Effect of Balloon Pulmonary Valvuloplasty on Growth of Pulmonary Annulus in Infants with Tetralogy of Fallot.

Abstract

Percutaneous balloon pulmonary valvuloplasty (PBPV) is an alternative intervention in infants with Tetralogy of Fallot (TOF). It can not only improve hypoxia but also promote pulmonary annulus (PA) growth. In this study, we evaluated the effect of PBPV on PA growth in infants with TOF. To eliminate the effect of the systemic to pulmonary shunt (SPS) that may promote PA growth, we divided TOF infants into 2 groups: group A, patients who underwent PBPV with or without other SPS, and group B, patients who attempted SPS but without PBPV. Sixty patients were included, 28 patients in group A and 32 patients in group B. Age at the time of intervention in group A (range, 0.4-5.4; median 1.4months) was lower than that in group B (range, 2.3-7.7; median 4.8months), p-value 0.02. The body weight in group A (range, 3-5.5; median 3.7kg) was also lower than that in group B (range 4.1-6.4; median 5.9kg), p-value 0.02. Echocardiographic data at the mean follow-up period of 37.2months (3-88months) in group A and 39.6months (6-95months) in group B demonstrated an increase in mean PA diameter from 5.0 ± 1.3mm to 10.2 ± 2.9mm, p-value < 0.001 in group A; and from 6.2 ± 2mm to 9.5 ± 2.9mm, p-value < 0.001 in group B. The median PA z-score increased from -3.4SD (-3.9 to -2.6SD) to -1.8SD (-2.5 to -0.8SD), with the p-value of 0.002 in group A; and increased from -2.9SD (-4.5 to -1.3SD) to -2.7SD (-3.6 to -1.4SD), with the p-value of 0.73 in group B. By using the PA z-score as the absolute value, there was a statistically significant increase in the PA z-score during follow-up in group A, but not in group B. Balloon pulmonary valvuloplasty in infants with TOF can facilitate the growth of the pulmonic annulus even after eliminating the effect of the systemic to pulmonary shunt.