Open heart surgery for tetralogy of Fallot - a definitive treatment for this congenital defect
Tetralogy of Fallot surgery in Turkey

Open heart surgery tetralogy of Fallot and what parents should know about this birth defect

The open heart operation of tetralogy of Fallot is one of the complex operations, as the tetralogy of Fallot surgery saves many patients annually, so Turkey has been interested in developing this operation at the hands of the most skilled doctors and the latest medical devices.

Tetralogy of Fallot surgery is usually performed in the first year of a child's life to correct congenital heart defects, as about 1,600 children annually are born with tetralogy of Fallot.

To find out what open-heart surgery is tetralogy of Fallot, and why tetralogy of Fallot is called by this name, continue reading this article.

Open heart surgery, Tetralogy of Fallot

before we get in open heart surgery Tetralogy of Fallot We must understand what Tetralogy of Fallot is, as it is not possible to understand what the process is and its risks before we learn about the causes, symptoms and complications that result from these congenital heart defects.

What is tetralogy of Fallot?

Tetralogy of Fallot is a rare and complex congenital (present at birth) heart defect. The condition is named after the doctor who first described it in 1888.

Tetralogy of Fallot is the name for a group of four heart defects:

Large ventricular septal defect (VSD).

The ventricles are the two lower chambers of the heart, and the ventricular septum is the wall that separates them.

A ventricular septal defect is a hole in the septum that allows oxygen-rich blood to flow from the left ventricle into the right ventricle and mix with oxygen-poor venous blood there, instead of flowing into the aorta on its way to the rest of the body.

Sometimes, oxygen-poor blood can flow through the hole (from right to left), bypassing the lungs and causing cyanosis and shortness of breath in the baby (low levels of oxygen in the circulatory system).

An image showing a large ventricular septal defect in tetralogy of Fallot

Pulmonary stenosis

Blood normally flows from the right ventricle through a valve, or valve, into the pulmonary artery in the lungs, where it is loaded with oxygen.

Pulmonary stenosis is a narrowing of the valve between the right ventricle and the pulmonary artery, or muscle growth just below the valve (subvalvular stenosis).

Often, the stenosis is not only limited to the valve, but also to the muscles directly below it. This stenosis causes the heart to pump harder to push blood through and reduces the amount of blood flowing through the valve.

An image showing the heart valves and pulmonary valve stenosis in tetralogy of Fallot

Right ventricular hypertrophy

The extra pumping required by pulmonary stenosis causes the right ventricle to thicken.

Aortic overlay

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 from the ventricle to the aorta. In tetralogy fallot, the aorta is located 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 the oxygen-poor blood from the right ventricle mixes with the oxygenated blood from the left ventricle.

How common is tetralogy of Fallot and what are the causes?

Tetralogy of Fallot is a relatively rare defect, as the number of people affected by tetralogy of Fallot is about 5 in 10,000 births. Although this heart defect was recognized 120 years ago, the exact cause is still unknown.

The defect occurs while a baby's heart is developing before birth. About 15 percent of babies with tetralogy of Fallot have a specific genetic abnormality that is also associated with other birth defects such as cleft palate.

Tetralogy of Fallot

This complex set of defects causes a lack of oxygen in the blood, and the reason is that not enough blood flows into the pulmonary artery to take oxygen from the lung, and the blood flowing through the aorta to the body is poor in oxygen.

In most cases, the defect is so severe when the baby is born that the lack of oxygen causes a bluish tint (cyanosis) to the baby's skin, lips, and nails.
Cyanosis usually gets progressively worse during the first few weeks of a child's life. Tetralogy of Fallot is usually diagnosed very early in a child's life, but it may not be diagnosed for a few months or even several years in the absence of symptoms.

How is tetralogy of Fallot corrected? What is open heart surgery, tetralogy of Fallot?

Tetralogy of Fallot can be corrected with surgery, generally during the first year of life, although it can sometimes be done at an older age.

The goal of these surgeries is to prevent diversion of blood through the ventricles and relieve pulmonary valve stenosis to improve blood flow to the lungs.

