Surgery For Tetralogy Of Fallot Research Articles

Hemodynamic evaluation of biomaterial-based surgery for Tetralogy of Fallot using a biorobotic heart, in silico, and ovine models.

Tetralogy of Fallot is a congenital heart disease affecting newborns and involves stenosis of the right ventricular outflow tract (RVOT). Surgical correction often widens the RVOT with a transannular enlargement patch, but this causes issues including pulmonary valve insufficiency and progressive right ventricle failure. A monocusp valve can prevent pulmonary regurgitation; however, valve failure resulting from factors including leaflet design, morphology, and immune response can occur, ultimately resulting in pulmonary insufficiency. A multimodal platform to quantitatively evaluate the effect of shape, size, and material on clinical outcomes could optimize monocusp design. This study introduces a benchtop soft biorobotic heart model, a computational fluid model of the RVOT, and a monocusp valve made from an entirely biological cell-assembled extracellular matrix (CAM) to tackle the multifaceted issue of monocusp failure. The hydrodynamic and mechanical performance of RVOT repair strategies was assessed in biorobotic and computational platforms. The monocusp valve design was validated in vivo in ovine models through echocardiography, cardiac magnetic resonance, and catheterization. These models supported assessment of surgical feasibility, handling, suturability, and hemodynamic and mechanical monocusp capabilities. The CAM-based monocusp offered a competent pulmonary valve with regurgitation of 4.6 ± 0.9% and a transvalvular pressure gradient of 4.3 ± 1.4 millimeters of mercury after 7 days of implantation in sheep. The biorobotic heart model, in silico analysis, and in vivo RVOT modeling allowed iteration in monocusp design not now feasible in a clinical environment and will support future surgical testing of biomaterials for complex congenital heart malformations.

Neurodevelopment in patients with repaired tetralogy of Fallot.

Neurodevelopmental sequelae are prevalent and debilitating for patients with congenital heart defects. Patients born with tetralogy of Fallot (TOF) are susceptible for abnormal neurodevelopment as they have several risk factors surrounding the perinatal and perioperative period. Some risk factors have been well described in other forms of congenital heart defects, including transposition of the great arteries and single ventricle heart disease, but they have been less studied in the growing population of survivors of TOF surgery, particularly in infancy and childhood. Adolescents with TOF, even without a genetic syndrome, exhibit neuro-cognitive deficits in executive function, visual-spatial skills, memory, attention, academic achievement, social cognition, and problem-solving, to mention a few. They also have greater prevalence of anxiety disorder, disruptive behavior and attention-deficit hyperactivity disorder. These deficits impact their academic performance, social adjustment, and quality of life, thus resulting in significant stress for patients and their families. Further, they can impact their social adjustment, employment and career development as an adult. Infants and younger children can also have significant deficits in gross and fine motor skills, cognitive deficits and abnormal receptive language. Many of the risk factors associated with abnormal neurodevelopment in these patients are not readily modifiable. Therefore, patients should be referred for evaluation and early intervention to help maximize their neurodevelopment and improve overall outcomes. More study is needed to identify potentially modifiable risk factors and/or mediators of neurodevelopment, such as environmental and socio-economic factors.

Assessment of Health-Related Quality of Life in Children with Totally Corrected Tetralogy of Fallot in Sulaymaniyah, Iraq

