Name of the Procedure:

Complete Repair of Tetralogy of Fallot without Pulmonary Atresia; with Transannular Patch

Summary

A complete repair for Tetralogy of Fallot (TOF) involves a surgical procedure where a transannular patch is used to widen the narrowed pulmonary valve and right ventricle outflow tract. This allows improved blood flow from the heart to the lungs.

Purpose

This procedure treats Tetralogy of Fallot, a congenital heart defect that presents with four heart abnormalities. The main goal is to ensure proper blood flow to the lungs so the blood can receive enough oxygen, thereby improving the patient's oxygen saturation levels and overall cardiac function.

Indications

• Symptoms include cyanosis (bluish skin), difficulty breathing, and fatigue.
• Indicated for children diagnosed with Tetralogy of Fallot without pulmonary atresia.
• Appropriate for patients showing evidence of right ventricular outflow tract obstruction and inadequate pulmonary blood flow.

Preparation

• Patient may need to fast for several hours before surgery.
• Pre-operative evaluations include echocardiograms, cardiac catheterization, blood tests, and chest X-rays.
• Medication adjustments, particularly blood thinners, will be directed by the medical team.

Procedure Description

1. Administer general anesthesia to ensure the patient is asleep and pain-free.
2. A median sternotomy is performed to access the heart.
3. The heart is connected to a heart-lung bypass machine to maintain circulation.
4. The surgeon repairs the ventricular septal defect (hole between the heart's ventricles).
5. A transannular patch is applied to widen the pulmonary valve and right ventricular outflow tract.
6. The heart-lung bypass machine is disconnected, and the chest is closed.

Duration

The procedure typically takes between 4-6 hours, depending on the complexity of the anatomy and severity of the case.

Setting

This surgery is performed in a hospital's operating room with specialized cardiac surgical facilities.

Personnel

• Cardiothoracic surgeon
• Pediatric cardiologist
• Anesthesiologist
• Surgical nurses
• Perfusionist (operates the heart-lung machine)

Risks and Complications

• Bleeding
• Infection
• Arrhythmias (irregular heartbeats)
• Residual or recurrent obstruction
• Heart valve leakage
• Risks associated with anesthesia

Benefits

• Improved oxygen levels in the blood
• Enhanced physical activity and growth
• Reduced symptoms such as cyanosis and fatigue
• Better overall cardiac function Benefits typically become noticeable within a few days to weeks post-surgery.

Recovery

• Hospital stay of about 1-2 weeks for monitoring and initial recovery.
• Follow-up appointments for echocardiograms and regular check-ups.
• Limit physical activity for a few months to allow complete healing.
• Instructions on wound care and medications, including pain management and antibiotics.

Alternatives

• Symptomatic management with medications
• Palliative shunt surgery, which is less definitive than a complete repair
• Risks and limitations of alternatives: do not fully correct the underlying defect, hence less effective in the long term.

Patient Experience

• The patient will be unconscious during the surgery due to general anesthesia.
• Post-operative pain is managed with medication.
• Feelings of discomfort, fatigue, and mild pain around the incision site are common but controlled with appropriate pain relief measures.
• Gradual return to normal activities as advised by the healthcare team.