Male1: -- open a valve by stretching it?
Male2: Valves can be opened and stretched with balloons by the cardiologist in a catheterization laboratory without surgery, at least the traditional type of open surgery. In Tetralogy of Fallot, almost always the type of blockage that the child has is a complicated multilevel blockage that extends from inside the heart through the area of the valve and even above the area of the valve and in addition to that, we do not want to open that connection widely because if we did with that very large hole in the wall between the bottom chambers of the heart, too much blood flow would occur through the lungs and then it would be uncontrolled.
Male1: There is a—seen in it?
Male2: It is and in most patients with Tetralogy, when they are born, they are pretty well balanced, but that balance shifts out of their favor as they get older, so that we have to time the surgery. In Tetralogy of Fallot, surgery is inevitable. It never goes away on its own. It never heals itself and there is no non-surgical way really to treat it, so we know all babies that are born with Tetralogy of Fallot will eventually come to cardiac surgery and one of the jobs of the cardiologist and the cardiac surgeon is for every individual child to pick the safest time on which that child should undergo surgery.
Male1: Usually, when is that be considered the safest time at a certain size, age, what?
Male2: All of those things go into consideration. Most babies with Tetralogy of Fallot grow pretty well and so they grow along a normal growth curve, and so small weight is not generally a problem for them. They usually gain weight pretty well. And we know from years of experience that the risk of the operation will generally decrease to be as low as it is going to be by the time the child is three or four months of age. So from the time the child is born, unless there is someone in usual circumstance or another illness which is what it means, we generally would tell the parents that they should plan on having the child undergo surgical correction sometime between three and six months of age.
Male1: You say correction a total correction or a partial correction, what do we do?
Male2: Well that is always an interesting point in congenital heart surgery. Generally speaking, congenital heart surgery—a surgery changes the natural history of the problem, in other words, we do surgery and that surgery gives the child a more favorable outcome and they would have and if they had not had surgery and so that sounds like a lot of medical gobbly goo, but basically what it means is that if you have had open heart surgery, for instance to repair Tetralogy of Fallot, you are not cured in the strict medical sense of the word. You may have to take medications, you require a medical follow up throughout your lifetime and there is always a possibility that some other things may happen in the future which may require surgery.
This is actually very rare in Tetralogy, but it can happen. The patients will require surgery in childhood or occasionally in adulthood as a follow up, so we do not really define that as a cure, you have the patent side of your heart, you have some scars in your heart, you have the scar on the outside of your chest, so you are much better off than you would be if you still had Tetralogy, but our definition of cure is that it is just as if you never had the illness to begin with.
Male1: So then if you do the surgery, generally, the life expectancy is normal or less than normal, what would you say?
Male2: Well, the surgery for this type of problem is an evolving thing. We do not do it now the way we did it 15 or 20 years ago and certainly not the way it was done 40 years ago. So the patients that are being operated on now and the ones that we have operated on in the last 10 to 15 years will serve as the standard to the answer to that question but generally speaking, patients who have had surgery for Tetralogy of Fallot have a very normal life and most of them do not require any medications, they do not have any particular restrictions in life, some of them may have some limitations at extremes of exercise, but for most of the normal types of activity is that most people and children do everyday, there is no limitations whatsoever.
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