Tetralogy of Fallot Repair

UT Southwestern Medical Center, one of the top cardiothoracic surgery centers in the U.S., offers advanced open-heart surgery to repair the cardiac abnormalities associated with tetralogy of Fallot (TOF).

These defects and their related complications are unique to every person, so UT Southwestern’s heart experts tailor this surgery to each patient as appropriate.

Surgical Expertise for Tetralogy of Fallot

Open-heart surgery is required to repair tetralogy of Fallot (TOF), a complex congenital heart condition. Depending upon the precise nature of the condition, surgery to repair it can include ventricular septal defect (VSD) closure, removal of muscle from the right ventricle, repair of the pulmonic valve, or pulmonary artery enlargement.

Our heart surgeons can perform surgery in small infants to temporarily manage the heart defects, with complete surgical repair to follow when the baby is older.

UT Southwestern’s cardiothoracic surgeons have the experience and expertise needed to treat tetralogy of Fallot. We offer specialized care that can minimize or prevent complications of congenital heart disease and help patients live longer, healthier lives.

We take a collaborative approach, combining cardiologists, interventional cardiologists, and surgeons to develop the best treatment plan for each patient. UT Southwestern has cardiac surgeons who specialize in complex neonatal surgery, enabling one surgical procedure for complete repair within the first six months of life – rather than multiple procedures in the first year.

Our surgeons and cardiologists work closely together in hybrid operative procedures, using a combination of surgery and minimally invasive catheter procedures. The team focuses on preserving the patient’s pulmonary valve and performing the procedure through the atrium and pulmonary artery, rather than open surgery that would require an incision into heart muscle. Our goal is to preserve the ventricles’ pumping function and provide the best opportunity to delay the need for future pulmonary valve replacement procedures.

UT Southwestern is also home to a dedicated Cardiac Rehabilitation Program. Cardiac rehabilitation is a critical component of recovery and can prevent future heart disease.

TOF Repair: What to Expect

Preoperative Details

The surgeon provides specific instructions to the patient’s parents prior to the tetralogy of Fallot repair procedure, also discussing risks such as bleeding, infection, or adverse reaction to anesthesia.

Parents also meet with the anesthesiologist prior to the surgery to review their and the patient’s medical history. Patients should not eat after midnight the night before the surgery.

On the day of surgery, the parents bring the patient to the hospital and, after registration, a hospital gown is put on the patient. A nurse reviews the patient’s charts to make sure there are no problems.

The patient is taken to the operating room, where the surgeon verifies the patient’s name and procedure before any medication is given. Surgery will begin once the patient is under anesthesia.

Operative Details

Before the surgery begins, a cardiologist starts a transesophageal echocardiogram (TEE) so the surgeon can look at the heart structure during surgery.

The surgeon then makes an incision in the breastbone to reach the heart, and the patient is placed on a cardiopulmonary bypass machine – which pumps blood to the body, bypassing the heart and lungs except for the coronary arteries – while the heart is temporarily stopped.

To close the ventricular septal defect (VSD), the surgeon makes an incision in the right atrium to access the defect through the tricuspid valve. A patch – either the patient’s own pericardial tissue or a synthetic graft – is then stitched onto the defect to close it. If there is an obstruction of the right ventricle’s outflow tract, it is removed.

The second incision is usually made in the main pulmonary artery to complete the VSD closure and remove any obstructing tissue.

Depending on the exact nature of the defects, the surgeon might need to make additional incisions to repair the heart.

Once the necessary repairs are made, the heart is closed with sutures and the cardiopulmonary bypass machine is removed. Pacing wires are placed temporarily on the heart to prevent heart rhythm abnormalities after the operation.

Chest tubes are placed to collect residual blood or fluid in the chest after the surgery, and another echocardiogram is done to ensure there are no remaining issues. The skin is then closed with stitches or staples.

Support Services

UT Southwestern’s support services for patients who have TOF include cardiology care from specialists in adult congenital heart disease and electrophysiology studies, as well as maternal-fetal care for women who have high-risk pregnancies because of TOF. We also offer psychological counseling and related services to help patients face the developmental and social challenges of living with TOF.

Clinical Trials

As one of the nation’s top academic medical centers, UT Southwestern offers a number of clinical trials aimed at improving the outcomes of patients with cardiovascular disease.

Clinical trials often give patients access to leading-edge treatments that are not yet widely available. Eligible patients who choose to participate in one of UT Southwestern’s clinical trials might receive treatments years before they are available to the public.