Perioperative management of tetralogy of Fallot with absent pulmonary valve

Standardized delivery room management for neonates with a prenatal diagnosis of congenital heart disease: A model for improving interdisciplinary delivery room care

Precise characterization of cardiac anatomy and physiology through fetal echocardiography can predict early postnatal clinical course. Some neonates with prenatally defined critical congenital heart disease have anticipated precipitous compromise during perinatal transition for which specialized, diagnosis-specific delivery room care can be arranged to expeditiously stabilize cardiopulmonary hemodynamics. In this article, we describe our institutional approach to the delivery room care of neonates with prenatally diagnosed congenital heart disease, emphasizing our diagnosis-specific care pathways for newborns with critical disease.

Correction of Tetralogy of Fallot with Absent Pulmonary Valve Syndrome in a Young Infant Using a Bicuspid Equine Pericardial Tube

Absent pulmonary valve syndrome (APVS) is an uncommon variant of tetralogy of Fallot (TOF), which manifests morphologically as vestigial pulmonary valve cusps at the right ventricle-pulmonary trunk junction. The aneurysmally dilated pulmonary arteries may compress the tracheobronchial tree and cause severe respiratory distress in the neonatal or infant stage. Early surgical correction in these patients is necessary despite the high operative mortality rate. A 1-day-old male neonate suffered from progressive shortness of breath after birth. Echocardiography confirmed the diagnosis of TOF with APVS. The marked dilatation of pulmonary arteries resulted in airway compression in addition to heart failure. Total surgical correction was performed at 40 days of age, using a homemade bicuspid equine pericardial tube for right ventricular outflow reconstruction. The short-term follow-up echocardiogram demonstrated good motility of the pericardial leaflet. However, patients receiving this type of valved conduit require meticulous long-term follow-up.

Tetralogy of Fallot with absent pulmonary valve syndrome

Tetralogy of Fallot with absent pulmonary valve syndrome is a rare variant of tetralogy of Fallot marked by severe pulmonary insufficiency in utero and significant, sometimes massive, dilation of the pulmonary arteries. This syndrome can be associated with airway abnormalities that can cause respiratory compromise. Patients who present with respiratory symptoms early in life continue to present a major clinical challenge associated with relatively high mortality rates, typically in the 20% to 30% range. A variety of surgical techniques have been developed to address absent pulmonary valve syndrome that may improve long-term outcomes.