What's the treatment for tetralogy of Fallot?
Once tetralogy of Fallot is diagnosed, the immediate management focuses on determining whether the child's oxygen levels are in a safe range. If oxygen levels are critically low soon after birth, a prostaglandin infusion is usually initiated to keep the ductus arteriosus open which will provide additional pulmonary blood flow and increase the child's oxygen level. These
infants will usually require surgical intervention in the neonatal period. Infants with normal oxygen levels or only mild cyanosis are usually able to go home in the first week of life.
Complete repair is usually done electively when the children are about six months of age, as long as the oxygen levels remain adequate. Progressive or sudden decreases in oxygen saturation may prompt earlier corrective repair. The surgical correction of TOF is typically carried out through an incision in the middle of the chest. The incision is continued through the breastbone, or sternum, which is spread apart to expose the heart. A heart-lung machine is used to do the work of the heart while the heart is cooled, stopped, emptied and opened, through the right atrium or ventricle. The hole in the wall between the right and left ventricles, or VSD, is closed with a patch of Dacron cloth or a patch of thin leather-like material called pericardium. The muscle bundles and the narrowed pulmonary valve blocking the right ventricle are divided and the passage out of the right ventricle toward the lungs is widened, usually by applying a patch to this area. The heart is then closed and begins pumping as the heart-lung machine is withdrawn. There are many variations of this surgery, each of which is tailored for the specific needs of a particular child's anatomy. |
