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Tetralogy of Fallot Video Series
This video series explains Tetralogy of Fallot (TOF), a congenital heart malformation in which blood flow is blocked from entering the lungs. Fetal Heart Program and Cardiac Center staff discuss how they diagnosis the condition before birth, monitor babies through pregnancy and delivery, and surgically repair the defect.
Videos in this Series
Transcript: TOF Surgery
J. William Gaynor, MD: When we repair Tetralogy of Fallot, there are two major things that we need to do. One is to close the ventricular septal defect so that there's no mixing between the two pumping chambers and the second is to relieve the blockage to the lungs.
Unknown Speaker 1: It's very, very important that the family feels comfortable with you as an individual taking their child from them and that the child recognizes that nothing bad is going to happen to them, that they can do this without being awake for any painful experience.
Unknown Speaker 2: They'll go to the operating room. The anesthesiologist will put them to sleep. We'll then clean--prepare everything--their chest and abdomen sterilely so that we can do the operation without infection.
Thomas Spray, MD: The surgical repair of Tetralogy of Fallot involves using the heart-lung machine to support the circulation while the operation is done.
Jack Rychik, MD: We're bypassing the heart and the lungs so that the operative field, the area where we're working, is clean, and we can see what's going on.
Thomas Spray, MD: And then the heart is stopped, and the upper chamber of the heart is opened. And working through the valve that enters the right side of the heart, the hole between the two pumping chambers of the heart is closed with a patch. The patch is made out of a, sort of, fuzzy Dacron material so the lining of the heart grows over that and makes it nice and smooth.
J. William Gaynor, MD: There can be blockage below the pulmonary valve inside the ventricle from big muscle bundles. The pulmonary valve itself can actually be blocked. The pulmonary valve has three leaflets which open and, if they're fused together, that can cause a blockage because they can't open completely. Sometimes just by separating the leaflets you can open up the valve. The pulmonary valve is a circle and the outer layer, that's called the annulus. If that's very small, even if you open up the leaflets, it's like having a small tube. It may be too little. And then you can also have blockage out in the pulmonary arteries themselves. So you can have blockage below the valve, at the valve, and above the valve.
Thomas Spray, MD: Sometimes if the artery to the lungs is quite small, it's enlarged by opening it and putting a small patch over it to make it bigger so blood can easily get to the lungs.
J. William Gaynor, MD: That's called a transannular patch. Some babies will tolerate that very well. Others will need a valve put in at some point in their life. After surgery, we will make sure that the heart is working okay, that the blood pressure is okay, that there's enough oxygen in the blood, that there's no bleeding. And then, usually, we leave a couple little tubes inside the heart that let us measure pressures in the heart and give drugs. These come out through the skin. There's also usually two little blue pacing wires which let us change the heart rhythm. We then leave a drainage tube, and once everything's stable, the baby will come back up to the Intensive Care Unit.
Thomas Spray, MD: That operation, nowadays, takes about three hours to do from start to finish. And the actual time it takes to do the repair inside the heart is only about 30 minutes. The results with that surgery now are very good. The risk of not surviving the operation, while not zero, is less than 1%. So children do extremely well with that particular surgery.
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