Tetralogy of Fallot Repair
What is tetralogy of Fallot repair (TOF)?
Some
children are born with a group of four heart problems that
is called Tetralogy (four) of Fallot.
This group includes:
- Pulmonary stenosis (a narrowing of the blood vessel to the lungs)
- Overriding aorta (the main blood vessel from the heart to the entire body is somewhat displaced)
- A ventricular septal defect (hole in the wall between the lower two chambers of the heart)
- Right ventricular hypertrophy (a thick muscle in the right pumping chamber)
This is the most common form of cyanotic heart defects (blue babies). In most children, primary total repair is performed. Occasionally, if a baby is found to be very blue at birth with a low birth weight or with very small pulmonary arteries, then a palliative(temporizing) shunt is performed and total repair is carried out when the child is somewhat larger and stronger.
Preparing for the procedure
Prior
to cardiac surgery, this heart defect will be diagnosed with
an EKG, a chest x-ray and an echocardiogram. Before surgery,
blood tests are conducted to be sure that there is no infection
and no problem with clotting, and that normal electrolyte
levels are in the blood. A blood test to determine the blood
type and compatibility will be performed so that blood will
be available for the surgery.
During the procedure
During
the procedure, the child will be placed under general anesthesia
and special monitoring intravenous lines will be put in. The
chest is entered through the sternum (breastbone), and the
heart/lung machine is connected. Once the heart is stopped
and empty, the two significant components of the defects are
repaired: the ventricular septal defect is closed with a patch of synthetic material,
and the narrowing between the right ventricle and the pulmonary
artery is enlarged by removing the obstructing muscle or pulmonary
valve and placing a patch to enlarge the area as needed. The
heart is then allowed to fill and start beating. Temporary
pacemaker wires and a drain are placed. Pressure measurements
and blood sampling from different chambers of the heart are
then carried out to assess the adequacy of the repair before
chest is closed. The child stays on the breathing machine
for a few hours after the surgery (sometimes overnight). When
the child is awake enough and the heart appears strong enough,
the breathing machine is discontinued.
After the procedure
After surgery, the child will need a number of days to recover from anesthesia, from the use of heart-lung bypass equipment and from the surgery. Initially, the child will be on a ventilator (breathing machine) and may need support from intravenous medicines and a temporary pacemaker. Once the breathing tube (endotracheal tube) is out, the main goals are for the child to return to normal activity and to resume normal eating and weight gain.
Click here for recovery guidelines after discharge for congenital heart defect repair at the Inova Heart Center.
- Atrial Septal Defect (ASD) Repair
- Ventricular Septal Defect
- Tetralogy of Fallot Repair
- Arterial Switch for TGA
- Atrioventricular Canal Surgery
- Bidirectional Glenn
- Fontan
- Heart Valve Repair and Replacement
- Ross Procedure for AVR
- Patent Ductus Arteniosus
- Coarctation of the Aorta Repair
- Systemic to Pulmonary Shunt
- Pediatric Recovery