ABSTRACT Purpose This study examined the health-related quality of life among children who have undergone surgery for tetralogy of Fallot (TOF) compared to healthy children. Design Cross-sectional study Methods The study was carried out at Children’s Heart Hospital and Primary Healthcare Centers in Sulaymaniyah, Iraq, between July 1, 2022, and November 1, 2022. The study involved 400 participants, comprised of 200 parents of healthy children and 200 parents with children with repaired TOF. Data collection involved utilizing a 5-point Likert Scale questionnaire administered through direct face-to-face interviews with the parents of the children. Findings Children with surgically repaired TOF had markedly lower mean scores (P ≤ 0.001) in the overall dimension of QoL (Mean rank = 137) when compared to healthy children (Mean rank = 263). Furthermore, it was observed that children with repaired TOF had significantly lower mean scores (P < 0.001) across all subdimensions of QoL compared to their healthy counterparts. In the subject of children with repaired TOF, the impact of maternal education (illiterate and lower education) on overall QoL was found to be highly significant (P < 0.001). In addition, children with repaired TOF from lower socioeconomic status (SES) families had worse quality of life than those from medium and high SES families, with a p-value <0.001. Conclusions Repaired TOF children exhibited notable deficiencies across all dimensions of QoL compared to healthy children. Moreover, SES emerged as a significant determinant influencing the QoL outcomes of repaired TOF children. Clinical evidence Despite undergoing corrective surgery for TOF, the QoL in children with repaired TOF continues to be lower than that of their healthy counterparts. Notably, the economic and educational status of the family significantly impacts the way these children perceive and experience their QoL. This finding underscores the critical significance of factoring in socioeconomic elements when addressing the well-being of this particular group of children.

Neurodevelopmental Outcomes of Infants after Neonatal Surgical Intervention for Tetralogy of Fallot or Pulmonary Atresia

To determine the 2-year neurodevelopmental outcomes for survivors of neonatal cardiac surgery for the most common right ventricular outflow tract obstructive lesions: tetralogy of Fallot and pulmonary atresia with a ventricular septal defect. A single-center consecutive cohort of 77 children underwent neonatal surgery for tetralogy of Fallot or pulmonary atresia with a ventricular septal defect at ≤6weeks of age between 2006 and 2017. The patients underwent a multidisciplinary neurodevelopmental assessment at 18-24months of age. Survivor outcomes were compared by univariable and multivariable analyses. The 2-year mortality was 7.8% (6/77) with a postoperative in-hospital mortality of 3.9% (3/77). Freedom from reintervention by cardiac catheterization or surgical intervention at 2years was 36%. Functional and neurodevelopmental assessment for 69 of 71 survivors was completed at a mean age of 22.6 ± 4.0 months using the Bayley Scales of Infant and Toddler Development III. The mean neurodevelopmental outcome scores were 83.4 ± 16.5 for cognitive skills, 82.2 ± 18.7 for language skills, and 81.4 ± 18.1 for motor skills. Cognitive, language, and motor delay, defined as a score of <70, was identified in 25%, 25%, and 23% of patients, respectively. Multivariable analyses for factors associated with worse neurodevelopmental outcomes identified chromosomal anomalies (P<.001) and postoperative complications (P<.03). Cyanotic tetralogy of Fallot and pulmonary atresia with ventricular septal defect requiring neonatal repair showed similar 2-year neurodevelopmental outcomes below normative values and a high prevalence of cognitive, ,language and motor delays.

Human heart tissue mitochondria isolation: experience from patients with tetralogy of Fallot

Background: Mitochondria have crucial roles in human cardiomyocyte metabolism. The isolation of mitochondria from various cells and tissues has been described in previous studies. However, the isolation of human heart muscle is rarely performed because of the ethical problems inherent in obtaining fresh human heart muscle samples. Resected infundibular hypertrophy muscle in tetralogy of Fallot surgery provides a fresh sample source without causing ethical issues. This study aimed to isolate mitochondria from patients with tetralogy of Fallot. Methods: The optimization of mitochondria isolation protocol in this in vitro study was performed to facilitate our study of ischemia and reperfusion injury. The samples of human heart tissue used in this study were resected infundibulum muscle collected during surgery to correct tetralogy of Fallot. Subjects were recruited from Cipto Mangunkusumo Hospital and Jakarta Heart Center Hospital between July 2021 and November 2022. Tissue was collected before aortic cross-clamp applied, after aortic cross-clamping applied and after aortic cross-clamping off. After collected tissue was trimmed and cleaned, mechanical disruption followed by enzymatic disruption using trypsin was performed. Homogenization was then performed with a sonicator. Mitochondria pellet was further obtained by differential fractionation of homogenate. Results: Mean infundibular tissue weight obtained from the three periods mentioned was 64.92-109.7 mg. Our protein yield was 7.65-8.38 mg/ml. Mean JC-1 was 9945-12430 FLU/mgP. The median value of SDH activity shown by our mitochondria pellet was 17.45-18.12 nmol/min/L). Conclusion: The fractionation method allowed us to successfully isolate mitochondria from human heart tissue with intact membrane integrity.

