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Stenting of the right ventricular outflow tract in a symptomatic newborn with tetralogy of Fallot.

Dryżek P, Moszura T, Góreczny S, Michalak KW - Postepy Kardiol Interwencyjnej (2015)

Bottom Line: This case describes a successful percutaneous stent implantation to critical stenosis of the right ventricle outflow tract in a female neonate with tetralogy of Fallot.At the time of the procedure she had poor development of the pulmonary arteries (McGoon and Nakata index 1.45 and 120, respectively).Stent implantation ensured an immediate increase in oxygen saturation level, and the physiological pulsating blood inflow caused good development of the pulmonary arteries during 12 months of follow up (McGoon 2.5; Nacata Index 436).

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Polish Mother Memorial Hospital Research Institute, Lodz, Poland.

ABSTRACT
This case describes a successful percutaneous stent implantation to critical stenosis of the right ventricle outflow tract in a female neonate with tetralogy of Fallot. At the time of the procedure she had poor development of the pulmonary arteries (McGoon and Nakata index 1.45 and 120, respectively). Stent implantation ensured an immediate increase in oxygen saturation level, and the physiological pulsating blood inflow caused good development of the pulmonary arteries during 12 months of follow up (McGoon 2.5; Nacata Index 436). After this time she was qualified for surgery and underwent surgical correction without using a patch or conduit implantation.

No MeSH data available.


Related in: MedlinePlus

Staged stent implantation into the critical RVOT stenosis in fluoroscopy. A – Early phase of balloon inflation and Palmaz-Genesis 7 × 18 mm stent (Cordis) expansion. B – Late phase of balloon inflation with only local incision in balloon shape – the site of main stenosis of the RVOT. C – Fully expanded Palmaz-Genesis 7 × 18 mm stent with the inflated balloon inside. D – Stent after implantation procedure
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Figure 0002: Staged stent implantation into the critical RVOT stenosis in fluoroscopy. A – Early phase of balloon inflation and Palmaz-Genesis 7 × 18 mm stent (Cordis) expansion. B – Late phase of balloon inflation with only local incision in balloon shape – the site of main stenosis of the RVOT. C – Fully expanded Palmaz-Genesis 7 × 18 mm stent with the inflated balloon inside. D – Stent after implantation procedure

Mentions: On the 7th day of life, under general anaesthesia with standard antibiotic prophylaxis, the femoral vein was punctured and one dose of heparin (100 IU/kg) was administered. Subsequently, a 4 Fr NIH catheter (Cook) was introduced into the right ventricle. Angiogram showed severe RVOT obstruction and narrow main pulmonary artery (5 mm) with stenosis at the subvalvular and valvular level and pulmonary arteries of 4.8 mm in diameter (Figure 1). It corresponded to McGoon and Nakata index 1.45 and 120, respectively. Wide ductus arteriosus supporting pulmonary blood was also noticed. After placement of a soft coronary guidewire 0.014 inch (0.356 mm) (Terumo) in the right pulmonary artery, pulmonary valvuloplasty was performed with a Tyshak II 6 × 20 mm balloon (NuMed). The original guidewire was replaced with a Teflon-coated 0.032 inch (0.812 mm) guidewire (Cordis), and a Palmaz-Genesis 7 × 18 mm stent (Cordis) was implanted below the pulmonary valve (Figure 2). Control rotational angiography from the right ventricle showed correct stent localisation with a minimal diameter of 6.8 mm and unobstructed blood flow (Figure 3). While oxygen saturation increased to 95%, prostaglandin infusion was stopped. For the next 3 days the patient received low molecular heparin once daily followed by acetylic acid (3 mg/kg). Control echocardiographic study showed turbulent flow through the RVOT with a maximal velocity of 3.6 m/s. Leaflets of the pulmonary valve were mobile, and mild insufficiency was noted as well. After 10 days of hospitalisation the patient was discharged home with oxygen saturations approaching 90%.


