| From your Guide Dr.MANI |  | |
Tetralogy of Fallot | ||
| From your Guide Dr.MANI | | |
Tetralogy of Fallot | ||
| |
OUTCOME AFTER TREATMENT FOR TETRALOGY
So now you know quite a bit about surgical treatment of the Tetralogy of Fallot. There is still one
major issue which I have deliberately left to the end. It was first brought to my notice by a parent,
who said it was most important to her to know WHAT HER CHILD's CHANCES WERE with
the different treatment options, and what were the risks in the periods between the different stages.
This is a highly uncertain topic. Surgical treatment is like an orchestra. A great soloist alone cannot
make a great performance. The smallest contributor to the surgical process has just as important a
role as the more glamorous heart surgeon ! And just as with any other technical matter, practice
makes perfect.
Differences are tremendous between hospitals. The best approach would be to gather information
from the specific center where you are planning to undergo surgery, about the outcomes at their
hospital.
What is the outcome after a one-stage intra-cardiac repair ?
In the best centers, a one-stage intracardiac repair - or total correction - is usually possible in most
cases, with a mortality risk of 2 to 5 percent.
Are these patients then CURED ?
Once again, this is a difficult question to answer. The longest
"follow-up" in studies of operated ToF patients is about 30 years. Analysis of these results show
that around 90% of the survivors live upto 20 years of age. Even after this, the life expectancy is
ALMOST NORMAL. When this is compared with the fact that 90% of unoperated patients with
ToF are dead by 30 years of age, the benefits of operation are unquestionable.
And again, much remains unknown. Maybe in another 30 years, medicine will have advanced
enough to provide better alternatives which will eliminate even this small added late risk !
Is there a risk of later operations ?
After a total correction operation, a few patients may also need a second operation for
complications. The most frequent complications are incomplete relief of pulmonary stenosis causing
residual obstruction, and incomplete closure of the VSD with a residual leak across the patch.
Other less frequent ones include disturbances of heart rhythm, aneurysmal dilation or hardening of
the outflow patch and severe pulmonary valve leak. Overall, nearly 40% of corrected ToF patients
will need re-operation over the next 10 years.
And what about the "shunted" patient ?
By its very nature, a shunt makes a later total correction operation necessary. Usually this is done
within 6 to 18 months, provided the conditions are then ideal for correction.
What happens in the intervening period ?
If the shunt is well performed, the cyanosis (blue color) becomes less or disappears entirely. The
child grows and is more active, and most importantly, is free from cyanotic spells which may be
life-threatening. Uncommonly, one of the complications mentioned earlier - infection, shunt
obstruction - may occur.
In very rare cases, conditions never become suitable for repair, and a intra-cardiac repair operation
cannot be safely performed. In such cases, the patient may survive on a shunt alone, although
results are not as good as with a corrective operation.
If there's anything more you want to read about, or some areas which aren't clear enough, don't
hesitate to write and let me know.
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Copyright 1998, All rights reserved. |
