paediatric surgeon need more insight?

Question

my 5 mth old son is set to undergo open heart surgery in 3 weeks and i still have no idea what the operation entails he has tetralogy of fallot. the paediatrition has told me one thing about the op and the cardiologist has told me another. how do they fix his heart and why dont they correct an over riding aorta

Answer 1

If you have doubts in your mind, pleases reconsult your consulting cardiac surgeon who will be performing the operation.
It's better to sort out the problem.
HOWEVER this topic I have searched out for a better understanding of line of treatment:

What are treatment options for tetralogy of Fallot?

Once tetralogy of Fallot is diagnosed, the immediate management focuses on determining whether the child's oxygen levels are in a safe range.

If oxygen levels are critically low soon after birth, a prostaglandin infusion is usually initiated to keep the ductus arteriosus open which will provide additional pulmonary blood flow and increase the child's oxygen level.

These infants will usually require surgical intervention in the neonatal period. Infants with normal oxygen levels or only mild cyanosis are usually able to go home in the first week of life.

Complete repair is usually done electively when the children are about six months of age, as long as the oxygen levels remain adequate. Progressive or sudden decreases in oxygen saturation may prompt earlier corrective repair.

Surgical correction of the defect is always necessary. Occasionally, patients will require a surgical palliative procedure prior to the final correction.

Corrective repair of tetralogy of Fallot involves closure of the ventricular septal defect with a synthetic Dacron patch so that the blood can flow normally from the left ventricle to the aorta.

The narrowing of the pulmonary valve and right ventricular outflow tract is then augmented (enlarged) by a combination of cutting away (resecting) obstructive muscle tissue in the right ventricle and by enlarging the outflow pathway with a patch.

In some babies, however, the coronary arteries will branch across the right ventricular outflow tract where the patch would normally be placed. In these babies an incision in this area to place the patch would damage the coronary artery so this cannot safely be done.

When this occurs, a hole is made in the front surface of the right ventricle (avoiding the coronary artery) and a conduit (tube) is sewn from the right ventricle to the bifurcation of the pulmonary arteries to provide unobstructed blood flow from the right ventricle to the lungs.

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What are the results of treatment for tetralogy of Fallot?

Survival of children with tetralogy of Fallot has improved dramatically over recent decades. In the absence of confounding risk factors, more than 95 percent of infants with tetralogy of Fallot successfully undergo surgery in the first year of life.

Surgical repair is more difficult when the pulmonary arteries are critically small or when the lung blood flow is supplied predominantly by aortopulmonary collaterals.

Most babies are fairly sick in the first few days after surgery, since the right ventricle is "stiff" from the previous hypertrophy (thickness) and because an incision is made into the muscle of the ventricle, making the muscle temporarily weaker.

This right ventricular dysfunction usually improves significantly in the days following surgery. Patients may also have rhythm problems after surgery.

An abnormally fast rhythm (called junctional tachycardia) may occur and may require treatment with medication or the use of a temporary pacemaker. This abnormal rhythm is usually temporary and the rhythm generally will return to normal as the right ventricle recovers.

Patients are also at risk for slow heart rates after surgery due to heart block. Heart block may be caused by injury to or inflammation of the conduction system in the heart. In many patients, the conduction improves and normal rhythm returns. Rarely, a permanent pacemaker may be necessary.

Since a normal circulation is produced by the tetralogy of Fallot repair procedure, long-term cardiac function is usually excellent.

However, the repair does usually leave the child with a leaky (insufficient) pulmonary valve. In this situation, after the right ventricle pumps blood out to the pulmonary arteries, some of the blood will flow back into the right ventricle. This creates extra volume in the right ventricle forcing it to work harder and become dilated.

In a small percentage of children, this pulmonary insufficiency can lead to diminished function of the right ventricle. Symptoms of fatigue, especially with exercise, may develop. In these cases, replacement of the pulmonary valve is often recommended.

Patients who have had repair of tetralogy of Fallot can also redevelop a narrowing at the outflow area or in the branch (left or right) pulmonary arteries, which will cause the right ventricle to pump at abnormally high pressures.

If these problems occur, surgical intervention to further widen the outflow tract or pulmonary arteries may be necessary. Narrowing the pulmonary arteries can sometimes be treated without surgery, with balloon dilation of the vessels during cardiac catheterization.

Long-term follow-up with a cardiologist to detect recurrent or new problems as early as possible is essential. Follow-up visits in the cardiology clinic usually consist of a physical examination, periodic echocardiography, and sometimes an exercise stress test or Holter evaluation as a child reaches the teenage and adult years.

Answer 2

A open heart surgery or "pulmonary bypass" is as follows:

They will stop your son's heart and remove it from his chest. They will then attach his Aorta (largest artery in the heart) to a machine that will artificially pump blood through his body.

While the heart is out of his body, they will take an artery out of his leg and attach it from his heart to one of the major arteries coming from the heart to bypass the blockage he (most likely) has.

The surgery is a big deal, but with the improvement in technology today, the death rate is very low.

If you would like to see an ideal pulmonary bypass surgery, watch Grey's Anatomy. I don't remember what episode - but one of the episodes in Season 1 - they do a full bypass surgery. It's very informative.

Wishing you and your son the best :)

Answer 3

I don't really have an answer for you question but I have a 7 year old daughter that has had 2 heart surgeries so far and I know how scary and confusing it all is. We made a list on paper of all the questions we had each time and took them with us. When we sat down with our doctors we just went through the list with them and they answered all of our questions. I hope everything goes well for you and your son. I will keep him in my prayers.

Answer 4

Ignore the first respondant - he is confusing a coronary artery bypass grafting with intracardiac repair...they are in no way related other than they both have to do with the heart.

Here are a few links from very reliable sources that you might find useful:

http://www.mayoclinic.com/health/tetralogy-of-fallot/DS00615/DSECTION=3

http://www.americanheart.org/presenter.jhtml?identifier=11071

http://www.med.umich.edu/cvc/mchc/partet.htm

Good luck and God bless.

Answer 5

Nobody knows as much about what will be done as the surgeon who will be operating on your baby. That is the person you need to speak with in order to get your questions answered. Good luck, and I hope all goes well for your baby.

Answer 6

I hope this will help you know whats happening.
"good luck" to your baby :-)