Chairman & Head - Adult Cardiac Surgery, Fortis Escorts, New Delhi, India
Part 14 of 16 in Advances in Cardiac Surgeries
Tetralogy of Fallot Surgery in Children: Timing, Outcomes and Survival
August 5, 2026
Tetralogy of Fallot surgery in children has excellent outcomes and is one of the most commonly performed paediatric cardiac operations, alongside repair of atrial septal defects and ventricular septal defects. Any paediatric cardiac surgery centre performs tetralogy of Fallot repair routinely, including centres treating children referred from Africa for tetralogy of Fallot surgery in India.
How common and how successful is tetralogy of Fallot surgery
Tetralogy of Fallot is a congenital heart condition and one of the commonest procedures performed in paediatric cardiac surgery. It is done very routinely at any paediatric cardiac centre, and clinical outcomes for tetralogy of Fallot are excellent.
Is six years old too late for tetralogy of Fallot surgery?
In response to a question from a doctor in Ethiopia about a six-year-old child with tetralogy of Fallot who had not yet had surgery, the answer was clear: six years is not a very late stage for this operation. In India, many children with tetralogy of Fallot are operated on at this age, and even older. Outcomes of tetralogy of Fallot surgery performed at six years old are excellent, and a child in this situation certainly needs surgical correction rather than continuing without treatment.
What this means for families outside India
For families in Africa whose child has tetralogy of Fallot and has not yet had surgery, the key message is that it is not too late to seek treatment, and outcomes remain excellent even if surgery has been delayed. Paediatric cardiac teams working with Jivo, in coordination with Fortis Escorts Heart Institute, can review a child's case and echocardiogram findings to confirm the right time for tetralogy of Fallot surgery in India.
← Foldax Tria Polymer Heart Valve: A New Generation of Valve Replacement | Series index | Myocardial Bridging: When Does It Need Surgery? →
This article is based on a Jivo Masterclass session conducted by Dr. Z. S. Meharwal, Chairman and Head, Adult Cardiac Surgery, Fortis Escorts Heart Institute, New Delhi. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
This guide is based on a live Jivo Masterclass — Dr. Z S Meharwal taught doctors across Africa on October 26, 2025.
FROM THE LIVE Q&A
Host (Varun, Jivo Healthcare)
What is the most common dilemma doctors practising in resource-constrained environments like Africa face: how do they decide whether a case should be handled locally or referred across the border for specialist intervention?
Dr. Z S Meharwal
The patient should be referred for further evaluation at the appropriate time — not too early, but also not too late, because if it is too late the patient develops more comorbidities and the outcome may not be as good. For valve disease specifically, there are definite guidelines for mitral and aortic valve disease on when a patient should be referred for cardiac surgery; whether it can be done locally depends on whether it looks like a straightforward repair or replacement, or a more challenging one. The two important criteria are the patient's clinical symptoms — which functional class (1, 2, 3, or 4) — and the echo findings, which show the severity of stenosis or regurgitation, LV function, and pulmonary artery pressures. Together these decide whether the patient should be referred for surgical treatment, locally or elsewhere.
Frequently Asked Questions
What is the financial implication of these surgeries, whether mechanical or tissue-based valve replacement?▼
Cost primarily depends on two things: which valve is used — mechanical valves are significantly less expensive than tissue valves, and among tissue valves, third-generation valves cost more than second-generation ones — and the patient's clinical course, since a straightforward surgery without a long hospital stay or comorbidities costs less. The average cost generally starts from $9,000 and goes up to $15,000–$16,000.
