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Catheter-based palliation for infants with tetralogy of Fallot
Dasana Lingaswamy1, Louisa Koepcke2, Mani Ram Krishna1
1Department of Paediatric Cardiology, Amrita Institute of Medical Sciences, Kochi, India.
Insights
Catheter-based palliation offers a safe and effective approach for infants with tetralogy of Fallot, particularly those with unfavorable anatomy unsuitable for immediate surgical repair.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Management
- Interventional Cardiology
Background:
- Optimal management for symptomatic tetralogy of Fallot in infants with unfavorable anatomy remains unclear.
- Resource limitations in low- and middle-income countries further complicate treatment decisions.
Purpose of the Study:
- To evaluate the safety and efficacy of catheter-based palliation as an alternative to surgical repair in infants with tetralogy of Fallot.
Main Methods:
- Retrospective review of 120 infants with tetralogy of Fallot undergoing procedures between January 2016 and June 2019.
- Comparison of outcomes between primary complete repair, surgical palliation, and catheter-based palliation.
Main Results:
- 33 infants underwent catheter-based palliation (balloon pulmonary valvuloplasty, RVOT stenting, PDA stenting).
- Catheterized infants were younger, had lower baseline saturation, and smaller pulmonary artery z-scores than surgical repair candidates.
- Follow-up in catheterized infants showed 12 later underwent complete repair, 10 were well awaiting repair, and 8 required further palliation.
Conclusions:
- Catheter-based palliation is a safe and effective alternative for high-risk infants with tetralogy of Fallot.
- This approach can be crucial in resource-limited settings.
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.
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