Intraoperative Ballon Dilation of Hypoplastic Pulmonary Annulus: New Strategy for Primary Early Repair of Tetralogy of Fallot

Background: Current surgical management of tetralogy of Fallot (TOF) is focusing on preservation of pulmonary valve (PV) to limit negative impact of pulmonary regurgitation on ventricular function. The aim of this study was to analyze the first experience with surgical reconstruction of PV combine with intraoperative balloon dilation (IBD) of the pulmonary annulus (PA) during primary correction of TOF.

Methods: Between May 2012 and April 2013, 18 consecutive patients < 6 months of age (group A) underwent primary correction of TOF. Six patients (33%) needed mini-transannular patch due to hypoplastic PA. In the remaining patients, the PV and PA were preserved. In this group of patients, IBD was successfully used in seven patients (39%) when PA was between – 2 and – 3 Z, while five patients (28%) with well-developed PA needed only PV-plasty. Group A was matched with historical cohort of 86 consecutive patients < 6 months of age (group B) who underwent primary correction of TOF between May 2005 and May 2012.

Results: There was no early or late death in both groups during the FU. FU in group A (mean, 5 months) was significantly shorter (p < 0.001). There was no difference in valve-sparing operation with well-developed PA between groups (A 28% vs. B 35%; p= 0.36). There was significant difference (p= 0.017) in the use of transannular patch between group A (33%) and B (65%), due to using IBD. None of the patients in group A was discharged at home with gradient on right ventricular outflow tract > 30 mm Hg, or needed reoperation/reintervention during FU.

Conclusion: IBD of PA in patients with moderate hypoplasia of PA is safe and effective. This approach might significantly decrease the need for transannular patching during primary early correction of TOF. Although the growths of the right ventricular outflow tract seem to be adequate, the long-term FU is needed for further evaluation.