Use of a laryngeal tube for sialolithotomy in a pediatric patient with left vocal cord paralysis: a case report

BackgroundThe laryngeal tube (LT), a closed esophageal supraglottic device comprising pharyngeal and esophageal cuffs, is used for emergency airway management. However, it is not often used in intraoperative airway management.Case presentationA 9-year-old boy was scheduled for a sialolithotomy for sialolithiasis. He had a history of surgery for tetralogy of Fallot and had undergone vocal cord fusion for postoperative left-sided vocal cord paralysis. Following a strong request by the mother to avoid tracheal intubation to reduce the risk of bilateral vocal cord paralysis, management without intubation was initially considered in the preoperative anesthesia plan. Airway management was planned using an LT in case of ventilation failure due to positional abnormalities. Although some leakage was observed during intraoral surgery, it was quickly resolved by adjusting the position of the LT outside the sterile surgical field.ConclusionsThe LT may be a viable option in cases where tracheal intubation is not preferred.

Pulmonary cavernous hemangioma combined with smooth muscle hyperplasia: a case report and review of the literature

BackgroundCavernous hemangiomas are usually located in the liver, skin, and subcutaneous tissues. Although they can arise from any organ, cavernous hemangiomas rarely occur as a pulmonary tumor. We herein report a rare case of a pulmonary cavernous hemangioma that was surgically resected.Case presentationA woman in her 40s was found to have 2 well-defined nodules in the lower lobe of the left lung by computed tomography during following up of bladder cancer. She had a history of surgery for tetralogy of Fallot at 6 years old and pulmonary valve replacement for pulmonary valve insufficiency in her late 30s. She had also undergone surgery for bladder cancer. Although there was no accumulation of 18F-fluorodeoxyglucose on positron emission tomography (PET), the tumor slowly grows. Surgical resection was therefore performed to obtain a definitive diagnosis. The postoperative histological examination revealed an encapsulated nodule comprising large, dilated vessels lined with vascular endothelium and filled with blood, which led to the diagnosis of a pulmonary cavernous hemangioma.ConclusionWe experienced a rare case of pulmonary cavernous hemangioma and reviewed the previous reports.

Utility of portal vein pulsatility fraction in patients undergoing corrective surgery for tetralogy of Fallot.

Right ventricle dysfunction is common after corrective surgery for tetralogy of Fallot and is associated with significant morbidity and mortality. We aimed to determine whether an increased portal vein pulsatility fraction (PVPF) was associated with worse clinical outcomes. In a prospective, observational, single-centre study, PVPF and other commonly used parameters of right ventricle function were assessed in patients of all ages undergoing corrective surgery for tetralogy of Fallot intraoperatively, with transesophageal echocardiography, before and after bypass, and post-operatively, with transthoracic echocardiography, at days 1, 2, at extubation, and at ICU discharge. The correlation was tested between PVPF and mechanical ventilation duration, prolonged ICU stay, mortality, and right ventricle function. The study included 52 patients, and mortality was in 3 patients. PVPF measurement was feasible in 96% of the examinations. PVPF in the immediate post-operative period had sensitivity of 73.3% and a specificity of 74.3% in predicting the occurrence of the composite outcome of prolonged mechanical ventilation, ICU stay, or mortality. There was a moderate negative correlation of PVPF with right ventricle fractional area change and right ventricle global longitudinal strain (r = -0.577, p < 0.001 and r = 0.465, p < 0.001, respectively) and a strong positive correlation with abnormal hepatic vein waveform (rho = 0.749, p < 0.001). PVPF is an easily obtainable bedside parameter to assess right ventricular dysfunction and predict prolonged mechanical ventilation, prolonged ICU stay, and mortality.

