Stenting in the right ventricular outflow tract and delayed correction in a patient with tetralogy of Fallot A clinical case.

Abstract

Introduction: Patients with symptomatic newborn tetralogy of Fallot indicate treatment, either palliative or corrective surgery; however, the initial management of these patients is currently controversial.

Clinical Case: Newborn female, 40 weeks gestation, who was admitted at 24 hours of life due to cyanosis, tachypnea, thoracic-abdominal retractions, and the presence of a III/VI systolic ejection murmur in the pulmonary focus.

Diagnostic workshop: In the tests: leukocytosis 27.05 x 103 /UL, metabolic acidosis PH: 7.36, pCO2: 36.2 mmHg, Base excess: -4.6 mEq/L, hypoxemia: pO2 54.1 mmHg and lactic acidosis five mmol/L. The echocardiogram showed tetralogy of Fallot, with severe infundibular and pulmonary valve stenosis, with a 3-mm (Z: -7.6) pulmonary ring, hypoplastic pulmonary trunk, and branches.

Treatment: Intravenous hydration and initiating prostaglandin, ampicillin, and gentamicin IV for seven days. On the 11th day, cardiac catheterization was performed with stent placement (4.5 and 16 mm) in the right ventricular outflow tract, with five high-flow aortopulmonary collaterals embolized.

Evolution: The procedure was well tolerated, with discharge after 17 days with acetylsalicylic acid 15 mg/day, furosemide 2 mg/day, and spironolactone 6.25mg/day. At ten months, corrective surgery for tetralogy of Fallot was performed with a transannular patch and plasty of the left pulmonary branch. Control at 18 months was standard.

Conclusion: The percutaneous placement of a stent in the right ventricular outflow tract is a safe method that guarantees stable pulmonary flow, allowing corrective surgery to be deferred beyond the neonatal stage.