Tetralogy of Fallot..surgical treatment

The occurrence of ‘tet spells’ is generally an indication for cardiac surgery, at least in the long term.

Surgery may be palliative or corrective.

Palliative traetment include BT Shunt and modified BT Shunt

BT shunt: It consists of anastomosis of the subclavian artery to the pulmonary artery, bypassing the pulmonary stenosis so that a part of the hypoxemic aorta blood is supplied to the hear

Modified BT Shunt is a surgically-created (goretex) conduit between a subclavian artery and the pulmonary artery.

It improves blood flow to the pulmonary circulation by providing a route for returning systemic blood that bypasses the right ventricular outflow obstruction. Following a modified BT shunt, arterial oxygen saturations of about 70 to 85% are optimal as they indicate relative balance between pulmonary and systemic blood flows.

Definitive repair involves closure of the ventricular septal defect (VSD) and opening up of the obstructed right ventricular outflow tract.

Elective repair in relatively asymptomatic children is usually performed at about 6 months of age.

Definitive repair has about 95% survival at 25 years, with the majority of patients living unrestricted adult lives.

Duncan A, Croston E. Guidelines for Intensive Care Management of Infants and Children after Congenital Heart Surgery. Pediatric Intensive Care Unit, Princess Margaret Hospital, 2008.

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