Tetralogy of Fallot Surgery and Treatment Explained

The blood should flow to the lungs to absorb oxygen after it enters the heart. After picking up its oxygen load, the blood returns to the heart from where it is pumped throughout the body. However, infants with Tetralogy of Fallot (TOF) have problems getting blood to their lungs, so their bodies receive unhealthy blood that is low in oxygen content. 

TOF is a medical condition that prevents the heart from properly pumping blood to the lungs and the rest of the body. It occurs when there is a problem with the development of the heart when a baby is still in the womb. The abnormal pumping of blood is a result of four different defects in the infant’s heart, which is why they need a Tetralogy of Fallot surgery at the earliest. At a rate of 3–5 per 10000 live births, it is the most prevalent cyanogenic defect.

Heart Defects Leading to Tetralogy of Fallot Surgery

As already mentioned, the word “tetralogy” refers to a set of four. Heart defects in TOF involve all four chambers. This includes:

Ventricular Septal Defect: It is a hole in the septum separating the heart’s bottom chambers called the ventricles.

Pulmonary Stenosis: It is the condition in which the pulmonary valve becomes constricted or fully shut, reducing the ability of the heart to pump blood to the lungs.

Malposition of the Aorta:  In this condition, the aorta’s position is incorrect, just over the ventricular septal defect. Whereas, a normal heart has the aorta positioned entirely on the left side.

Right Ventricular Hypertrophy: With this heart defect, the pulmonary valve narrowing leads to right ventricular hypertrophy, which is a thickening of the right pumping chamber.

All these defects make Tetralogy of Fallot symptoms clearer, making it obvious that the patient needs a surgery. The severity of the symptoms depends on the condition of the heart. 

Causes of Tetralogy of Fallot

There are certain causes that may increase the risk for a pregnant woman to have a child with TOF.  

• German measles (rubella) and some viral illness
• Poor nutrition
• Excessive consumption of alcohol
• Age (being older than 40)
• Diabetes
• Heredity
• Genetic Disorders such as Down Syndrome and DiGeorge Syndrome

Tetralogy of Fallot Symptoms

Cyanosis is an indicative Tetralogy of Fallot symptoms. The skin, lips, and fingernails of a child with cyanosis turn blue because of the lack of oxygen in the blood. An infant with untreated Tetralogy of Fallot may experience ‘Tet spells’. This is a term used to describe when the child’s skin, nails, and lips turn pale blue after crying or when they’re bothered. Tet spells are caused because blood oxygen level drops too quickly in a child’s body. 

The kid may also develop dyspnea – the shortness of breath. Even minimal effort drains them physically to the point of collapse. This may also lead to making them insensitive toward their parents’ voices and touch. Kids with Tetralogy of Fallot may have trouble gaining weight and may have slow physical growth.

A cardiac murmur is also a typical Tetralogy of Fallot symptom. When doctors listen to the heartbeat through a stethoscope, they can detect an abnormal sound known as a cardiac murmur. The aberrant blood flow through the heart is what produces the heart defect and the accompanying noise. However, not all murmurs indicate serious cardiac problems. 

Diagnosis of Tetralogy of Fallot

The diagnosis of TOF depends on the child’s Tetralogy of Fallot symptoms, physical examination, and the evaluation of the tests.

Mostly, children born with heart defects exhibit symptoms within the first weeks of coming to this world. Parents may notice some of the earliest symptoms like cyanosis, dyspnea, or repeated episodes of chest pain. That may help detect and diagnose the condition. 

Need of Specialists

It is important for parents or child’s caregivers to consult only specialists like pediatric cardiologists and cardiac surgeons to have a proper diagnosis for TOF.

Physical Exam

The first step to diagnosing a heart defect in children is a physical examination by a cardiologist. The doctor uses a stethoscope to listen to their heart and lungs and check for any visible symptoms like a blue tinge on the skin, lips, or fingernails, fast breathing, and overall physical appearance.

Various Procedures of Diagnosis

The severity of the four cardiac defects in the Tetralogy of Fallot can be determined through the following diagnostic tests.

