Tetralogy of Fallot is a congenital heart condition. It requires open-heart surgery for complete repair of the four heart structure abnormalities.
Your surgeon will give specific instructions and details before the surgery, including risks such as bleeding, infection, and adverse reaction to anesthesia. Please be sure to contact your insurance company for coverage.
It's important that children are free from infection, including dental infections, up to six weeks prior to surgery. Please be sure that your child's immunization records are made available to your surgeon or the nurse.
You will meet with the anesthesiologist prior to the surgery to go over your child’s medical history. The child should not eat after midnight the night before the surgery.
On the day of surgery, a nurse will review your child’s chart to make sure there are no problems and the anesthesiologist will start an IV. Your child will be taken to the operating room, where his or her name and procedure are verified before any medication is given. Surgery will begin once the child is under anesthesia.
Before an incision is made, a cardiologist will do a transesophageal echocardiogram to provide the surgeon a way of looking at the structure of the heart during the surgery. The incision will then be made in the breastbone to access the heart. The child is placed on cardiopulmonary bypass, a device used to provide oxygenated blood to the body while bypassing the heart and lungs so the surgeon can operate.
Depending on the defects, multiple incisions can be made on the heart for repair. If there is a ventricular septal defect (VSD), an incision will be in the right atrium to access the defect through the tricuspid valve. The patch (either the child’s own pericardial tissue or a synthetic graft) is then stitched onto the defect to close it. If there is any obstruction in the outflow tract in the right ventricle, it is taken away at this time.
The second incision is usually made in the main pulmonary artery to complete the closure of the VSD and remove any other obstructing tissue. Once these repairs are made, the heart is closed with sutures and the cardiopulmonary bypass machine is removed. Pacing wires will then be placed temporarily on the heart as a safety measure for heart rhythm abnormalities after the operation.
The child will also have chest tubes placed to collect any residual blood or fluid left in the chest after the surgery. Another echocardiogram is done to ensure there are no other issues or problems not seen by the surgeon. The skin is then closed with stitches or staples.
After the surgery, your child will be taken to the intensive care unit and monitored for heart and lung changes. Pain is likely, so pain medication will be given appropriately. He or she will also have a breathing tube and respirator for the first period after surgery. It is important to keep the incision areas clean and dry.
The length of the hospital stay depends on how quickly your child is able to recover and perform some physical activity. Please let your doctor know immediately if your child experiences fever, severe pain, redness, swelling, warmth where the incisions were made, or drainage from the incisions. Your surgeon will give specific instructions about recovery time.