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Immediate and Intermediate-Term Outcomes of Right Ventricular Outflow Tract Interventions in Neonates and Infants: A
Bhavik Champaneri1, Vicky Garhwal2, Abhay Pota1
1Pediatric Cardiology, U.N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, IND.
Insights
Transcatheter interventions for right ventricular outflow tract anomalies in infants are safe and effective, improving pulmonary blood flow and artery growth. These procedures demonstrate high survival rates and significant clinical benefits for neonates and infants.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Right ventricular outflow tract (RVOT) anomalies in neonates and infants require early intervention for pulmonary blood flow and artery growth.
- Transcatheter interventions offer a less invasive approach to managing these complex conditions.
Purpose of the Study:
- To evaluate the immediate and intermediate-term outcomes of various transcatheter RVOT interventions in infants.
- To assess the safety and efficacy of balloon pulmonary valvotomy, RVOT perforation with PDA stenting, and RVOT stenting.
Main Methods:
- Prospective, single-center descriptive study of 52 infants (<1 year) undergoing transcatheter RVOT interventions.
- Procedures included balloon pulmonary valvotomy (BPV), RVOT perforation with BPV and PDA stenting, and RVOT stenting.
- Outcomes assessed included hemodynamics, procedural success, complications, oxygen saturation, weight gain, PA growth, and re-intervention rates at 3 and 6 months.
Main Results:
- High six-month survival (96.2%) with minimal procedural complications.
- BPV significantly reduced RV pressure and RVOT gradient; RVOT perforation with PDA stenting showed marked hemodynamic improvement and robust PA growth.
- RVOT stenting was 100% successful, significantly improving SpO2 and enabling candidacy for intracardiac repair in some infants.
Conclusions:
- Transcatheter RVOT interventions are safe and effective for neonates and infants with RVOT anomalies.
- These strategies provide targeted benefits, leading to improved clinical outcomes and pulmonary artery development.
Background:
Right ventricular outflow tract (RVOT) anomalies in neonates and infants necessitate early intervention to restore adequate pulmonary blood flow and promote pulmonary artery (PA) growth. This study aimed to evaluate the immediate and intermediate-term outcomes of various transcatheter RVOT interventions in this vulnerable population.
Methods:
This prospective, single-center descriptive study enrolled 52 infants (aged <1 year) undergoing balloon pulmonary valvotomy (BPV, n=29), RVOT perforation with BPV and patent ductus arteriosus (PDA) stenting (n=11), or RVOT stenting (n=12) between February 2021 and November 2022. Key immediate outcomes included hemodynamic changes, procedural success, and in-hospital complications. Intermediate outcomes at three and six months assessed oxygen saturation (SpO2), weight gain, PA growth, and re-intervention rates.
Results:
Overall six-month survival was high at 96.2% (50/52), with minimal procedural complications, which included two transient arrhythmias. In-hospital mortalities occurred in one BPV patient and one RVOT perforation patient, both attributed to non-procedural causes such as septic shock. BPV procedures achieved significant reductions in RV pressure (from 106±26.18 mmHg to 40.74±9.91 mmHg, p=0.04) and RVOT gradient (from 85.41±26.04 mmHg to 15.67±4.2 mmHg, p<0.0001), with a 14.3% re-intervention rate for restenosis by three months. For RVOT perforation with BPV and PDA stenting, there was marked hemodynamic improvement, with RV pressure decreasing from 105.36±18.98 mmHg to 40±12.06 mmHg (p<0.0001) and robust PA growth (RPA measuring 5.72±1.13 mm and LPA 5.10±0.93 mm at six months). Lastly, RVOT stenting was 100% successful, significantly improving SpO2 (from 73.83±5.46% to 86.83±4.61% at discharge) and enabling five infants to become candidates for complete intracardiac repair by six months.
Conclusion:
Transcatheter RVOT interventions are safe and effective strategies for managing RVOT anomalies in neonates and infants. These intervention strategies offer targeted benefits and improve clinical outcomes.
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