Introduction: Managing congenital heart disease (CHD) with decreased pulmonary blood flow is challenging. Up to 26% of those patients require palliative approach in the first months of life,such as systemic-to-pulmonary shunt creation, with relatively high morbidity and mortality rates, especially among patients presenting with hypercyanotic spells (HS) And percutaneous treatment options, such as ductus arteriosus stenting and right ventricular outflow tract (RVOT) stenting. RVOT stenting gained importance in recent years due to its lower mortality and low re-intervention rates, promoting pulmonary artery growth and improvement in hypoxia. Objective:evaluate the outcomes of RVOT stenting for children with CHD and decreased pulmonary blood flow and compare the outcomes between patients with and WSH. Methods: Retrospective study conducted in a pediatric cardiovascular center in Brazil between May 2013 and April 2024 . A total of 41 patients under 6 months old who underwent RVOT stenting were divided in two groups: with HS and without HS (WSH). HS was defined as the presence of oxygen saturation under 80% associated with the need of vasoactive drugs and mechanical ventilation. Results: Twelve patients were included in the group with HS ( 29%) while 29 patients were included in the group WSH (71%). The diagnoses of the cases were tetralogy of Fallot (TOF) [group with HS 8 (67%) and group WSH 15 (52%)], double outlet right ventricle [group with HS 3 (25%) and group WSH 8 (28%)], pulmonary atresia (PA) with VSD [none in the group with HS and group WSH 4 (14%)], atrioventricular septal defect with TOF [none in the group with HS and group WSH 2 (7%)] and atrioventricular septal defect with PA [group with HS 1 (8,3%) and [none in the group WSH]. The patients in the group with HS were older than children in group WHS at the time of the intervention [54 (8-130)days vs 29(4-117)days, P=0.028]. There was no difference between the group with HS and WSH regarding weight at the time of stent implantation  [3,4 (1,9 - 4,8)Kg vs 3,2 (2,1 - 6,3)Kg, P=0,532] or the  internal stent diameter used  [5 (3,5 - 7)mm vs 4,5 (3 - 6)mm, P=0,061].  The group with HS had lower oxygen saturation pre-procedure [66 (40 - 89)% vs 80 (60 - 88), P=0,003].  No difference in the size of the pulmonary valve, main pulmonary artery, right pulmonary branch, left pulmonary branch between the groups was found (all P> 0,05). No difference between the group with HS and WSH was found regarding oxygen saturation post-procedure  [89 (60 - 98)% vs 91 (84 - 97), P=0,604]. There was no difference between children in groups with and WSH regarding the need of reintervention [3 (25)% vs 7(24)%, P=1,0] or achieving total corrective surgery  [6 (33)% vs 9(31)%, P=1,0]. No difference comparing the mortality in the groups with HS and WSH was found [2 (17)% vs 2(7)%, P=0,567]. Conclusion: The RVOT stenting remains a safe palliative option, especially in cases with increased surgical mortality rate such as in patients with HS.