Results of urgent interventions in patients with Tetralogy of Fallot within the first three months of age

Ashry, A, Khan, S, Mohammed, HM, Lotto, R, Narayanan, A, Jivanji, S, Kutty, R, Dhannapuneni, R and Lotto, AA Results of urgent interventions in patients with Tetralogy of Fallot within the first three months of age. World Journal for Pediatric and Congenital Heart Surgery. ISSN 2150-1351 (Accepted)

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Abstract

Background: Most patients with Tetralogy of Fallot (ToF) undergo reparative surgery at around six months of age. However, some experience severe cyanotic spells during the neonatal or infancy period, requiring urgent interventions to increase pulmonary blood flow. We present our experience managing symptomatic Tetralogy of Fallot in infants younger than three months of age. Methods: Retrospective review of patients younger than 3 months old with ToF and severe cyanotic spells who required intervention between January 2015 and December 2021. A total of 42 infants underwent urgent intervention (19 surgical procedures in group 1 and 23 transcatheter intervention in group 2). Results: Median age and weight were 38 days (IQR 19-70 days) and 3.7 Kg (IQR 3.4-4.2 Kg) in the surgical group (group 1) and 29 days (19-43 days) and 3.2 Kg (2.9-3.7 kg) in transcatheter group (group 2).In Group 1, nine infants(21.4%) had full surgical repair, eight (19%) required modified BTT shunt, one (2.4%) had isolated transannular patch and one (2.4%) received RV-PA conduit. In Group 2, nine infantsunderwent PDA stent (21.4%), nine had RVOT stent (21.4%), three required pulmonary valve balloon dilatation (7%) and two RVOT balloon dilatation (4.8%). Median ICU stay and hospital stay were four days (3-8) and nine days (7.5-20) in group 1, compared to one day (1-1.5) and five days (3-15.5) in group 2. Six infants(14.3%) had surgical procedures after unsuccessful transcatheter interventions. No infantsdied following surgical repair, while there was one mortality (2.4%) in the transcatheter group due to cerebral infarction following ECMO rescue. In group 2, median time to full repair was 10 months (6-12), and13 months (10-19.5) in palliative surgical procedures of group 1. One patient (2.4%) in group 1 needed reintervention after a salvage procedure before the full repair, while five patients (11.9%) in group 2 required further catheter reinterventions before proceeding to full repair. Conclusion: Our experience demonstrates that in patients with Tetralogy of Fallot requiringurgent early intervention, excellent outcomes can be achieved when choice of procedure is tailored to patient-specific anatomy and clinical status. In patients with favorable anatomy, full repair can be performed as primary procedure with good long-term outcome.

Item Type:	Article
Additional Information:	This is the Accepted Version accepted for publication in World Journal for Pediatric and Congenital Heart Surgery
Subjects:	R Medicine > RA Public aspects of medicine R Medicine > RT Nursing
Divisions:	Nursing and Advanced Practice
Publisher:	SAGE Publications
Date of acceptance:	15 May 2025
Date of first compliant Open Access:	19 May 2025
Date Deposited:	19 May 2025 11:11
Last Modified:	19 May 2025 11:30
URI:	https://researchonline.ljmu.ac.uk/id/eprint/26375

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