Tetralogy of Fallot: Timing of Repair and Why Waiting Is Dangerous

For TGA with VSD and LVOT obstruction, these kids essentially have pulmonary stenosis with a VSD, and timing depends on the kid's oxygen saturation — they will need a Rastelli or a Nikaidoh operation, both requiring an implant, and the intent is to give the biggest implant possible since a smaller implant means an earlier return for a change. If saturations are above 75% and the kid is growing and doing well, they can wait and have surgery at around one year of age; if saturations are less than 75% with significant failure to thrive, they should come for surgery at any age or weight. On late presenters: we are also a resource-limited country — four or five surgeons doing this work for half of India — and face the same problem of kids coming late every day. My suggestion is education programmes, including pulse oximeter screening at birth, 1 month, and 6 months, referring for an echo early if abnormal. Late-presenting PDAs and cyanotic conditions apart from TGA are usually still operable, even if at slightly higher risk, but VSD shunt lesions can become inoperable if too late — however, even when a kid looks clinically inoperable, we always offer a cardiac catheterisation to confirm, since a significant proportion will still turn out to be operable, if high risk. And even an inoperable VSD child, with good, appropriately timed medical management (diuretics, pulmonary vasodilators), can still survive 25–35 years, whereas without that care they will die much earlier.

Approximately 5,500 USD.

In a child who is asymptomatic or only mildly symptomatic, a single-stage complete repair is carried out at around 6 to 9 months of age. Symptomatic infants need complete repair at any age or weight.

Left untreated, almost 25 percent of children die within the first year of life, rising to around 40 percent by 3 years of age.

Very good. There is an initial drop reflecting surgical risk, but the survival curve afterward closely tracks the general population, a far better outcome than the poor survival seen without treatment.

Because it is one of the most frequently seen cyanotic congenital heart conditions, and its treatment decision, weighing the risk of death from the untreated condition against the risk of surgery, illustrates the general principle used across cyanotic heart disease.