What is Tetralogy of Fallot ?

Figure: Anatomical location of tetralogy of fallot

Indications for Surgery :  The diagnosis of tetralogy is considered as an indication for surgery. If the child is very symptomatic and anatomy for repair is suitable, one stage repair is advised at three months or above that age. In a baby of one or two months who is severely symptomatic and in who pre-operative studies show the necessity of a Trans annular patch, many surgeons will do a shunt. However there are some centers where intracardiac repair is done irrespective of the age of the baby. A shunt is followed by intra cardiac repairs within twelve months. When the child is asymptomatic or only mildly symptomatic,
intracasdiac repair can be postponed safely until the child is one or two years old. There is no advantage in waiting any further.

To a certain extent the question of single stage repair versus palliative shunt followed by intra cardiac repair depends on the experience of the surgeon and hospital.

When a baby with tetralogy has a coronary artery crossing the outflow that requires transannular patch, preliminary shunt is done. Later on when the child is big enough a conduit repair (Rastelli Operation) is performed. Tetralogy of Fallot with multiple VSDs in a very young baby will have higher risk if one stage repair is attempted. For them also a staged approach gives better results.