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Simultaneous Double Balloon Dilatation for Supravalvar Pulmonary Obstruction After Arterial Switch Operation

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Abstract

The optimal approach for supravalvar right ventricular outflow tract obstruction(RVOTO) after arterial switch operation(ASO) is unclear. The results of percutaneous balloon dilatation have been variable. We report the results of simultaneous double balloon dilation for RVOTO after ASO. Sixteen patients (1.3(0.7–3.8) years; 9.8(8.1–15.1) kgs underwent the procedure at 14(8–44.5) months after ASO. Salient technical features included placement of balloons over stiff guide-wires positioned in both branch pulmonary arteries to enable dilation of the distal-most main pulmonary artery (MPA) with high inflation pressures (~ 12–14 atmospheres) and short inflation-deflation cycles. Effective balloon size was based on the PA annulus or MPA distal to the narrowing. The final balloon: narrowest segment diameter ratio was 2.7. Following dilation, the right ventricle to systemic systolic pressure ratio decreased from 0.9 ± 0.18 to 0.52 ± 0.16 (p  < 0.001) and mean RVOT gradient from 78 ± 18 to 34 ± 13.9 mmHg (p < 0.001). Narrowest diameter improved from 5.4 ± 2.2 to 9.2 ± 2.2 mm. There were no major complications. Two patients with inadequate relief (final RV-systemic ratios: 1.03 and 0.7) were referred for surgery. At median follow up of 9 months, IQR 7–22, range 5–73, others are free of re interventions with median RVOT gradient of 42, IQR 27–49, range 21–55 mmHg. The immediate and short-term follow up results of double balloon dilatation for supravalvar RVOTO is encouraging and may avoid the need for repeat surgery in the majority of patients. Further follow up is needed to determine the long-term durability of the results.

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Authors and Affiliations

  1. Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, Kochi, Kerala, 682041, India

    Navaneetha Sasikumar, Sujata Alawani, Abish Sudhakar & Raman Krishna Kumar

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  1. Navaneetha Sasikumar
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  2. Sujata Alawani
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  3. Abish Sudhakar
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  4. Raman Krishna Kumar
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Contributions

NS: conceptualization, data curation, formal analysis, investigation, methodology, project administration, supervision, validation, visualization, writing—original draft preparation, writing—review & editing. SA: data curation, formal analysis, investigation, methodology, validation, visualization, writing—original draft preparation. AS: data curation, formal analysis, investigation, methodology, project administration. RKK: conceptualization, data curation, formal analysis, investigation, methodology, resources, project administration, supervision, validation, visualization, writing—original draft preparation, writing—review & editing. The manuscript has been read and approved by all the authors, the requirements for authorship have been met, and that each author believes that the manuscript represents honest work.

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Correspondence to Navaneetha Sasikumar.

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None. Retrospective chart review maintaining patient confidentiality, ethics approved.

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Consent was waived as this is a retrospective chart review.

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Sasikumar, N., Alawani, S., Sudhakar, A. et al. Simultaneous Double Balloon Dilatation for Supravalvar Pulmonary Obstruction After Arterial Switch Operation. Pediatr Cardiol (2023). https://doi.org/10.1007/s00246-023-03288-6

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