Right Ventricular Outflow Tract Obstruction: Transcatheter Correction In Tetralogy Of Fallot: A Pilot Study.

This study evaluated transcatheter approach for relieving right ventricular outflow tract (RVOT) obstruction using combined non-compliant balloon dilatation of the RVOT and conal artery occlusion in patients with Tetralogy of Fallot (TOF), both uncorrected and post-intra-cardiac repair (ICR) restenosis. A prospective study was conducted from January 2022 to June 2023, including 40 symptomatic patients aged over 12 years with RVOT obstruction in TOF. Exclusion criteria included moderate to severe pulmonary regurgitation. The procedure involved two steps: non-compliant balloon dilatation of the RVOT and conal artery embolization using alcohol or coils or both. Clinical and echocardiographic assessments were performed pre-procedure, immediately post-procedure, and at 1-year follow-up. Thirty-five patients completed the study. Mean age was 19.8 (±4.2) years, with a male-to-female ratio of 4:3. Twenty-five patients had uncorrected TOF, and ten were post-ICR. Post-procedure, uncorrected patients showed a significant increase in oxygen saturation from 84.7 (±1.4) % to 94.6 (±1.2) %. Procedural success was 91.4%, with three patients experiencing significant restenosis. No procedural complications were observed. There were no arrhythmic events till the 1 year of follow up. At 1-year follow-up, the mean RVOT pressure gradient was significantly reduced, and all patients remained symptom-free. In conclusion, combined balloon pulmonic valvuloplasty and conal artery occlusion is a safe and effective method for alleviating RVOT obstruction in TOF patients, showing promising intermediate-term outcomes with minimal complications.