Right Ventricular Outflow Tract Stenting in a Premature Infant With Tetralogy of Fallot.

OBJECTIVE

To demonstrate a detailed procedural guide for right ventricular outflow tract (RVOT) stent placement for palliation of tetralogy of Fallot and pulmonary stenosis in a patient weighing <2 kg.

KEY STEPS: Obtain wire position with an 0.018-inch Hi-Torque floppy wire in a distal branch pulmonary artery. Exchange femoral venous sheath with a 5-F CHB sheath for stable stent delivery and angiograms during stent positioning. Stent RVOT with a 5 × 16 mm Formula 418 stent.

POTENTIAL PITFALLS: Coronary stents have a smaller profile and can be easier to position in the RVOT, but limit subsequent dilations to larger diameters without additional stent placement. Long sheaths can be difficult to manipulate in small infants, but allow for angiograms during stent positioning for optimal placement.

TAKE-HOME MESSAGE: Bare metal stents that are expandable to larger diameters can be safely used for RVOT stenting even in neonates <2 kg and allow for palliation until surgical repair with a single stent.