Department of General Medicine, Sri Lakshmi Narayana Institute of Medical Sciences, Puducherry – 605502, India.
Case presentation ,Pulmonary stenosis ,diagnosis ,percutaneous pulmonary valvuloplasty technique ,

Tetralogy of Fallot (TOF) is defined by right ventricular outflow tract stenosis, a ventricular septal defect (VSD), an overriding aorta, and RV hypertrophy. The most frequent cyanotic congenital heart disease, accounting for 3.36 percent of all congenital heart illnesses, it is the most frequent cyanotic congenital heart disease. After the introduction of cardio-pulmonary bypass in 1953, surgical repair for TOF became conceivable, and surgical outcomes have improved considerably since the 1970s. Currently, the survival percentage of patients over 20—30 years after TOF repairs is 85—90%, which is considered good. The age at the time of repair, when the repair was performed, residual pulmonary stenosis, pulmonary regurgitation (PR), and arrhythmia are all particular factors that affect survival after surgical repair. The patient was a 37-year-old female who had undergone TOF surgery when she was 4 years old. After the surgery, she had pulmonary stenosis of about 70 mmHg, but she was controlled medically. She was hospitalized on 2017, for a thorough assessment and treatment after experiencing increased fatigue and dyspnea during exertion. Cardiac catheterization revealed a peak-to-peak gradient of about 90 mmHg from the RV to the pulmonary artery and a restricted opening of the pulmonary valve (dome-shaped development) in the right ventriculography. Due to the inability of conservative treatment to alleviate the subjective symptoms, the patient was admitted to the hospital again on November 27 to have percutaneous pulmonary valvuloplasty. We have seen an adult with chronic right heart failure caused by pulmonary stenosis that had persisted following a TOF surgery. It is hypothesized that pressure overload of the RV caused by residual pulmonary stenosis following TOF surgery, as seen in this case, produces right heart failure and critical arrhythmia, and that this is a decisive factor in TOF prognosis. Balloon valvuloplasty is suggested by the ACC/AHA Task Force in patients with pulmonary stenosis who have symptoms of heart failure and an RV-to-pulmonary artery peak-to-peak gradient more than 30 mmHg. . The RV-to-pulmonary artery peak-to-peak gradient in the current patient was 13 mmHg after the treatment, showing that the operation had a favorable alleviating effect on the right ventricular pressure load. After the treatment, there were no increases in the pressure load in the chronic phase, and her subjective symptoms have since been eased. Based on this instance, we feel that triple-balloon valvuloplasty is a potential method for improving the chronic prognosis of pulmonary stenosis.

8 , 2 , 2018