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Normal Heart
Tetralogy of Fallot
Large ventricular septal defect: The ventricles are the hearts two lower chambers, and the septum is the wall that separates the left and right chambers. A ventricular septal defect is a hole in the septum that allows oxygen-rich blood to flow from the left ventricle back into the right ventricle and mix with the oxygen-poor blood there, instead of flowing to the aorta and out to the rest of the body. Alternatively, oxygen-poor blood can flow across the defect at times (right to left) bypassing the lungs and leading to low oxygen levels in the bloodstream (cyanosis). Pulmonary stenosis: Blood normally flows from the right ventricle through a valve into the pulmonary artery in the lungs where it gets loaded with oxygen. Pulmonary stenosis is a narrowing of that valve tissue. Often, the narrowing not only involves the valve, but also the muscle directly below it. The constriction of the passageway causes the heart to pump harder to push the blood through and reduces the amount of blood flowing through the valve. Right ventricular hypertrophy: The extra pumping required by the pulmonary stenosis causes the right ventricle to thicken (hypertrophy). Overriding aorta: The aorta is the main artery that carries oxygen-rich blood from the heart to the rest of the body. Normally the aorta is connected to the left ventricle, and oxygenated blood flows out of the ventricle into the aorta. In tetralogy of Fallot, the aorta is positioned between the left and right ventricles, above the ventricular septal defect. This location allows the aorta to receive blood from both sides of the heart, so that oxygen-poor blood from the right ventricle mixes with oxygenated blood from the left ventricle.
What type of ongoing care is necessary for an adult who has had surgical repair of tetralogy of Fallot?
Specialists in adult congenital heart disease recommend that an adult who has had surgery for tetralogy of Fallot as a child periodically undergo a thorough cardiac evaluation. The shunts used in the palliation are associated with problems such as narrowing (stenosis), high blood pressure in the pulmonary artery or causing excess volume load on the left side of the heart. Definitive surgery often results in significant leaking of the pulmonary valve and the size and function of the right side of the heart needs to be monitored closely. Some patients may also develop large aortopulmonary collateral vessels as a way of getting extra blood flow to the lungs. These need to be closed prior to definitive surgical repair. The presence of any of these problems or worsening of symptoms, such as cyanosis or fatigue, are reasons for an adult to undergo a repeat surgery. Occasionally, an individual reaches adulthood without having had any surgical repair, although this is not common. Specialists recommend that these individuals consider undergoing a complete surgical repair to prevent future complications or sudden death.
Are there any potential problems or complications associated with the surgery?
Although the surgery to correct tetralogy of Fallot is very effective in correcting the structural defects and blood flow through the heart, it can cause some ongoing abnormalities in the hearts function. If these problems develop, they can be treated with surgery. Many adults who undergo repair for tetralogy of Fallot will eventually require further surgical treatment. In a study reported by the Canadian Adult Congenital Heart Network, 10 to 15 percent of people required a re-operation over a 20-year period. The potential complications associated with surgical repair for tetralogy of Fallot include: y y Electrical disturbances: Putting a patch on the ventricular septal defect can block the ability of the atria to transmit electrical signals to the ventricles. This can be corrected by a pacemaker. Rhythm disturbances (arrhythmias): Atrial fibrillation when the hearts upper chambers contract irregularly and often too quickly - is a common complication following heart surgery. This can be treated with medication or a nonsurgical procedure. A rarer but more serious arrhythmia is ventricular tachycardia. This is a life-threatening, overlyrapid heartbeat in the lower heart chambers. The congenital heart disease specialist will determine if an individual is at risk for this postoperatively.
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Leaking valves: Heart valves are designed to allow blood to flow in one direction. When a valve leaks, blood can flow back into the chamber. The most common valve problem after tetralogy of Fallot repair is a leaking pulmonary valve, but the aortic and tricuspid heart valves can leak also. Leaky valves can be surgically repaired. Residual ventricular septal defect: Sometimes the ventricular septal defect does not seal completely and there is some leaking around the patch. If the leak is large or causes major symptoms, it can be repaired surgically. Aneurysm: The patches placed on the ventricle to repair it can cause weak sections of the ventricle to bulge out, forming an aneurysm. There is also an increased risk for developing aneurysms of the ascending aorta. Aneurysms require surgical repair.
Is pregnancy safe for women who have had the defect repaired?
Women who have undergone surgical repair for tetralogy of Fallot and are considering pregnancy should consult an obstetrician who specializes in caring for women with special medical conditions. With proper prenatal care and careful monitoring, most women with repaired tetralogy of Fallot are able to carry a pregnancy safely to term. The obstetrician, in consultation with an adult congenital heart disease specialist, can help determine an individuals risk profile related to pregnancy.