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. 2023 Feb 13:10:1056772.
doi: 10.3389/fsurg.2023.1056772. eCollection 2023.

Right ventricular outflow tract stenting promotes pulmonary artery development in tetralogy of fallot

Hui Guo  1 , Zhongshi Wu  1 , Tianli Zhao  1 , Jinfu Yang  1 , Shijun Hu  1 , Can Huang  1 , Yifeng Yang  1 , Li Xie  1
Affiliations

Right ventricular outflow tract stenting promotes pulmonary artery development in tetralogy of fallot

Hui Guo et al. Front Surg. .

Abstract

Background: Right ventricular outflow tract (RVOT) stenting seems to be suggested as a promising treatment option and an alternative to modified Blalock-Taussig shunt (mBTS) in the initial palliation of patients with Fallot-type lesions in recent years. This study sought to assess the effect of RVOT stenting on the growth of the pulmonary artery (PA) in patients with Tetralogy of Fallot (TOF).

Methods: Retrospective review analyzing 5 patients with Fallot-type congenital heart disease with small pulmonary arteries who underwent palliative with RVOT stenting and 9 patients underwent modified Blalock-Taussig shunt within 9 years period. Differential left PA (LPA) and right PA (RPA) growth was measured by Cardiovascular Computed Tomography Angiography (CTA).

Results: RVOT stenting improved arterial oxygen saturation from median of 60% (interquartile range [IQR]: 37% to 79%) to 95% (87.5% to 97.5%) (p = 0.028). The LPA diameter Z-score improved from -2.843 (-3.51-2.037) to -0.78 (-2.3305-0.19) (p = 0.03), the RPA diameter Z-score improved from median -2.843 (-3.51-2.037) to -0.477 (-1.1145-0.459) (p = 0.002), the Mc Goon ratio increased from median 1 (0.8-1.105) to 1.32 (1.25-1.98) (p = 0.017). There were no procedural complications and all 5 patients have undergone final repair in the RVOT stent group. In the mBTS group, the LPA diameter Z-score improved from -1.494 (-2.242-0.6135) to -0.396 (-1.488-1.228) (p = 0.15), the RPA diameter Z-score improved from median -1.328 (-2.036-0.838) to 0.088 (-0.486-1.223) (p = 0.007), and there were 5 patients occur different complications and 4 patients was not attained the standards of final surgical repair.

Conclusion: RVOT stenting, compared with mBTS, seems to better promote pulmonary artery growth, improve arterial oxygen saturations, and have less procedure complications in patients with TOF who being absolute contraindicated for primary repair due to high risks.

Keywords: oxygen saturation; primary palliation; pulmonary artery; right ventricular outflow tract stent; tetralogy of fallot.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Pulmonary artery growth. Box is first to third quartile. Median is line in box. First, Cardiovascular CTA measure diameter before palliation procedure. Last, Cardiovascular CTA measure diameter before final surgical repair. ROVTs group showed in (A-C); mBTS group showed in (D-F).
Figure 2
Figure 2
Images in ROVT stenting group. (A), patients’ pulmonary artery CTA image before procedure. (B and C), the pulmonary artery and ROVT stent image during procedure under Digital subtraction angiography or Ultrasound. (D), CTA image before final surgical repair. The red arrow indicates the stent shadow.
Figure 3
Figure 3
Images in mBTS group. Image (A), patients’ pulmonary artery CTA image before procedure; Image (B), anastomotic stenosis; Image (C), shunt duct and RPA thrombosis; Image (D), 3D image before final surgical repair. The red arrow indicates the thrombus.
See this image and copyright information in PMC

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