Since the VSD is nonrestrictive, both right and left ventricle have the same systolic pressure. From the hemodynamic point of view, TOF has two basic components viz., a large ventricular septal defect (VSD) and RVOT obstruction.
TOF patients can present with severe cyanosis or can be asymptomatic without clinically evident cyanosis. Essentially, a cyanotic TOF child was converted to 'pink TOF' by balloon pulmonary valvotomy. However, the systemic saturation increased to 88% with appearance of a 3/6 ejection systolic murmur. Severe RVOT obstruction persisted with a gradient of 100mHg. Repeat pressure studies showed normal waveform in the pulmonary artery pressure tracing with a systolic pressure of 20mmHg. Pulmonary valvotomy was done with a 20mm Tyshak balloon with complete abolition of the waist. The basal pulmonary artery pressure tracing showed poor waveform with a mean pressure of 8mmHg. Right ventricular angiogram revealed doming pulmonary valve with a diminished antegrade flow. Right ventricular outflow tract (RVOT) gradient was 110mmHg. Special attention was paid to her hydration before bringing her to the catheterization laboratory. Total intracardiac repair could not be done due to financial reasons and hence it was decided to palliate her with balloon pulmonary valvotomy.Ĭardiac catheterization was done under local anesthesia and intravenous sedation with midazolam. The branch pulmonary arteries were confluent but the right pulmonary artery (7mm) was hypoplastic as compared to the left pulmonary artery (12.5mm). Echocardiography revealed tetralogy of Fallot (TOF) with severe infundibular and valvar pulmonary stenosis. Her systemic oxygen saturation was 65% and hemoglobin was 22g%. On examination, she had quiet precordium, single second sound with 1/6 ejection systolic murmur. She was suspected to have a heart disease at the age of 2 years but did not undergo any further evaluation. Available from: Ī seven year old girl presented with exertional syncope.
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Keywords: Balloon valvotomy, tetralogy of Fallot, hemodynamics How to cite this article: Kannan BR. Consultant Interventional and Pediatric Cardiologist, Vadamalayan Hospitals, Madurai, IndiaĬlick here for correspondence address and
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