Tetralogy of Fallot is one of the most common congenital heart defects, accounting for about 5-7% of all congenital heart diseases worldwide. The surgery aims to improve blood flow to the lungs and ensure oxygen-rich blood reaches the body.

Dr. Dinesh Mittal is a renowned Pediatric Cardiologist with expertise in treating congenital heart defects, including the Tetralogy of Fallot. With years of experience, Dr. Dinesh specializes in performing successful Tetralogy of Fallot repair surgeries, ensuring optimal outcomes for his young patients. His compassionate approach and dedication to providing comprehensive care make him a trusted choice for families seeking treatment for this complex condition.

Knowing what to expect and how to prepare can help parents and caregivers better support their children through this critical medical journey. This blog provides a comprehensive guide on what to expect before, during, and after the surgery.

What is a Tetralogy of Fallot Repair?

Tetralogy of Fallot is a congenital heart defect (present at birth). It is composed of 4 significant characteristics: A hole in the ventricular septal wall (ventricular septal defect); the aorta is on top of both ventricles instead of just the left ventricle (overriding aorta); narrowing of the pulmonary valve or the pulmonary arteries (pulmonary stenosis); and the right ventricle becomes thicker and more muscular than normal (hypertrophy).

These four defects collectively result in inadequate blood reaching the lungs for oxygenation while oxygen-poor blood is circulated to the rest of the body.

Tetralogy of Fallot must be repaired either soon after birth or later in infancy. The timing of the surgery depends on how severely the pulmonary valve is narrowed.

To address the Tetralogy of Fallot, open-heart surgery (involves dividing the breast bone / general anesthesia) will be performed.

What to Expect Before the Procedure?

Before the procedure, your doctor may perform a variety of diagnostic tests, including:

• Echocardiogram (ECHO)
• Computed tomography (CT scan)
• Magnetic resonance imaging (MRI)
• X-Rays
• Electrocardiogram (EKG/ECG)

What to Expect During the Procedure?

This procedure usually takes 5 to 6 hours, but preparation and recovery may add several hours. The procedure is generally performed in the cardiothoracic operating room (OR). In general, during this procedure:

• Your baby will be sedated. Then, a doctor will insert a breathing tube through your baby’s throat into their lungs and connect it to a ventilator. This will breathe for your baby during surgery.
• Your doctor will administer general anesthesia (which will make your baby feel sleepy).
• The procedure begins when your doctor exposes your baby’s heart by dividing the breastbone (sternum) in half. Your doctor then spreads both halves to gain access to your baby’s heart (open-heart surgery).
• For this type of surgery, the heart must be still. Before doing so, your doctor will place tubes into your baby’s heart so that blood can be pumped through your baby’s body using a heart-lung machine. This machine takes over the heart by replacing the heart’s pumping action and the lungs by adding oxygen to the blood.
• Once the blood has been diverted into the bypass machine for pumping, your doctor will stop the heart by injecting it with a cold solution.
• When the heart has been stopped, your doctor will start the procedure. The surgery aims to improve blood flow to the lungs and ensure that oxygen-rich and oxygen-poor blood flows to the right places.
• First, the pulmonary valve is widened or replaced, and the passage from the right ventricle to the pulmonary artery is enlarged. These procedures improve blood flow to the lungs, allowing the blood to get enough oxygen to meet the body’s needs.
• Second, a patch covers the hole in the ventricular septum (VSD). This patch stops oxygen-rich and oxygen-poor blood from mixing between the ventricles.
• Fixing these two defects resolves problems caused by the other two defects. When the right ventricle no longer has to work so hard to pump blood to the lungs, it will return to an average thickness. Fixing the VSD means only oxygen-rich blood will flow from the left ventricle into the aorta.
• After the procedure, the doctor will closely check to ensure everything works correctly. Once checked, the doctor will let the blood circulating through the bypass machine back into your baby’s heart.
• Once the procedure is complete, the machine will be turned off. The tubes will be removed, and the sternum will be sewn together with the use of sutures or surgical staples.

What to Expect After the Procedure?

After the procedure, your baby will be taken to the cardiothoracic intensive recovery unit (CTICU) for a few days. Your baby will also spend several days in the recovery unit. During this time, the cardiac team will:

• Ensure your baby’s vital signs, such as heart rate and breathing, are watched
• Make sure your baby feels no pain by giving pain medication
• Make sure to look after your newborn’s medications
• Manage the tubes (drains) that were placed in your baby’s chest during surgery
• Take care of the chest wound (sternal incision) and any other incision sites
• Make sure that your newborn can feed well by mouth
• Then, the team will give you instructions to follow during your baby’s recovery

Dr. Dinesh explains, “During Tetralogy of Fallot repair surgery, we aim to correct the four heart defects. Firstly, we open the chest and connect the child to a heart-lung machine, temporarily taking over the heart’s function. Then, we patch the hole in the heart’s wall and widen the pulmonary valve and artery to improve blood flow to the lungs. This helps the right ventricle return to its normal size and function. Finally, we ensure that only oxygen-rich blood flows to the body. It’s a complex procedure, but advancements in surgery have made it safer and more effective.”

A happy parent expressed deep gratitude for Dr. Dinesh Mittal’s exceptional expertise and care during their child’s Tetralogy of Fallot repair surgery. “Dr. Mittal took the time to explain every step of the procedure and patiently answered all our questions. Thanks to him, our child is thriving and living a healthy life. We are forever grateful to Dr. Mittal for his skill and compassion.”

What is the Cost of TOF Repair in India?

The cost of Tetralogy of Fallot repair surgery in India can vary depending on the patient’s hospital, surgeon, and specific medical needs. The average cost ranges from INR 2,00,000 to INR 6,00,000, approximately USD 2,700 to USD 8,100. This cost typically includes pre-operative tests, surgery, hospital stay, and post-operative care.

However, consulting with a healthcare provider or hospital for an accurate estimate based on the individual’s condition is essential.

Conclusion

Preparing for Tetralogy of Fallot repair involves thoroughly understanding the procedure, potential risks, and post-operative care. Patients can expect a multidisciplinary approach involving pediatric cardiologists, surgeons, and anesthesiologists to ensure a successful outcome.

Pre-operative evaluations, including imaging and blood tests, are essential to assess overall health and identify potential complications. Post-operatively, close monitoring and follow-up care are crucial for a smooth recovery. With proper preparation and care, patients can look forward to improved heart function and a better quality of life.

FAQs

1. Is Tetralogy of Fallot repair surgery safe?

Yes, Tetralogy of Fallot repair surgery is generally safe, with a high success rate.

2. How long does it take to recover from Tetralogy of Fallot repair surgery?

Recovery time varies, but most children can resume normal activities within weeks or months.

3. Are there any long-term effects of Tetralogy of Fallot repair surgery?

Most children recover fully without long-term effects, but regular follow-up with a cardiologist is essential.

4. Can Tetralogy of Fallot recur after surgery?

Recurrence is rare, but regular check-ups are necessary to monitor for any issues.

5. Can children with Tetralogy of Fallot lead normal lives after surgery?

Yes, with proper care and follow-up, children with Tetralogy of Fallot can lead normal, active lives.

Explre more blogs: Tetralogy Of Fallot: What Are The Causes and Symptoms?