The features of step-by-step surgical approach for correction of tetralogy fallot using modern palliative methods

Aim. To evaluate the hospital results of one-stage radical correction (RC) of Fallot's tetrad (TF) and stage-by-stage correction of the defect using stenting of the right ventricular outflow tract (RVOT).

Methods. The group of step-by-step correction included 24 patients with the classic cyanotic form of TF: 1st stage – stenting of the RVOT (Me age 73.5 days, weight 3.8 kg), 2nd stage – RC of TF Me age 187 days. The group of one-stage RC TF included 30 newborns with Me aged 121.5 days and weight 5.5 kg.

Results. After performing stenting of RVOT, there was a significant increase in SpO2 from 80 to 94%, end diastolic volume of left ventricle index from 24 to 33.3 ml/m2 , a decrease in the severity of hypoplasia of the pulmonary artery trunk (PA) compared with the stage before stenting of RVOT (p˂ 0.05). Patients of the two groups had equal values of weight, SpO2, the severity of PA hypoplasia, and a gradient in the RVOT at the time of RC. After the RC in stenting group there was an increase in SpO2 up to 98%, a decrease in the RVOT gradient from 75 to 16.5 mm Hg, an increase in the end diastolic volume left ventricle index to 56.5 ml/m2 (p˂ 0.05). The dynamics of the status of patients in Group 1 with the use of palliative intervention did not significantly differ from the dynamics in Group 2 (one-stage RC TF).

Conclusion. Application of the approach of step-by-step correction of TF with stenting of RVOT in low weight infants with severe hypoxemia demonstrated an equal effect on the dynamics of SpO2, reverse cardiac remodeling compared with patients who underwent simultaneous RC of classical TF.

1. Loomba R.S., Buelow M.W., Woods R.K. Complete Repair of Tetralogy of Fallot in the Neonatal Versus Non-neonatal Period: A Meta-analysis. Pediatr Cardiol. 2017;38(5):893–901. doi: 10.1007/s00246-017-1579-8

2. Bakhtiary F., Dähnert I., Leontyev S., Schröter T., Hambsch J., Mohr F.W., Kostelka M. Outcome and Incidence of ReIntervention After Surgical Repair of Tetralogy of Fallot. J Card Surg. 2013;28(1):59–63. doi: 10.1111/jocs.12030

3. Associacija serdechno-sosudistyh hirurgov Rossii. Klinicheskie rekomendacii Tetrada Fallo. Moskva, 2019. Available at: https://racvs.ru/upload/iblock/370/370a77a4310ff67d26aa4778 815c58f3.pdf (accessed 23.07.2021) (In Russian)

4. Bentham J.R., Zava N.K., Harrison W.J., Shauq A., Kalantre A., Derrick G., Chen R.H., Dhillon R., Taliotis D., Kang S.L., Crossland D., Adesokan A., Hermuzi A., Kudumula V., Yong S., Noonan P., Hayes N., Stumper O., Thomson J.D.R. Duct Stenting Versus Modified BlalockTaussig Shunt in Neonates With Duct-Dependent Pulmonary Blood Flow: Associations With Clinical Outcomes in a Multicenter National Study. Circulation. 2018;137(6):581–8. doi: 10.1161/CIRCULATIONAHA.117.

5. Glatz AC, Petit CJ, Goldstein BH, et al. : Comparison Between Patent Ductus Arteriosus Stent and Modified Blalock-Taussig Shunt as Palliation for Infants With Ductal-Dependent Pulmonary Blood Flow: Insights From the Congenital Catheterization Research Collaborative. Circ ulation.2018;137(6):589–601.10.1161/CIRCULATIONAHA.117.029987