Tetralogy of Fallot

Tetralogy of Fallot repair is an open-heart surgery that requires breaking the chest bone (this is called a sternotomy) and use of a heart-lung bypass machine (also known as cardiopulmonary bypass). During this all-in-one surgery, pediatric heart surgeons close the ventricular septal defect and widen the connection between the heart and the pulmonary artery, restoring proper oxygenation and blood flow. This connection can be made through several surgical approaches, depending on your child’s anatomy.

Valve Replacement in Infants
Babies with a severely malformed or missing pulmonary valve will also need their valve replaced during their lifetime. Timing and options for valve replacement depend on your child’s type of defect, age, and size.

Your child may be eligible for valve-sparing surgery, which uses a child’s own tissue to build a functioning pulmonary valve. This means the valve grows with them, potentially eliminating the need for valve replacement surgery later in life.

A partial heart transplantation, also known as a living heart valve replacement, is another potential option. It uses a healthy valve from a donor heart to replace a defective valve. Like valve-sparing surgery, the transplanted valve grows with your child.

To stabilize heart function until tetralogy of Fallot repair surgery can be performed, newborns may require one or more of the following treatments to improve oxygenation and blood flow in the meantime.

• Medication: Prostaglandin keeps the ductus arteriosus open to improve blood flow to the lungs. This passageway, which normally closes on its own after birth, connects the pulmonary artery and aorta.
• Catheterization Procedures: During minimally invasive catheterization procedures, interventional cardiologists can make heart repairs by inserting a small, flexible tube called a catheter into a blood vessel (usually in the groin) and guiding it to the heart. They pass small tools through the catheter to place the following stents (metal mesh tubes):
  • A ductal stent may be placed in the ductus arteriosus to keep it open. This allows babies to stop taking prostaglandin medicine, which can have undesirable side effects.
  • A right ventricular outflow tract (RVOT) stent may be placed across the pulmonary valve and muscle bundles to hold them open.

As adolescence nears and/or in adulthood, you may need to have your pulmonary valve replaced, either for the first time, or again if you had valve-replacement surgery as a child. Duke offers several approaches to valve-replacement surgery, including traditional open-heart surgery, a less-invasive approach in which surgeons access the heart through a small incision between two ribs, or a minimally invasive catheterization approach that requires only a small incision in the groin.

Proven Outcomes
Duke’s pediatric tetralogy of Fallot surgery survival rates exceed the national average,
according to the Society of Thoracic Surgeons. This not-for-profit organization’s mission is to ensure patients receive the highest quality care,

Experienced Team Approach to Care
Our team includes highly specialized pediatric and adult congenital heart experts, including cardiologists, interventional cardiologists, heart surgeons, cardiothoracic imaging specialists, anesthesiologists, and more. We combine our experience and expertise to ensure you or your child receives the best possible care.

Robust Adult Congenital Program
The Duke Adult Congenital Heart Disease Program offers advanced care to people living with congenital heart defects. Our board-certified adult congenital heart disease specialists have completed advanced training and have years of experience treating adults with congenital heart disease. We offer the full range of therapies to treat problems that arise in adults living with congenital heart disease.

Access to the Latest Treatments
From the catheterization lab to surgery and beyond, you may have access to clinical trials studying new and better ways to care for people with congenital heart defects. As a Duke patient, you may be eligible to receive new treatments before they are available elsewhere.