[Percutaneous pulmonary valvuloplasty in neonates and infants with tetralogy of Fallot].

Percutaneous pulmonary valvuloplasty remains controversial as a palliative procedure in Tetralogy of Fallot. This paper reports the results of this technique with respect to clinical improvement and growth of the pulmonary arterial tree. Between June 1990 and July 1995, valvuloplasty with a balloon catheter was performed in 25 neonates or infants with Tetralogy of Fallot (13 girls and 12 boys). All patients were symptomatic with severe cyanosis associated with anoxic malaise in 14 cases. At catheterisation, the children were aged 3.5 +/- 2.6 months and weighted 4.7 +/- 1.2 kg. After dilatation, cutaneous oxygen saturation increased from 75 +/- 11 to 88 +/- 8% (p = 0.001). However, 3 children were referred for early surgery (one complete correction and two systemico-pulmonary anastomoses because of persistent desaturation. There were no lethal complications. A control (catheterisation or surgery) allowed evaluation of the growth of the pulmonary tract, on average 5.5 +/- 4.3 months after dilatation. The pulmonary artery diameter increased from 6.17 +/- 1.26 mm to 8.66 +/- 1.22 mm (p = 0.0015). Expressed as a Z score, the annulus diameter changed from -3.93 +/- 0.91 to -2.54 +/- 1.2 SD (p = 0.0019). The mean Z score of the right pulmonary artery increased from -3.01 +/- 0.69 to -1.98 +/- 1.12 SD (p = 0.0251) and the Z score of the left pulmonary artery from -2.68 +/- 0.85 to -1.61 +/- 1.46 SD (p = 0.0357). At complete correction, 50% of patients had had correction of their malformation without section of the pulmonary annulus. In conclusion, pulmonary valvuloplasty in Tetralogy of Fallot enables growth of the annulus and pulmonary arteries and is a valuable alternative to palliative systemico-pulmonary anastomosis.