Valvular and aortic surgery in an adult patient late after repaired tetralogy of Fallot

BackgroundThe most common complication after tetralogy of Fallot repair is pulmonary valve regurgitation. However, concomitant surgery for tricuspid valve regurgitation and/or aortic dilatation is occasionally required.Case presentationA 56-year-old woman who underwent surgery for tetralogy of Fallot at age 29 years was diagnosed with progressive tricuspid valve regurgitation, hepatosplenomegaly, and thrombocytopenia. Moreover, computed tomography and transesophageal echocardiography revealed regurgitation in pulmonary and mitral valves and dilatation of the ascending aorta. One month after splenectomy for increasing platelet count, she underwent pulmonary valve replacement, tricuspid and mitral valve annuloplasty, and ascending aortic replacement. Postoperatively, the intensive care stay was complicated because of ventricular dysfunction and long-term ventilation. After 1 week, the patient was disconnected from the respirator, and she was transferred on the 55th postoperative day to another hospital for rehabilitation, without permanent disabilities.ConclusionWe herein reported a patient with repaired TOF who successfully underwent PVR, tricuspid and mitral valve annuloplasty, and ascending aortic replacement.

Analysis of the risk factors for severe lung injury after radical surgery for tetralogy of fallot

ObjectiveThis study aimed to determine the risk factors for severe lung injury (SLI) (partial pressure of oxygen/fraction of inspired oxygen <150) after radical surgery for tetralogy of Fallot with pulmonary stenosis (TOF/PS) in children.MethodA retrospective analysis was conducted including a total of 287 children with TOF/PS aged below 10 years (including 166 males) who had undergone radical surgery at the Center of Pediatric Heart Disease of the Beijing Anzhen Hospital (China) from 2018 to 2020.ResultsA total of 83 cases (28.9%) had SLI after surgery. Univariate analysis showed that age, weight, pulmonary artery index (PAI), cardiopulmonary bypass (CPB) time, and polymorphonuclear leukocyte (PMN) percentage on the first day after surgery were risk factors for postoperative SLI. Multivariate logistic regression analysis showed that PAI, PMN percentage on the first day postoperatively, and CPB time were independent risk factors for SLI after surgery. The prediction model was established as follows: Logit(P) = 2.236 + 0.009*CPB-0.008*PAI-0.035*PMN, area under the curve (AUC) = 0.683, P < 0.001, sensitivity 65.8%, and specificity 68.6%. Following surgery, static lung compliance was significantly lower in the SLI group compared with the routine group. Complication rates and mortality were significantly higher in the SLI than in the routine group. Ventilator support times, the length of intensive care unit stays, and the total lengths of hospital stay were significantly longer in the SLI than in the routine group.ConclusionThe occurrence of SLI following radical surgery for TOF in children significantly affected postoperative recovery, and PAI, PMN percentage on the first day postoperatively, and CPB time were independent risk factors for SLI.

Effect of preoperative pulse oximeter oxygen saturation on postoperative prolonged mechanical ventilation in patients with tetralogy of Fallot.

BackgroundAs an easily accessible and intervened clinical indicator, preoperative pulse oximeter oxygen saturation (SpO2) is an important factor affecting the prognosis of patients with tetralogy of Fallot (TOF). However, whether SpO2 is associated with postoperative mechanical ventilation (MV) time remains unknown. Therefore, this study aimed to investigate the impact of preoperative SpO2 on postoperative prolonged mechanical ventilation (PMV) in children with TOF.Materials and methodsThe study included children younger than 18 years who underwent corrective operations for TOF between January 2016 and December 2018 in Fuwai Hospital, China. Univariate and multivariate logistic regression analyses were used to evaluate the influence of preoperative SpO2 on postoperative PMV. After identifying SpO2 as an independent risk factor for PMV, patients were further divided into two groups according to the cutoff value of SpO2, and propensity score matching (PSM) analysis was used to eliminate the effect of confounding factors. The logistic regression was used to compare the outcomes between the two groups after PSM.ResultsA total of 617 patients were finally enrolled in this study. By the univariable and multivariate logistic analysis, four independent risk factors for PMV were determined, namely, SpO2, surgical technique, aortic cross-clamp time, and intraoperative minimum temperature. According to the outcomes of 219 paired patients after PSM, the incidence of PMV was significantly higher in patients with lower preoperative SpO2 (P = 0.022). Also, there was significant increase in mechanical ventilation time (P = 0.019), length of intensive care unit stay (P = 0.044), postoperative hospital stay (P = 0.006), hospital stay (P = 0.039), and hospitalization cost (P = 0.019) at the lower preoperative SpO2 level.ConclusionLow preoperative SpO2 represents an independent risk factor of postoperative PMV in children with TOF.

