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Palliative balloon valvoplasty of the pulmonary valve in tetralogy of Fallot

Published online by Cambridge University Press:  19 August 2008

Ikram Massoud ,
Adel Imam ,
Ahmed Mabrouk ,
Nader Boutros ,
Ashraf Kassem ,
Ahmed Daouod ,
Mahmoud Abd  and
El Hakem
Ikram Massoud*
Affiliation:
Department of Pediatric Cardiology, National Heart Institute, Imbaba, Giza, Egypt
Adel Imam
Affiliation:
Department of Pediatric Cardiology, National Heart Institute, Imbaba, Giza, Egypt
Ahmed Mabrouk
Affiliation:
Department of Pediatric Cardiology, National Heart Institute, Imbaba, Giza, Egypt
Nader Boutros
Affiliation:
Department of Pediatric Cardiology, National Heart Institute, Imbaba, Giza, Egypt
Ashraf Kassem
Affiliation:
Department of Pediatric Cardiology, National Heart Institute, Imbaba, Giza, Egypt
Ahmed Daouod
Affiliation:
Department of Pediatric Cardiology, National Heart Institute, Imbaba, Giza, Egypt
Mahmoud Abd
Affiliation:
Department of Pediatric Cardiology, National Heart Institute, Imbaba, Giza, Egypt
El Hakem
Affiliation:
Department of Pediatric Cardiology, National Heart Institute, Imbaba, Giza, Egypt
*
Dr Ikram Massoud, Head, Department of Pediatric Cardiology, National Heart Institute, Imbaba, Giza, Egypt. Tel./Fax: 202–3479893
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Abstract

Balloon dilation of the pulmonary valve was performed in 54 patients with tetralogy of Fallot with severe cyanosis, high haematocrit and severe valvar pulmonary stenosis. Clinical, echocardiographic, angiographic, and haemodynamic data were analyzed before and after the procedure. After balloon dilation, the systemic oxygen saturation increased from a mean value of 66% to 85<%. The mean value of the haematocrit before dilation was 55 + 13, and decreased to 47 after dilation (p < 0.002) in 2 months follow-up. Balloon dilation increased the size of the pulmonary valvar orifice from a mean value of 9 + 5mm to 11.5 + 2mm (p < 0.005). The mean Z score of the pulmonary valves, which was -3 + 1.3 before dilation, increased to -1.1 + 1.1 immediately after the procedure (p < 0.05).

The size of the right and left pulmonary arteries increased after dilation from 9mm to 10 mm, and from 8.7 + 2.4mm to 9.8 + 2.3mm, respectively (p <0.05). The comparable mean Z scores increased from -2.8 + 1.9 SD to -1.8 + 1.4 SD, and from -2.4 + 1.9 SD to -1.5 + 1.6 SD for the right and left branches, respectively (p < 0.05).

In patients with stenosis at the bifurcation of the pulmonary trunk and hypoplasia of the left artery, successful dilation of the pulmonary valve lead to an increase of flow and improvement in size of the hypoplas-tic segment.

In conclusion, initial balloon dilation of the pulmonary valve in tetralogy of Fallot resulted in increase of the Z score for the pulmonary valve and improved antegrade pulmonary blood flow, inducing growth of the pulmonary arteries and ameliorating the anatomic and physiologic preoperative condition.

Keywords

Balloon valvoplastyPallet‘s tetralogycardiac catheterization
Type
Original Articles
Information
Cardiology in the Young , Volume 9 , Issue 1 , January 1999 , pp. 24 - 36
Copyright
Copyright © Cambridge University Press 1999

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