Balloon Pulmonary Valvuloplasty in Tetralogy of Fallot: Effects on Growth of Pulmonary Annulus and Transannular Patch
Engcanit Cholkraisuwat MD*, Pornthep Lertsapcharoen MD**, Apichai Khongphatthanayothin MD**, Vidhavas La-orkhun MD**, Kanyalak Vithessonthi MD**, Vichai Benjacholamas MD***, Jule Namchaisiri MD***
Affiliation : * Department of Pediatrics, Faculty of Medicine, Naresuan University, Pitsanulok, Thailand ** Department of Pediatrics, Faculty of Medicine, Chulalongkorn University and Cardiac Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand *** Department of Surgery, Faculty of Medicine, Chulalongkorn University and Cardiac Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
Background : Balloon pulmonary valvuloplasty and its benefit on the growth of pulmonary annulus and pulmonary artery in
tetralogy of Fallot (TOF) patients remains controversial. The purpose of the present study was to determine the growth of
pulmonary valve annulus and pulmonary artery and to evaluate the need of transannular patch during total surgical
correction in patients with tetralogy of Fallot (TOF) after balloon pulmonary valvuloplasty.
Material and Method: Fifty-one severely hypoxic TOF patients, who underwent balloon dilatation of pulmonary valve, were
included in the present study. The clinical outcomes, oxygen saturation, and echocardiographic parameters before and after
balloon dilatation were analyzed.
Results : There were 33 males and 18 females. The mean age was 3 years 5 months old (range, 1 month-15 years 8 months
old). The mean oxygen saturation increased from 73.9 + 9.1 to 84.8 + 6.7% immediately after the procedure (p-value < 0.05).
There was no serious procedural-related complication. At the mean follow-up period of 2 years and 4 months, the mean
Z-score of pulmonary annulus size increased from -2.56 SD to -1.87 SD (p-value < 0.05) and the right pulmonary artery size
from -0.29 SD to + 0.46 SD (p-value < 0.05). Thirty-seven patients (66.1%) underwent corrective surgery. Pulmonary
transannular patch was performed in 11 of 37 patients (29.7%).
Conclusion : Pulmonary valve dilatation in patients with TOF is safe. It promotes the growth of the pulmonary valve annulus
and pulmonary artery and may decrease the need of transannular patch at the time of surgical correction.
Keywords : Balloon pulmonary valvuloplasty, Tetralogy of Fallot (TOF)