Stenting of the right ventricular outflow tract in a symptomatic newborn with tetralogy of Fallot.

Dryżek P, Moszura T, Góreczny S, Michalak KW - Postepy Kardiol Interwencyjnej (2015)

Staged stent implantation into the critical RVOT stenosis in fluoroscopy. A – Early phase of balloon inflation and Palmaz-Genesis 7 × 18 mm stent (Cordis) expansion. B – Late phase of balloon inflation with only local incision in balloon shape – the site of main stenosis of the RVOT. C – Fully expanded Palmaz-Genesis 7 × 18 mm stent with the inflated balloon inside. D – Stent after implantation procedure
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4372631&req=5

Figure 0002: Staged stent implantation into the critical RVOT stenosis in fluoroscopy. A – Early phase of balloon inflation and Palmaz-Genesis 7 × 18 mm stent (Cordis) expansion. B – Late phase of balloon inflation with only local incision in balloon shape – the site of main stenosis of the RVOT. C – Fully expanded Palmaz-Genesis 7 × 18 mm stent with the inflated balloon inside. D – Stent after implantation procedure
Mentions: On the 7th day of life, under general anaesthesia with standard antibiotic prophylaxis, the femoral vein was punctured and one dose of heparin (100 IU/kg) was administered. Subsequently, a 4 Fr NIH catheter (Cook) was introduced into the right ventricle. Angiogram showed severe RVOT obstruction and narrow main pulmonary artery (5 mm) with stenosis at the subvalvular and valvular level and pulmonary arteries of 4.8 mm in diameter (Figure 1). It corresponded to McGoon and Nakata index 1.45 and 120, respectively. Wide ductus arteriosus supporting pulmonary blood was also noticed. After placement of a soft coronary guidewire 0.014 inch (0.356 mm) (Terumo) in the right pulmonary artery, pulmonary valvuloplasty was performed with a Tyshak II 6 × 20 mm balloon (NuMed). The original guidewire was replaced with a Teflon-coated 0.032 inch (0.812 mm) guidewire (Cordis), and a Palmaz-Genesis 7 × 18 mm stent (Cordis) was implanted below the pulmonary valve (Figure 2). Control rotational angiography from the right ventricle showed correct stent localisation with a minimal diameter of 6.8 mm and unobstructed blood flow (Figure 3). While oxygen saturation increased to 95%, prostaglandin infusion was stopped. For the next 3 days the patient received low molecular heparin once daily followed by acetylic acid (3 mg/kg). Control echocardiographic study showed turbulent flow through the RVOT with a maximal velocity of 3.6 m/s. Leaflets of the pulmonary valve were mobile, and mild insufficiency was noted as well. After 10 days of hospitalisation the patient was discharged home with oxygen saturations approaching 90%.

Bottom Line: This case describes a successful percutaneous stent implantation to critical stenosis of the right ventricle outflow tract in a female neonate with tetralogy of Fallot.At the time of the procedure she had poor development of the pulmonary arteries (McGoon and Nakata index 1.45 and 120, respectively).Stent implantation ensured an immediate increase in oxygen saturation level, and the physiological pulsating blood inflow caused good development of the pulmonary arteries during 12 months of follow up (McGoon 2.5; Nacata Index 436).

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Polish Mother Memorial Hospital Research Institute, Lodz, Poland.

ABSTRACT
This case describes a successful percutaneous stent implantation to critical stenosis of the right ventricle outflow tract in a female neonate with tetralogy of Fallot. At the time of the procedure she had poor development of the pulmonary arteries (McGoon and Nakata index 1.45 and 120, respectively). Stent implantation ensured an immediate increase in oxygen saturation level, and the physiological pulsating blood inflow caused good development of the pulmonary arteries during 12 months of follow up (McGoon 2.5; Nacata Index 436). After this time she was qualified for surgery and underwent surgical correction without using a patch or conduit implantation.

No MeSH data available.


Related in: MedlinePlus