Tetralogy of Fallot
Tetralogy of Fallot Treatment continued...
The Blalock-Taussig operation: A palliative procedure performed in smaller infants to increase blood flow to the lungs. This allows the child to grow big enough to have complete surgical repair.
A connection is made between one of the major arteries of the body, usually the right subclavian artery, and the right pulmonary artery, which increases the amount of red oxygenated blood reaching the lungs, relieving cyanosis with dramatic relief of the patient's symptoms.
Total correction: The hole in the ventricular septum (between the ventricles) is closed with a patch and the obstruction to right ventricular outflow, pulmonic stenosis, is opened. These corrections allow blood flow to the lungs for oxygenation before being pumped out into the body.
The timing of the operation depends on symptoms. Surgery usually is performed within the first 2 years of life. Operative mortality rates have dramatically dropped over the last 20 years. Still, about 1%-5% of children who undergo complete correction die during or immediately after the procedure, secondary to other additional defects in the body and/or heart, and the heart lung bypass procedure itself.
Your health care provider should schedule regular follow-up visits for your child. At these visits, the child should be checked for abnormal heart rhythms, which may develop in children who have undergone surgical correction for tetralogy of Fallot.
After successful surgery, children generally don't have any symptoms and lead normal lives with few, if any, restrictions. However, the surgery itself may have some long-term complications. These include the following:
- Right ventricular failure: Right ventricular failure is possible, especially if surgery created severe pulmonary valve insufficiency, which is leaking of blood backward from the pulmonary artery into the right ventricle.
- Electrical conduction abnormalities: Every patient with tetralogy of Fallot has right bundle branch block secondary to the congenital ventricular septal defect. But sewing the patch into the ventricular septum can create heart block or failure of the upper atria to conduct/communicate with the lower ventricles. A permanent pacemaker is occasionally needed.
- Arrhythmias: Because of surgery on the ventricles, postoperative ventricular tachycardia (VT) is an infrequent risk. This is a life-threatening arrhythmia, so follow-up to detect risk for ventricular tachycardia is important.
- Residual hole in the ventricular septum: This is also possible, with oxygenated blood passing from the left side of the heart to the right (shunting).