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The Predicament of Surgical Correction of Tetralogy of Fallot

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Abstract

Surgery for tetralogy of Fallot has a long history, which may be described as both a success story and a failure story. It is a success story because prognosis without surgery is very poor, but surgery makes it possible for affected babies to reach adulthood and lead productive lives. It is a failure story, however, since we still cannot cure this condition; we can only palliate it as illustrated in the sobering long-term outcome of affected patients. In this review article, we aim to explore the reason for this failure. This may be summed up in terms of the nature of the obstruction to the right ventricular outflow tract, which characterizes this malformation and must be relieved. This obstruction has several possible components, but none may be eliminated without harming the ventricle. There seems to be no ‘extra’ muscle band in tetralogy of Fallot that may be dispensed with without undermining ventricular function; every muscle band that is there should be there, just like in the normal heart, except that these are thicker than normal and somewhat displaced in tetralogy of Fallot, thus narrowing the right ventricular outflow tract. Consequently, ventricular function deteriorates with every muscle band that is cut, just like in the normal heart. We have to harm the heart in order to repair it. Every repaired Fallot is inevitably a damaged heart. Consequently, repair of this condition cannot be curative at present; it is palliative surgery.

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Authors and Affiliations

  1. Department of Cardiac Surgery, Virgen del Rocio Children’s Hospital, University Hospitals of Seville, Avenida Manuel Siurot s/n, 41013, Seville, Spain

    Amir-Reza Hosseinpour, Antonio González-Calle & Alejandro Adsuar-Gómez

  2. Cardiac Morphology, Royal Brompton Hospital, National Heart & Lung Institute, Imperial College London, London, UK

    Siew Yen Ho

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  1. Amir-Reza Hosseinpour
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  2. Antonio González-Calle
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Contributions

All contributed to the conception and writing of this manuscript. The concepts were first discussed between A-RH and SYH. Subsequently, these concepts were discussed between A-RH, AG-C and AA-G for criticism or agreement. The first draft was written by A-RH. This draft was given to AG-C and AA-G who independently edited the manuscript such that we came to a mutual agreement. The revised manuscript was then reviewed by SYH who made a few corrections related to anatomical concepts.

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Correspondence to Amir-Reza Hosseinpour.

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Hosseinpour, AR., González-Calle, A., Adsuar-Gómez, A. et al. The Predicament of Surgical Correction of Tetralogy of Fallot. Pediatr Cardiol 42, 1252–1257 (2021). https://doi.org/10.1007/s00246-021-02662-6

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  • DOI: https://doi.org/10.1007/s00246-021-02662-6

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