Magnetic resonance imaging of the heart as a method of long-term monitoring of right heart function after tetralogy of Fallot surgery

&amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Introduction.&amp;lt;/strong&amp;gt; Cardiac magnetic resonance imaging (CMR) is considered the reference diagnostic method for quantifying right ventricular size and function, and pulmonary regurgitation in patients with tetralogy of Fallot surgery. The aim of this paper is to confirm the importance of magnetic resonance continuous postoperative monitoring of right and left heart function parameters as a diagnostic method that provides the most precise and accurate assessment.&amp;lt;/p&amp;gt;&amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Methods.&amp;lt;/strong&amp;gt; The prospective observational study included subjects with TOF surgery who were diagnosed with residual morphological and/or functional disorders on control postoperative echocardiographic examinations. All subjects underwent magnetic resonance imaging of the heart on a 1.5 T scanner with dedicated coils for the heart surface according to the standard protocol for a period of one year from the beginning of the study. Criteria for exclusion from the study were: significant residual pulmonary stenosis, condition after pulmonary valve replacement, existence of residual shunt lesions, contraindications for cardiac magnetic resonance imaging (pacemaker, ICD, claustrophobia). Depending on the time elapsed since the tetralogy of Fallot surgery, the subjects were divided into groups: more than 15 years, 11&amp;minus;15 years, 6&amp;minus;10 years, less than 5 years.&amp;lt;/p&amp;gt;&amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Results.&amp;lt;/strong&amp;gt; The study included 131 subjects with an average age of 24.18 &amp;plusmn; 11.57 years with complete correction of TOF. Intergroup differences in values of right ventricular enddiastolic volume, right ventricular ejection fraction, and left ventricular ejection fraction were demonstrated, but there was no statistically significant intergroup difference in values of pulmonary regurgitation fraction. The negative interaction of the right and left ventricles intensifies during the years of follow-up of patients after TOF surgery, which is especially true fifteen years after surgery.&amp;lt;/p&amp;gt;&amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Conclusion.&amp;lt;/strong&amp;gt; CMR has the most significant role in research efforts aimed at improving the outcomes of operated patients with tetralogy of Fallot.&amp;lt;/p&amp;gt;

Respiratory disorders in a child with multiple malformations

Concomitant congenital malformations are an actual problem in pediatrics. Association of tracheobronchial tree anomalies and congenital heart disease (CHD) could be the cause of the patient’s condition deterioration before and after cardiac surgery. We present a clinical case of a patient with multiple malformations with a long-term and poorly corrected broncho-obstructive syndrome, combined with pneumonia and hypoventilation. After surgery for tetralogy of Fallot at 3 months, the boy needed mechanical ventilation for a long time due to bilateral pneumonia complicated by bilateral pneumothorax. At 7 months, a respiratory infection required hospitalization in the intensive care unit. When pneumonia resolved, the boy was discharged home with continued oxygen support using an oxygen concentrator. The reason for the patient’s prolonged respiratory failure could be explained by prolonged hypoventilation due to narrowing of the left main bronchus and consecutive congenital pneumonia, repeated aspirations, and postoperative mechanical ventilation-associated pneumonia with bilateral pneumothorax. At the age of 1 year 3 months in the Department of Thoracic Surgery of St. Vladimir’s biodegradable stent in the left main bronchus was installed. The bronchus lumen was restored. The boy did not need oxygen support, and his physical and motor development indicators improved. Thus, in patients with tetrad of Fallot, a thorough assessment of the condition of the tracheobronchial tree is advisable in order to develop an appropriate treatment plan if needed. The collaboration of specialists in various fields of care for pediatric patients is the basis for a favorable prognosis in terms of the full growth and development of patients with multiple malformations.