The surgery involves partial or complete correction of the tetralogy of Fallot in which the opening between the ventricles (the foramina) is closed with a patch, opening the obstruction to blood flow to the lungs and widening the outlet of the right ventricle.

The method by which the blockage is opened depends on the exact situation of each person, but can include removing some of the thickened muscle below the pulmonary valve, widening the valve itself - sometimes by placing a graft across it - and, if necessary, widening the branches of the arteries that go to each lung If the valve is completely blocked, a valvular tube (or duct) may be needed to allow blood from the heart to the pulmonary arteries.

Treatment options for tetralogy of Fallot

There is no medical treatment for tetralogy of Fallot. Structural abnormalities of the heart require surgical correction. In most cases, children undergo open-heart tetralogy of Fallot surgery by the age of one.

In some babies, complete repair of tetralogy of Fallot early in life (early surgery) may not be optimal. This may be the case for a very young or premature baby, a severely cyanotic baby in critical condition, or other medical problems in early life.

In these children, primary surgery may be performed to supply more blood to the lungs and counteract cyanosis.
One way to do this is to surgically place a small tube, called a shunt, from the aorta to the pulmonary artery to provide more blood flow to the lungs.

This does not completely correct tetralogy of Fallot and a full second surgery will be required later when the child is older.

Another option that can be done soon after the baby with tetralogy of Fallot is born is to place a stent or mesh tube in the patent ductus arteriosus (a normal bridge artery between the aorta and the pulmonary artery that every baby has while in the womb but closes after a few days few from birth).
This procedure is done in a department cardiac catheterization, and a complete overhaul must be made at a later time.

Repeated operations may be necessary in some people with tetralogy of Fallot. Surgery to widen the narrowed pulmonary valve often leads to valve regurgitation.

Pulmonary valve regurgitation usually doesn't cause symptoms and the body adjusts for it, but it can lead to symptoms or significant enlargement of the right side of the heart in some people over time.

In these cases, another surgery may be required To replace the pulmonary valveMostly in adolescence or adulthood, you can read about Switching valves by robots in Turkey.

What care is needed for an adult who has undergone surgical repair of tetralogy of Fallot?

Adult congenital heart disease specialists recommend that an adult who underwent palliative surgery for tetralogy of Fallot as a child undergo a comprehensive cardiac evaluation periodically.

The shunts help relieve some of the problems associated with tetralogy of Fallot such as stenosis, high blood pressure in the pulmonary artery or causing overload on the left side of the heart.
Definitive surgery often results in a large leaking pulmonary valve, and the size and function of the right side of the heart must be closely monitored.

Some patients may also develop large collateral vessels of the aorta as a means of increasing blood flow to the lungs. These must be closed prior to definitive surgical repair.

Having any of these problems or worsening symptoms, such as cyanosis or fatigue, are reasons why an adult should undergo a full surgical repair.

In some cases of tetralogy of Fallot, the patient may reach adulthood without undergoing any surgical repair, but such cases are rare, and specialists recommend that these individuals consider complete surgical repair to prevent future complications or sudden death.

In the event that this article did not answer your questions, do not hesitate tocontact us, Bimaristan center your family in Turkey,

Open heart surgery, tetralogy of Fallot
Cross-sectional image of an adult heart after surgery

How is Tetralogy of Fallot surgically treated in adults in Turkey?

Surgical repair of tetralogy of Fallot is complex, delicate and highly technical, and must be performed by a surgeon who specializes in adult congenital heart disease. The procedure involves a combination of techniques to repair all four defects.

For a complete repair, the surgeon closes the ventricular septal defect with a patch, the right ventricle's exit passage is opened, and the pulmonary valve is repaired or replaced.
The pulmonary arteries are dilated to both lungs, and sometimes a tube is placed between the right ventricle and the pulmonary artery to improve blood flow.

Complications of open-heart surgery, tetralogy of Fallot

Although surgical treatment of tetralogy of Fallot is very effective in repairing structural defects and blood flow through the heart, it can cause some persistent abnormalities in heart function. If these problems develop, they can be treated with additional surgery.

