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Posts Tagged ‘emergency balloon pulmonary valvotomy for tof tetrology hypoxix spells cyanotic spells’

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

Balloon pulmonary valvotomy for tof tetrology of fallot

balloon angioplasty for TOF cutting balloon

pulmonary valvotomy in tof tetrology

pulmonary valvotomy in tof tetrology 3

 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.

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