721-6 Pulmonary Balloon Valvuloplasty: Effective Palliation for Infants with Tetralogy of Fallot and Small Pulmonary Arteries

Infants with tetralogy of Fallot (TOF) and small pulmonary arteries (PAs) may need palliation to improve pulmonary blood flow and allow growth of the PAs prior to complete repair. Shunts may become occluded, distort the PAs or cause pulmonary overcirculation. As an alternative palliation, we performed pulmonary balloon valvuloplasty (PBV) on infants with TOF and small PAs.20 infants, ages 1.8±1.5 mo and weights 4.1±1.6kg, undervvent PBV as initial palliation for persistent cyanosis or “spells”. 4/20 pts were intubated prior to or for PBV All pts had pre and post-PBV angiograms. In all pts, single balloon valvuloplasty was performed. The ratio of balloon: pulmonary valve annulus (PVA) diameter was 1.51±0.32. Post-PBV, there was no change in the PYA diameter (5.2±1.1mm vs 5.6 + 1.1mm; p=0.1) or PA branch diameter(4.1±1.6mm vs 4.5±1.7mm, p>0.05). The systemic 02 saturation increased from 81±8% to 93±6%. (p<0.001)7/20 pts undervvent follow-up (F/U) cath 8.2±2.4 mo post-PBV Compared to pre-PBV measurements, the PYA diameter increased from 5.2 ± 1.1mm to 7.1±1.4mm (p<0.03) and the McGoon ratio increased from 1.4±0.4 to 2.1±0.3 (p<0.02).Of the 20 pts, 11 pts undervvent corrective surgery 8.0±3.1 mo post-PBV with no surgical deaths; 5 pts remain in stable condition awaiting surgery; 3 pts required shunt placement 9-66 days post-PBV; 1 pt died due to other congenital anomalies.ConclusionsPulmonary balloon valvuloplasty promotes growth of the PAs and PYA in infants with TOF and small PAs, offering a safe and effective alternative palliation for infants who are not yet candidates for complete repair