Tetralogy of Fallot is a congenital heart defect with four abnormalities: 1) a ventricular septal defect, 2) pulmonary stenosis, 3) overriding aorta, and 4) right ventricular hypertrophy. This causes deoxygenated blood to bypass the lungs and mix with oxygenated blood, resulting in cyanosis. The severity depends on the degree of pulmonary stenosis and ventricular septal defect. Surgical repair involves relieving the stenosis and closing the VSD.

1. Tetrology of fallot
 complex of 4
abnormalities :
1. ventricular
septal defect.
 A VSD is a hole
in the part of
the septum
that separates
the ventricles

2.  hole allows
oxygen‑ rich
blood to flow
from the left
ventricle into
the right
ventricle
instead of
flowing into
the aorta, the
main artery
leading out to
the body

3. Pulmonic
stenosis
 2.Pulmonic
stenosis
 In pulmonary
stenosis, the
heart has to
work harder
than normal to
pump blood,
and not
enough blood
can get to the
lungs.

4.  3. The aorta
"overrides" the
ventricular septal
defect.

the aorta - between
-the left and right
ventricles, directly
over the VSD. As a
result, oxygen‑ poor
blood from the right
ventricle can flow
directly into the
aorta instead of
into the pulmonary
artery to the lungs.

5.  4. Thickening
(hypertrophy) of
the right
ventricle
 Thickening
(hypertrophy) of the
 This is when the right ventricle
right ventricle
thickens because  This is when the right
the heart has to ventricle thickens
pump harder because the heart has
to pump harder than it
than it should to
should to move blood
move blood through the narrowed
through the pulmonary valve
narrowed
pulmonary valve

6. Harm
 Decrease blood flow to lungs
 Mixing of blood
 Together, these four defects
mean that not enough blood is
able to reach the lungs to get
oxygen, and oxygen-poor blood
flows out to the body.

7. Prognosis
 Despite its seeming complexity,
it is quite common and often can
be completely repaired.

9.  THE SERIOUSNESS DEPENDS ON THE
DEGREE OF PULMONARY STENOSIS AND
VSD
 MORE THE STENOSIS – MORE BLOOD IS
DIVERTED TO LEFT VENTRICLE THROUGH
VSD
 UNOXYGENATED BLOOD TO BODY PARTS
 BLUISHNESS OF INDIVIDUALS- CYANOSIS
IS A CARDINAL SIGN

10. SIGNS
 What are the warning signs and
symptoms of Tetralogy of Fallot?
 Bluish coloring around the mouth,
lips, tongue, and fingertips (called
cyanosis)
 DYSPNOEA

11.  Presence of a heart murmur
 Occasionally, early on, the degree of
Pulmonary Stenosis will be very mild
and the symptoms will be that of a
Ventricular Septal Defect, including
labored breathing, poor feeding, and
poor weight gain.
 Polycyaethemia secondary to
hypoxia

12.  How is Tetralogy of Fallot detected?
 Heart murmur or Cyanosis. This leads
to performing an
 Cardiac catheterization with
angiography is needed prior to surgery to
obtain more detailed anatomical
information.

14.  Colour Doppler
echo

15.  Relieving the stenosis
 Closing the ventricular septal
defect by suturing or patch
grafting during cardiopulmonary
by – pass.
 Constraints:
Size/condition- patient
Severity of malformation
Lack of cardiopulmonary by pass
facilities

16.  (large concentric hypertrophy of
rt. Ventricle and only a narrow
slit like lumen of PA- cannot be
managed by a closed
procedure )
 Construction of a palliative shunt
– rather than correcting the
pulmonary stenosis by a closed
technique

17.  The open-heart repair is then
deferred until the patient gets
bigger.
 Less serious TF , have balanced or
left to right shunt- and not cyanotic-
correcting pulmonary stenosis
without correcting VSD is
contraindicated

18.  Palliative shunts
 Cyanotic – congenital heart
disease, polycythemia, history of
excessive dyspnea or fainting
 Subclavean artery with PT
(Blalock- Tausssig operation)

19.  If above not possible- Potts-Smith
operation-lt.PA with descending
aorta
 rt.PA with ascending aorta(Waterson
shunt)
 All these – increase blood flow to PA-
so spontaneous shunts like PDA in TF
– should not be corrected unless
hemodyanamics are corrected

20. Lobectomy
 Commonly performed- GA and
IPPV
 Partial/ complete
 Partial – penetrating wounds –
cannot be sutured
 Complete- pulmonary
neoplasms /
abscess/cyst/severe lacerations

21.  Site – depends-
-caudal / accessory lobe- 5th or 6th
i.c.s.
-cranial/middle- 4th /5th ics
No noticeable reduction in
respiratory function

22. Isolate a lobe-
hilus is reached-
art., bronchus
and vein are
divided
Ligatures with 3-0
silk- vessels

23. Lobectomy
 Area immediately
around bronchus –
carefully packed off
– moist sponges
 Lobe should be
handled as little as
possible
 Cut the shortest
possible stump of
bronchus
 Donot apply
crushing forecep-
stump that is to
remain

24. Lobectomy
 After cutting
bronchus – a
short distance-
suture is placed
across the
edges- prevent
escape of air
 Continue ctting
and placing
suture- remove
the lobe

25. Lobectomy
 Alternatively, hold
with rt. Angled
foreceps- without
crushing- apply 2nd
clamp and divide
 Remove the lobe-
close the stump
with double row of
continuous sutures

26.  Drip saline during
IPPV, - check for
air leakage-close
the leaks by simple
interrupted or
matress suture