Pediatric valve-sparing repair of tetralogy of Fallot (TOF)

What is a pediatric valve-sparing repair of tetralogy of Fallot (TOF)?

Tetralogy of Fallot (TOF) is a rare heart condition that is present at birth (congenital heart disease). Valve-sparing repair is one of several open-heart surgery procedures to repair TOF.

TOF involves four heart problems, including obstructed blood flow between the heart and the blood vessels in the lungs (the pulmonary arteries). The obstruction usually involves excess muscle below the pulmonary valve between the heart and lungs. The pulmonary valve may also be narrow. This obstruction restricts blood flow to your baby’s lungs. As a result, the body doesn’t get enough oxygen.

Our heart surgeons perform valve-sparing repair surgery to treat slightly narrowed pulmonary valves. This procedure keeps the valve intact. Your child’s doctor widens the valve and the area under it to improve blood flow to the lungs and body. If the valve is extremely narrow, the surgeon will perform a different procedure to place a patch across the valve.

What are the benefits of a pediatric valve-sparing repair of tetralogy of Fallot (TOF)?

Compared with the patch procedure, valve-sparing repair of TOF has significant benefits, including:

• Reduced risk of later pulmonary valve regurgitation (a valve that leaks because it doesn’t close completely)
• Lower need for future procedures to replace an artificial pulmonary valve because the child’s own valve grows with them
• Less risk of developing arrhythmias (irregular heart rhythms)

What are the risks of a pediatric valve-sparing repair of tetralogy of Fallot (TOF)?

Like other surgeries, valve-sparing repair of TOF involves certain risks, which include:

• Bleeding during or shortly after surgery
• Infection, such as pneumonia
• Blood clots
• Difficulty breathing

In some babies, their pulmonary valve may still be too narrow after valve-sparing repair, requiring later surgery to repair or replace the valve.

What to expect with pediatric valve-sparing repair of tetralogy of Fallot (TOF)

The pediatric heart care team meets with you to provide all the information you need about the procedure and what you can expect.

What to expect before pediatric valve-sparing repair of tetralogy of Fallot (TOF)

Before the surgery, the care team meets with you to discuss what’s involved. We work with you to help you prepare your child for the procedure. Our Child Life team is available to help your child and family before and during the surgery.

What to expect during pediatric valve-sparing repair of tetralogy of Fallot (TOF)

The surgery takes several hours. Parents and family members stay in a waiting area, and someone from the care team comes to update you during the procedure. Your child’s surgeon meets with you after to let you know how the procedure went.

What to expect after pediatric valve-sparing repair of tetralogy of Fallot (TOF)

After surgery, the care team takes your child to the cardiac intensive care unit (CICU), where our pediatric heart intensivists care for your child. The cardiac nursing team trains you in all you need to know about caring for your child once they are ready to go home.

Your child continues to see our care team for follow-up care after surgery.

We take echocardiograms (heart ultrasounds) and use other tests to monitor your child’s heart and overall health.

Child Life services for pediatric valve-sparing repair of tetralogy of Fallot (TOF)

Child Life

What questions should I ask my child’s provider about pediatric valve-sparing repair of tetralogy of Fallot (TOF)?

To understand the options for repairing TOF, you might ask your child’s care team:

• What is the likelihood of sparing the valve?
• If the valve can’t be saved, what are the other alternatives?
• How long will my child be in the hospital?
• How soon will I be able to see my child after the surgery?