve the pulmonary valve annulus during repair of tetralogy of Fallot. World J Pediatr Congenit Heart Surg 9:285–288

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University and Cardiac Center, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, 1873 Rama IV Rd. Pathumwan, Bangkok, 10330, Thailand

    Khwaunrat Whaidee, Sarin Lekchuensakul & Pornthep Lertsapcharoen

  2. Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University and Cardiac Center, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand

    Jule Namchaisiri & Vichai Benjacholamas

Authors
  1. Khwaunrat Whaidee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sarin Lekchuensakul
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Pornthep Lertsapcharoen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jule Namchaisiri
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Vichai Benjacholamas
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the manuscript as follow: Substantial contributions to the conception or design of the work (KW, SL, PL), acquisition of data (KW) or analysis and interpretation of data (KW, SL, PL). Drafting the work (KW) or revising it critically for important intellectual content (SL, PL). Final approval of the version to be published (KW, SL, PL, JN, VB). Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved (KW, SL, PL, JN, VB).

Corresponding author

Correspondence to Sarin Lekchuensakul.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Whaidee, K., Lekchuensakul, S., Lertsapcharoen, P. et al. Effect of Balloon Pulmonary Valvuloplasty on Growth of Pulmonary Annulus in Infants with Tetralogy of Fallot. Pediatr Cardiol 44, 1471–1478 (2023). https://doi.org/10.1007/s00246-023-03205-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00246-023-03205-x

Keywords

Search

Navigation