Tetralogy of fallot surgical techniques

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Priyamvada Singh, MBBS [2]; Cafer Zorkun, M.D., Ph.D. [3]; Keri Shafer, M.D. [4]; Assistant Editor(s)-In-Chief: Kristin Feeney, B.S. [5]

Overview[edit | edit source]

Repair of tetralogy of Fallot reduces mortality. we can either perform palliative surgery which involves forming an anastomosis between the subclavian artery and the pulmonary artery. This redirected a large portion of the partially oxygenated blood leaving the heart for the body into the lungs, increasing flow through the pulmonary circuit, and greatly relieving symptoms in patients or total surgical repair which involves making incisions into the heart muscle, relieving the right ventricular outflow tract stenosis by careful resection of muscle, repairing the VSD using a Gore-Tex or Dacron patch or a homograft. Additional reparative or reconstructive work may be done on patients as required by their particular anatomy.The repair could be done by either of the approaches i.e.transatrial or transpulmonary.

Surgery[edit | edit source]

Palliative Surgery[edit | edit source]

• The condition was initially thought untreatable until surgeon Alfred Blalock, cardiologist Helen B. Taussig, and lab assistant Vivien Thomas at Johns Hopkins University developed a surgical procedure. It was actually Helen Taussig who convinced Alfred Blalock that the shunt was going to work.
• The surgery involved forming an anastomosis between the subclavian artery and the pulmonary artery. This redirected a large portion of the partially oxygenated blood leaving the heart for the body into the lungs, increasing flow through the pulmonary circuit, and greatly relieving symptoms in patients.
• The first Blalock-Thomas-Taussig shunt surgery was performed on 15-month old Eileen Saxon on November 29, 1944 with dramatic results.
• The Pott shunt and the Waterson procedure are other shunt procedures which were developed for the same purpose.
• Waterson shunt: Shunt between right pulmonary artery and ascending aorta.
• Potts shunt: Shunt between left pulmonary artery and descending aorta.
• The technique has been modified and is usually performed using a Gortex tube to create the connection.
• Currently, Blalock-Thomas-Taussig shunts are not normally performed on infants with TOF except for some conditions like-
  • Severe variants such as tetralogy of Fallot with pulmonary atresia
  • Premature babies
  • Coronary artery origin anomalies
• The Blalock-Taussig procedure was the only surgical treatment until the first total repair was performed in 1954.
• They are usually performed through lateral thoracotomy.

Disadvantages[edit | edit source]

• Shunt placement causes pulmonary artery distortion such as kink, thrombosis and occlusion
• Large shunt produces pulmonary hypertension and pulmonary vascular disease.
• Large shunt causes volume overload of left ventricle.

Total Surgical Repair[edit | edit source]

• The total repair was performed by C. Walton Lillehei at the University of Minnesota in 1954 on a 10-month boy.
• Total repair initially carried a high mortality risk which has consistently improved over the years.
• Surgery is now often carried out in infants 1 year of age or younger with a <5% perioperative mortality.
• The surgery generally involves
  • Making incisions into the heart muscle, relieving the right ventricular outflow tract stenosis by careful resection of muscle
  • Repairing the VSD using a Gore-Tex or Dacron patch or a homograft.
  • Additional reparative or reconstructive work may be done on patients as required by their particular anatomy.
  • The repair could be done by either of the approaches i.e.transatrial or transpulmonary
• Patients who have undergone "total" repair of tetralogy of Fallot often have good to excellent cardiac function after the operation with some to no exercise intolerance and have the potential to lead normal lives. Surgical success and long-term outcome greatly depends on the particular anatomy of the patient and the surgeon's skill and experience with this type of repair.
• Pulmonary valve should be replaced before right ventricle dysfunction occurs.

Video[edit | edit source]

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After Repair[edit | edit source]

Arrythmia may occur after the surgical repair of TOF.

2008 ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease (DO NOT EDIT)^[1][edit | edit source]

Evaluation and Follow-up in the Repaired Patients of Tetralogy of Fallot (DO NOT EDIT)^[1][edit | edit source]

Surgery for Adults with Previous Repair of Tetralogy of Fallot (DO NOT EDIT)^[1][edit | edit source]

References[edit | edit source]

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