Many adults who have tetralogy of Fallot repair do not need further surgical treatment. In a study published by the Canadian Network of Adult Congenital Heart Disease, only 10 to 15 percent of people needed repeat surgery over a 20-year period.

Possible complications associated with surgical repair of tetralogy of Fallot include:

  • Electrical disturbances: Placing a VSD patch can impede the ability of the atria to transmit electrical signals to the ventricles. This can be corrected with a pacemaker.
  • Arrhythmia: Atrial fibrillation (the upper chambers of the heart contract irregularly and often very quickly) is a common complication after heart surgery. It can be treated with medication or a non-surgical procedure. Ventricular tachycardia (very fast heartbeat in the lower chambers of the heart) it is more rare, but it is more dangerous, and life-threatening, and the patient may need surgery Defibrillator or pacemaker.
  • Leaky (regurgitation) valves: Heart valves are designed to allow blood to flow in one direction. When a valve leaks, blood can flow back into the chamber from which it came out. Leaky valves are generally repaired surgically, but new methods of implantation are currently being explored. valves without surgery (Aortic valve replacement with catheters, or Transcatheter mitral valve replacementor a robot).
  • VSD: Sometimes the VSD does not close completely and there is still some leakage around the patch. If the leak is large or causes significant symptoms, it can be repaired surgically or modernly. through the catheter.

    Picture of a heart with tetralogy of Fallot
    CT scan of an injured heart

Is pregnancy safe for women who have had tetralogy of Fallot surgery?

Women who have undergone surgical repair of tetralogy of Fallot and are considering pregnancy should consult an adult congenital cardiologist and an obstetrician who specializes in caring for women with special medical conditions.

With proper prenatal care and close monitoring, most women with repaired tetralogy of Fallot are able to become pregnant and give birth safely.

What after surgical correction of tetralogy of Fallot?

The long-term outlook for children and adults with tetralogy of Fallot is good, but you will need regular follow-up with a cardiologist throughout your life to monitor your heart function and heart rhythm problems - and you should see your doctor and ask if post pulmonary valve replacement surgery, can use different tests to help your doctor The heart is on your watch, including:

  • Electrocardiogram (EKG)
  • Echocardiogram
  • Holter monitors
  • Doing stress tests
  • Cardiac magnetic resonance imaging

Your doctor will determine if you can participate fully in sports and exercise, or if there are some things that should be avoided in patients with tetralogy of Fallot.
Most people can engage in at least recreational exercise, and in many cases, women with tetralogy of Fallot have successful pregnancies, although it's important to discuss the risks and recommendations with your cardiologist before becoming pregnant.

In conclusion, we find that the open-heart operation, Tetralogy of Fallot, is a necessary and life-saving operation, and that congenital heart defects have become more treatable after the great medical and therapeutic development witnessed by the world, and Turkey in particular.


  1. CDC
  3. CincinnatiChildrens

Frequently Asked Questions

Tetralogy of Fallot (ToF) is the most common congenital heart disease causing cyanosis, studies show that the treatment strategies currently used to treat ToF in Turkey lead to excellent long-term survival (30-year survival ranges from 68.5% to 90.5%).

Tetralogy of Fallot surgery takes about 6-8 hours and is performed under general anaesthesia.

Treatment in Turkey is considered an economical, safe and effective treatment for patients compared to other countries such as the United States of America, Britain and France.
Patients can save approximately 40-50% in the total cost of treatment while ensuring the best results due to the highly experienced surgeons and advanced hospital equipment.

Doctors recommend that people with congenital heart diseases seek medical advice before marriage and childbearing. In some cases, there may be a need for pre-conception consultations by specialists in cases of high-risk childbirth. Some heart disease medications may be considered unsafe for pregnant women, so they must be replaced or their dosage changed before pregnancy.

If you are planning for treatment in Turkey
you can talk to us here.

If you are planning for treatment in Turkey
you can talk to us here.