Del22q11.2 Syndrome in the pediatric practice

SummaryDel 22q11.2 syndrome is one of the most frequent ge-netic syndromes with clinical manifestations of immune deficiency, congenital heart defect, including aplasia or hypoplasia of thymus, and pathology of other organs. Disseminating knowledge about this syndrome among practicing pediatricians will allow not only to timely dia gnose, but also to increase the life span of patients thanks to adequate management. In most cases, 22q11.2 deletion is detected during the study, of those 93% are sporadic cases, and only 7% inherited from parents, the incidence being from 1:3,000 to 1:6,000 of newborns, and 1:1,000-2,000 for some types of populations. More than 190 clinical variants of Di George syndrome symptoms have been described in all. Usually, DiGeorge syndrome is a combination of three most frequently observed forms: congenital heart defect, aplasia or hypoplasia of thymus, hypocalcaemia due to hypoplasia of parathyroid gland. The objective of therapy is to correct life-threatening conditions and improve quality of life by correcting mor-phological defects, infectious complications treatment and immunity defects compensation. Two clinical cases are presented in the article. First case: 3 year old, linked to care due to retardation of speech development, brain cyst, relapsing bronchial obstruction, choking when con-suming solid food, one-time precedent of febrile seizure and hypocalcaemia, which was diagnosed by accident but turned out to be a key to diagnosis. Second case: 9 year old, tetralogy of Fallot surgery at 3 months. Observed due to relapsing bronchial obstruction and frequent but mild respiratory infections. No hypocalcaemia, no seizures. Hy-poplasia of thymus was diagnosed but focused upon only at age of 9 years

Outcomes for unplanned reinterventions following paediatric cardiac surgery for tetralogy of Fallot.

Advances in surgical techniques and post-operative management of children with CHD have significantly lowered mortality rates. Unplanned cardiac interventions are a significant complication with implications on morbidity and mortality. We conducted a single-centre retrospective case-control study for patients (<18 years) undergoing cardiac surgery for repair of Tetralogy of Fallot between January 2009 and December 2019. Data included patient characteristics, operative variables and outcomes. This study aimed to assess the incidence and risk factors for reintervention of Tetralogy of Fallot after cardiac surgery. The secondary outcome was to examine the incidence of long-term morbidity and mortality in those who underwent unplanned reinterventions. During the study period 29 patients (6.8%) underwent unplanned reintervention, and were matched to 58 patients by age, weight and sex. Median age was 146 days, and median weight was 5.8 kg. Operative mortality was 7%, and 1-year survival was 86% for the entire cohort (cases and controls). Hispanic patients were more likely to have reinterventions (p = 0.04) in the unadjusted analysis, while Asian, Pacific Islander and Native American (p = 0.01) in the multi-variate analysis. Patients that underwent reintervention were more likely to have post-op arrhythmia, genetic syndromes and higher operative and 1-year mortality (p < 0.05). Unplanned cardiac interventions following Tetralogy of Fallot repair are common, and associated with increased operative, and 1-year mortality. Race, genetic syndromes and post-operative arrhythmia are associated with increased odds of unplanned reinterventions. Future studies are needed to identify modifiable risk factors to minimise unplanned reinterventions.