For a child born with a non-obstructing mass over the apical side of the heart, around 1.4 cm by 1 cm, with no sign of heart failure — the baby is now 3 months old, echo is otherwise normal except for the mass, which is likely a rhabdomyoma on differential, and has shown some decrease in size (from 1.4x1 cm to 1.2x0 cm over a month) — should we consider surgical management, or when should surgical management be considered?▼
Cardiac tumours in children are well known, though this exact pathology is not very common. The echo gives us an idea, but I would suggest also doing an MRI and a CT to further delineate it. I would like the details of this patient sent to our institute so we can forward it to our paediatric cardiac surgeon, since paediatric cardiac surgery is a separate subspecialty from the adult cardiac surgery I practise, and we do have a dedicated paediatric cardiac surgical team. This child needs very close follow-up and further investigation.
For a tetralogy of Fallot patient where surgery was not done at an early age and the patient is now around 6 years old, what is the survival rate if surgery is not done, and what is the success rate of surgery done now?▼
Tetralogy of Fallot is one of the commonest surgical procedures, and the outcome depends on the exact anatomy delineated by a proper paediatric echo, but six years is not a very late stage — in India a lot of patients are operated on at this age or even older. The outcome of tetralogy repair even at 6 years is excellent, so this patient certainly needs surgical correction.
An adult patient with myocardial bridging is on a beta blocker — should surgery be done, and if surgery is not done, what are the possible negative complications?▼
Myocardial bridging is not uncommon and is often seen on angiography. If it is asymptomatic, nothing needs to be done. If it is symptomatic, we normally do a stress thallium test — if positive, we recommend surgery; if negative, which is most of the time, only medical treatment is needed. If it is only myocardial bridging with no stenosis involved in other arteries (the circumflex or right coronary artery are normal), nothing needs to be done, but if the stress test is positive, surgery is recommended.
What is the place of surgery in children with tetralogy of Fallot?▼
Tetralogy of Fallot is one of the commonest procedures in paediatric cardiac surgery, alongside ASD and VSD repair. It is a very commonly performed procedure with excellent outcomes — any paediatric cardiac centre does this routinely, and the clinical outcomes are excellent.
How common is tetralogy of Fallot surgery in paediatric cardiac care?▼
Tetralogy of Fallot is one of the commonest procedures performed in paediatric cardiac surgery, alongside repair of atrial septal defects and ventricular septal defects, and any paediatric cardiac surgery centre performs the repair routinely.
What should families do if a child's tetralogy of Fallot surgery has been delayed?▼
The key message for families whose child has not yet had surgery is that it is not too late to seek treatment, since outcomes remain excellent even when surgery has been delayed beyond early childhood.
How can families outside India get a case reviewed for tetralogy of Fallot surgery?▼
Paediatric cardiac teams working with Jivo, in coordination with Fortis Escorts Heart Institute, can review a child's case and echocardiogram findings to confirm the right time for surgery.
In This Series: Advances in Cardiac Surgeries
- 1.Advances in Heart Valve Surgery
- 2.Anticoagulation After Mechanical Heart Valve Replacement: Risks and Management
- 3.Cost of Heart Valve Replacement Surgery in India
- 4.Foldax Tria Polymer Heart Valve: A New Generation of Valve Replacement
- 5.Home INR Monitoring After Heart Valve Surgery: Is It Better Than Hospital Visits?
- 6.Mechanical Heart Valves: History, Types and What Patients Should Know
- 7.Mechanical vs Tissue Heart Valve: How Doctors and Patients Choose
- 8.Minimally Invasive Heart Valve Surgery: Less Pain, Faster Recovery
- 9.Mitral Valve Repair: Techniques for Posterior and Anterior Leaflet Prolapse
- 10.Myocardial Bridging: When Does It Need Surgery?
- 11.Recovery After Heart Valve Surgery in India: Hospital Stay and Travel Timeline
- 12.Warning Signs You May Need Heart Valve Surgery
- 13.Sutureless Heart Valves: A Faster, Less Invasive Alternative
- 14.Tetralogy of Fallot Surgery in Children: Timing, Outcomes and Survival
- 15.Third-Generation Tissue Valves and Valve-in-Valve Technology
- 16.Tissue (Bioprosthetic) Heart Valves: How They Work and Why They Degenerate