How is surgical treatment of tetralogy of Fallot (TOF) performed in adults?

Updated: Nov 13, 2018
  • Author: Shabir Bhimji, MD, PhD; Chief Editor: Yasmine S Ali, MD, FACC, FACP, MSCI  more...
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Answer

Before any surgery is undertaken, the risks of the procedure must be weighed against the benefits. If the patient is not adequately worked up and the patient has irreversible RV dysfunction, surgery will be futile and nothing short of a transplant will be lifesaving.

Surgery to repair tetralogy of Fallot in adults is usually performed under cardiopulmonary bypass using cardioplegia. Once the heart is arrested, the VSD is closed with a patch, the infundibulum is widened, and the pulmonary valve is repaired. Unlike in infants, transannular patching is rarely performed in adult patients because this procedure often leads to pulmonary insufficiency later in life. Currently, most surgeons replace or repair the pulmonary valve in adults rather than performing a transannular patch.

The ideal treatment for pulmonary valve insufficiency is pulmonary valve replacement, which can help decrease the RV size as well as improve RV function over the long term. In general, however, the incidence of arrhythmias remains unchanged. [26]


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