Echocardiography

Echocardiography (ECHO) provides a moving image of the heart using the sound waves. Ultrasound is used to know the structure of the heart as the sound waves echo off the organ and its chambers and ventricles. If there is a problem with the heart’s structure or function, this test helps the doctors detect and diagnose it easily. An echocardiogram is a crucial diagnostic test to detect Tetralogy of Fallot.

EKG (Electrocardiogram)

The electric pulses of the heart are recorded using a simple, painless test called an electrocardiogram (EKG). The results of the test will reveal the rate and rhythm of the child’s heartbeat (steady or irregular) and help to know if they need Tetralogy of Fallot surgery or not. It helps a doctor to see if the right ventricle is enlarged (ventricular hypertrophy).

X-ray of the Chest

An x-ray of the chest produces images of the organs and structures within it, including the heart and lungs, without causing any discomfort. The presence of any risk related to heart failure is determined by this test. It tells the doctor about the size of the heart and the flow of blood in the lungs.

Blood Oxygen Levels Using a Pulse Oximeter

The test involves the attachment of a tiny sensor to the subject’s finger or toe (like an adhesive bandage). The sensor provides an approximation of the blood oxygen level.

Catheterization of the Heart

During cardiac catheterization, the doctor can also assess the volume and oxygen content of the heart’s chambers and blood arteries. The doctor can use this to see if blood flows normally between the heart’s left and right sides.

TOF Surgery Options

In pediatric cardiac surgical procedures, Tetralogy of Fallot surgery is one of the most prevalent processes. There is no medical treatment available for TOF, therefore, heart defects are restored with help of surgery only. Usually, such surgeries are performed during the early years of life.

There are different surgeries available for restoring heart defects in TOF, but it depends on the child’s age, general health, medical history, the severity of the problem, and endurance medicines.

Typically, a team of cardiac surgeons performs the Tetralogy of Fallot surgery under general anesthesia. The primary purpose of repairing cardiac abnormalities is to restore the poorly oxygenated blood to flow normally through the pulmonary artery to acquire oxygen.

These are the two surgical options:

Complete Repair

To enhance blood flow to the lungs, the surgeons enlarge the route between the right ventricle and the pulmonary artery. Patching the ventricular septal defect prevents high-oxygen blood from mixing with the low-oxygen one between the ventricles. These modifications also correct the remaining two flaws, such as the overriding aorta and right ventricular hypertrophy. Since the right ventricle does not have to exert as much effort to pump blood into the lungs, the wall thickness of the ventricle will reduce. The patch for VSD closure stops low-oxygen blood from entering the aorta.

Temporary or Palliative Surgery

This Tetralogy of Fallot surgery can increase blood flow to the lungs through minor repairs. It is often reserved for infants who are too weak or little to undergo complete surgery. By inserting a short tube (called a shunt) between a big artery branching from the aorta and the pulmonary artery, the surgeon establishes an alternative pathway for blood to get to the lungs.

Complications for Tetralogy of Fallot

The following are the complications of TOF:

• Arrhythmia
• Blood clotting
• Death
• Heart failure
• Infection in the lining of the heart and heart valves (bacterial endocarditis)
• Leakage (regurgitation) from the repaired pulmonary valve

Transparent Hands Facilitating Hundreds of TOF Surgeries in Pakistan

More than 60,000 children are diagnosed with congenital heart defects each year in Pakistan. It is highly important for infants to undergo cardiac surgeries to enhance their chances of survival. Unfortunately, awareness of heart disease is deficient, and many children die due to a lack of medical assistance and awareness. Cardiac surgeries are expensive. Therefore, even if infants have the right diagnosis in their early years, most families cannot afford the surgical expenses. 

Transparent Hands helps patients in getting a number of pediatric cardiac surgeries each year, with the help of donors, and Tetralogy of Fallot surgery is one of them. The parents of children with congenital heart diseases register their cases through an easy process. We arrange the funds for the surgery with the help of the largest and most transparent crowdfunding platform.

“Make a donation today at https://www.transparenthands.org/crowdfunding/ and save an ailing heart.”