Growth and development of children under 5\xa0years of age with tetralogy of Fallot in a Chinese population

Congenital Heart Defects (CHDs) are associated with different patterns of malnutrition and growth retardation, which may vary worldwide and need to be evaluated according to local conditions. Although tetralogy of Fallot (TOF) is one of the first described CHDs, the etiology outcomes in growth and development of TOF in early age child is still unclear in most cases. This study was designed to investigate the growth retardation status of Chinese pediatric TOF patients under 5 years old. The body height, body weight and body mass index (BMI) of 262 pediatric patients (138 boys and 124 girls) who underwent corrective surgery for TOF between 2014 and 2018 were measured using conventional methods. The average body height, body weight and BMI of the patients were significantly lower than WHO Child Growth Standards, while the most affected was body height. Meanwhile, higher stunting frequency and greater deterioration of both the body height and weight happened in elder age (aged 13–60 months) rather than in infant stage (aged 0–12 months) among these patients. Our results confirmed that intervention should be given at early age to prevent the growth retardation of TOF patients getting severer.

The Predicament of Surgical Correction of Tetralogy of Fallot.

Surgery for tetralogy of Fallot has a long history, which may be described as both a success story and a failure story. It is a success story because prognosis without surgery is very poor, but surgery makes it possible for affected babies to reach adulthood and lead productive lives. It is a failure story, however, since we still cannot cure this condition; we can only palliate it as illustrated in the sobering long-term outcome of affected patients. In this review article, we aim to explore the reason for this failure. This may be summed up in terms of the nature of the obstruction to the right ventricular outflow tract, which characterizes this malformation and must be relieved. This obstruction has several possible components, but none may be eliminated without harming the ventricle. There seems to be no 'extra' muscle band in tetralogy of Fallot that may be dispensed with without undermining ventricular function; every muscle band that is there should be there, just like in the normal heart, except that these are thicker than normal and somewhat displaced in tetralogy of Fallot, thus narrowing the right ventricular outflow tract. Consequently, ventricular function deteriorates with every muscle band that is cut, just like in the normal heart. We have to harm the heart in order to repair it. Every repaired Fallot is inevitably a damaged heart. Consequently, repair of this condition cannot be curative at present; it is palliative surgery.

Our experience of epidural anesthesia for cesarean section in pregnant women with corrected tetralogy of fallot: A case report

Tetralogy of Fallot (TOF) is the most commonly encountered cyanotic congenital cardiac disease in pregnancy. While most pregnancy cases after surgical repair of TOF have focused on cardiovascular and obstetric concerns, relatively few authors have focused on specific intraoperative and postoperative anesthetic management strategies. Determine the type of anesthesia in these patients is very difficult and current recommendations are based only on reported clinical experiences and pathophysiological concepts. In this case report, we aimed to share our epidural anesthesia experience for caesarean surgery in 37 weeks pregnant who underwent corrected TOF surgery.

Postpacing interval is shorter than tachycardia cycle length-What's the mechanism?

A 33-year-old male who underwent surgery for Tetralogy of Fallot presented with atrial flutter. Electrophysiology study revealed concealed entrainment along the mid lateral right atrium with postpacing interval shorter than the tachycardia cycle length. Ablation at this site terminated the tachycardia. The presence of shorter PPI than TCL was due to a large virtual electrode leading to downstream capture of far field tissue. This case demonstrates that sites showing PPI shorter than TCL are in a slow conducting narrow critical isthmus and hence constitute good ablation targets.

Echocardiographic Evaluation of Postoperative Patient with Tetralogy of Fallot: A Step-Wise Approach

As tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease, with the advancements in cardiac surgical techniques, there has been an ever-increasing number of postoperated patients with this condition. TOF repair is denoted as “total correction,” however, many hemodynamic and electrophysiologic sequelae remain or come into picture over time, which need to be tackled for the improvement of quality of life and life expectancy. Therefore, regular life-long follow-up is required after TOF surgery. During follow-up visits, only clinical assessment does not suffice, and various investigations are employed from time to time. These include electrocardiogram, echocardiogram, computed tomogram angiography, perfusion scanning, cardiac catheterization, and cardiac magnetic resonance imaging. Echocardiography nevertheless, is the easiest, quickest, noninvasive and overall, the most informative investigation. In this review, step-by-step echocardiographic evaluation of a postoperated TOF patient is described.