Teralogy of Fallot (TOF)

Introduction:

Tetralogy of fallot has four key features. A ventricular septal defect (a hole between the ventricles) and many levels of obstruction from the right ventricle to the hugs (pulmonary stenosis) are the most important. Also the aorta (major artery from heart to the body) lies directly over the ventricular septal defect and the right ventricle develops this cleared muscle.

Because the aorta overrides the ventricular defect and there’s pulmonary stenosis, blood from both ventricles (oxygen rich and oxygen poor) is pumped into the body. Sometimes the pulmonary valve is completely obstructed (pulmonary atresia). Infants and young children with unrepaired tetralogy of fallot are often blue (cyanotic). The reason is that some oxygen-poor blood is pumped to the body.

Surgical Treatment

TOF is treated surgically. A temporary operation may be done at first in the baby is small. Complete repair comes later. Sometimes the first operation is a complete intra-cardiac repair.

Temporary operation

In small and very blue infants a shunt operation may be done first to provide adequate blood flow to the lungs. This lets the baby grow big enough to have a full repair. The shunt is built between the aorta and the pulmonary artery. The shunt is removed when a complete intracardiac repair is done later.

Complete repair

Complete repair tend to be done early in life. Once it was more common to do a temporary operation first and a complete repair later in childhood.

To do a complete repair, the surgeon close the ventricular septal defect with a patch and opens the right ventricular outflow track by removing some thickened muscle below the pulmonary valve, repairing or removing the peripheral pulmonary arteries that go to both lungs. Sometimes a tube is placed between the right ventricle and the pulmonary artery. This is sometimes called a Rastelli repair.

Post operative care

Medical Care

If you have had tetralogy of fallot repaired, you need regular follow up with a cardiologist who’s had special training in congental heart defects. Your cardiologist will follow you progress with various tests, these include ECG, holtermonitor, exercise stress tests and echo cardiogram. This will help determine if you need another procedure such as a caridiac catheterization or more surgery.

Will who need more surgery?

After the first complete repair, residual problem may require you to have more open heart surgeries or procedures in the cardiac catheterization laboratory. In some cases, a procedure using a balloon-tipped catheter to dilate and /or place an expandable stent in narrowed areas may be needed instead of or along with more heart surgery.