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Chapter 8 - Repaired Tetralogy of Fallot

from Section 2 - Right-Sided Obstructive Lesions

Published online by Cambridge University Press:  09 September 2021

By
Joanna Rosing Paquin
Edited by
Laura K. Berenstain  and
James P. Spaeth
Laura K. Berenstain
Affiliation:
Cincinnati Children's Hospital Medical Center
James P. Spaeth
Affiliation:
Cincinnati Children's Hospital Medical Center
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Summary

Tetralogy of Fallot (TOF) describes an association of cardiac anomalies consisting of right ventricular outflow tract obstruction, ventricular septal defect, overriding aorta, and concentric right ventricular hypertrophy. Right ventricular outflow tract obstruction may occur at the infundibular, subvalvular, valvular, or supravalvular stenosis or a combination thereof. TOF is the most common cyanotic congenital heart disease. Repair involves relieving right ventricular outflow tract obstruction, often with a transannular patch, and closure of the ventricular septal defect. Pulmonary insufficiency often results, and although initially well tolerated, it places an increased volume load on the right ventricle and over time leads to right ventricular enlargement, dysfunction, heart failure, and tachyarrhythmias. This chapter describes the pathophysiology and perioperative anesthetic management of a patient with repaired TOF presenting for emergent noncardiac surgery.

Keywords

atrial reentrant tachycardiaDiGeorge syndromefree pulmonary insufficiencyright bundle branch blocktetralogy of Fallotventricular tachycardia
Type
Chapter
Information
Congenital Cardiac Anesthesia
A Case-based Approach
 , pp. 45 - 51
Publisher: Cambridge University Press
Print publication year: 2021

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References

References

Seki, M., Kuwata, S., Kurishima, C., et al. Mechanism of aortic root dilation and cardiovascular function in tetralogy of Fallot. Pediatr Int 2016; 58: 323–30.CrossRefGoogle ScholarPubMed
Khairy, P., Harris, L., Landzberg, M. J., et al. Implantable cardioverter-defibrillators in tetralogy of Fallot. Circulation 2008; 117: 363–70.CrossRefGoogle ScholarPubMed
Ayer Botrel, T. E., Clark, A. C., Queiroga, M. C., et al. Transcatheter pulmonary valve implantation: systemic literature review. Rev Bras Cardiol Invasiva 2013; 21: 176–87.Google Scholar
Ramamoorthy, C., Haberkern, C. M., Bhananker, S. M., et al. Anesthesia-related cardiac arrest in children with heart disease: data from the Pediatric Perioperative Cardiac Arrest (POCA) Registry. Anesth Analg 2010; 110: 1376–82.Google Scholar
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Suggested Reading

Smith, C. A., McCracken, C., Thomas, A. S., et al. Long-term outcomes of tetralogy of Fallot: a study from the Pediatric Cardiac Care Consortium. JAMA Cardiol 2019; 4: 34–41.CrossRefGoogle ScholarPubMed
Twite, M. D. and Ing, R. J. Tetralogy of Fallot: perioperative anesthetic management of children and adults. Semin Cardiothorac Vasc Anesth 2012; 16: 97–105.CrossRefGoogle ScholarPubMed
Valente, A. M., Cook, S., Festa, P., et al. Multimodality imaging guidelines for patients with repaired tetralogy of Fallot: a report from the American Society of Echocardiography: developed in collaboration with the Society for Cardiovascular Magnetic Resonance and the Society for Pediatric Radiology. J Am Soc Echocardiogr 2014; 27: 111–41.CrossRefGoogle Scholar
Wilson, W., Taubert, K. A., Gewitz, M., et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation 2007; 116: 1736–54.CrossRefGoogle Scholar

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