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Tetralogy of Fallot: Anatomy, Physiology, and Outcomes
1 Department of Cardiovascular and Thoracic Surgery, Children’s Mercy, Kansas City, MO, 64108, USA
2 Department of Pediatric Cardiovascular Surgery, Arkansas Children’s Hospital, Little Rock, AR, 72202, USA
3 Department of Pediatric Cardiology, Arkansas Children’s Hospital, Little Rock, AR, 72202, USA
4 Department of Pediatric Cardiothoracic Surgery, Medical College of Georgia, Augusta, GA, 30912, USA
* Corresponding Author: Edo Bedzra. Email:
Congenital Heart Disease 2024, 19(6), 541-562. https://doi.org/10.32604/chd.2025.059788
Received 17 October 2024; Accepted 17 January 2025; Issue published 27 January 2025
Abstract
Since the first identification of Tetralogy of Fallot in 1671, consisting of a combination of anatomical defects including biventricular origin of the aorta, maligned ventricular septal defect, overriding aorta, and narrowing or atresia of the pulmonary outflow tract. The first successful operation consisted of a shunt between the left subclavian artery and pulmonary artery. Following this palliative procedure, complete repair is performed once the patient reaches indicative criteria. Since the first attempts at surgical palliation and repair, techniques and outcomes have improved drastically. Definitive repair of Tetralogy of Fallot consists of a multi-patch closure of any Ventricular Septal Defect along with clearance of any muscular obstructions of the Right Ventricular Outflow Tract and reconstruction of the outflow tract. Current results of Tetralogy of Fallot palliation yield excellent long and short-term results with 5-year freedom from reintervention of 90%. The iterative improvement of repair techniques has greatly reduced intraoperative and postoperative complications. Future innovations such as increased use of percutaneous repair methods and additional data on the benefits of primary repair as opposed to staged palliation will continue to improve patient outcomes.Keywords
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