Pulmonary valvotomy for Tetrology of Fallot : Will soon become a worthy option

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Pulmonary valvotomy for Tetrology of Fallot : Will soon become a worthy option

December 24, 2019 by dr s venkatesan

Catheter based interventions in TOF has caught the imagination of Interventional cardiologists.decades ago. (Quereshi reported first in 1988 Royal Liverpool hospital ) .Somehow it could not develop into a full-fledged modality. The key issue in TOF is, RVOT obstruction is infundibular with some degree of valvular involvement. While the valvular component is amenable for easy correction by balloon, the infundibular stenosis requires some form of cutting or splitting. Embryologically, the malalignment of IVS is the primary mechanism of obstruction. The balloon catheter is will find it difficult to tackle the alignment defect. .Obviously, surgeons can do a comprehensive RVOT reconstruction.

Things are beginning to change. Cutting balloons are available. Various dedicated VSD devices are being developed. Closure of large sub-aortic VSD followed by RVOT dilatation appears challenging task but distinctly possible in the near future.

Few cases of palliative RVOT dilatation with a balloon in critical TOF is been attempted We hope, in the coming decades at least simple forms of TOF are conquered by the interventional cardiologists!

Hardware: A small profile coronary cutting balloon from Boston scientific .

What is in store for the future ?

3D printing of live heart and designer device or deployable patches for the malaligned VSD is possible. Currently, intracardiac ultrasound would assist the procedure.

RVOT reconstruction with RVOT stenting and percutaneous valves (Melody or Right sided TAVR equivalents) is already been done in post-ICR residual obstructions or late RVOT failure

Coronary cutting balloon flextome tof pulmonary valvuloplasty coronary hard ware

Flextome -Coronary cutting balloon

Other References

1.Boucek MM, Webster HE, Orsmond GS, Ruttenberg HD. Balloon pulmonary valvotomy: palliation for cyanotic heart disease. Am Heart J. 1988;115:318-322.

2.Qureschi SA, Kirk CR, Lamb RK, Arnold R, Wilkinson JL. Balloon dilatation of the pulmonary valve in the first year of life in patients with tetralogy of Fallot: a preliminary study. Br Heart J. 1988; 60:232-235.

3.Parsons JM, Ladusans EJ, Qureshi SA. Growth of the pulmonary artery after neonatal balloon dilatation of the right ventricular outflow tract in an infant with tetralogy of Fallot and atrioventricular septal defect. Br Heart J. 1989;62:65-68.

4.De Geeter P, Weisburd P, Dillenseger P, Willard D. Valvuloplastie pulmonaire percutanée palliative dans les formes néonatales de tétralogie de Fallot. Arch Fr Pediatr. 1989;46:117-119.

5.Guntheroth WG. Balloon valvuloplasty as palliation in tetralogy. J Am Coll Cardiol. 1992;19:234-237.

Posted in cardiology -congenital heart disease, cardiology -Therapeutics, Interventions -Structural heart disease, Tetrology of Fallot | Tagged balloon pulmonary valvotomy in tof, camera tipped catheters, cyanotic spell in tof tetrology management, emergency balloon pulmonary valvotomy for tof tetrology hypoxix spells cyanotic spells, HD camers in cardic catheters, hypoxic spells, interventions in tetrology of fallot | Leave a Comment

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Dr.S.Venkatesan MD

Expressions in cardiology