Cardiosurgery: Tetralogy of Fallot (tof) — Complete intracardiac repair . Treatment
Fallot tetralogy is one of the most common defects of the heart, which is a combination of four anomalies, i.e. narrowing of the right ventricle output, hole in the interventricular septum, displacement of aorta to the right and hypertrophic changes of the right ventricle, emerging as a result of high blood pressure in the heart chambers. Hypoxia resulting from this defect is caused by mixing of venous and arterial blood, so the main visual feature of the disease is blueness (cyanosis) of the skin. According to statistics, Fallot tetralogy accounts for about 10% of all congenital anomalies of the heart structures.
A conservative therapy is conducted to alleviate the disease symptoms, but it is only a preparation for surgical correction. To improve the patient’s condition, the following aid are prescribed:
- oxygen inhalation;
- plasma expanders.
Fallot Tetralogy Surgical Correction
For young children with severe symptoms, the palliative interventions are usually indicated, which aim at improvement of condition for subsequent defect correction at a later age. These surgeries may imply:
- creation of aorto-pulmonary anastomosis, which is used to improve the blood flow in the small circle of blood circulation;
- creation of anastomosis between the subclavian and right pulmonary artery;
- creation of anastomosis between the left pulmonary artery and the aorta;
- balloon dilation of stenotic portion of the right ventricle.
Synthetic materials and specially treated animal tissues are used to create anastomoses.
The final correction of Fallot tetralogy is usually carried out when the child becomes 3 years old. A later the intervention usually gives worse results, but the final decision is made by a cardiac surgeon, based on the survey findings. The surgery is performed using the cardiopulmonary bypass and general hypothermia, which is required to increase the tissue resistance to hypoxia. Opening in the ventricular septum is closed by a patch overlay, aorta is moved leftward, and the narrowed segment of the right ventricle is expanded by plastic methods using an artificial prosthesis or modified xenopericardium.
Adequate treatment of the Fallot tetralogy symptoms and professional performance of surgical correction yields a favorable prognosis in 75-80% cases.Hide