Tetralogy of Fallot

  • Damien J. LaParEmail author
  • Emile A. Bacha


Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease beyond 1 week of age. “Classic” TOF usually presents for surgical repair during the first 3–9 months of life. Surgical repair techniques vary among surgeons and institutions. The optimal timing and approach to complete (vs. staged) surgical repair remain a topic of continued debate in the modern surgical era. A pulmonary valve sparing or reconstruction surgical approach has become popularized over the past decade or so. The purpose of this chapter will be to review the morphologic and physiologic features of “classic” TOF with an emphasis on contemporary approaches to surgical treatment.


Cyanotic congenital heart disease Tet spell Tetralogy of Fallot Transannular patch Valve-sparing transannular reconstruction 


  1. 1.
    Al Habib HF, Jacobs JP, Mavroudis C, et al. Contemporary patterns of management of tetralogy of Fallot: data from the Society of Thoracic Surgeons Database. Ann Thorac Surg. 2010;90:813–9.CrossRefGoogle Scholar
  2. 2.
    Woldu KL, Arya B, Bacha EA, Williams IA. Impact of neonatal versus nonneonatal total repair of tetralogy of Fallot on growth in the first year of life. Ann Thorac Surg. 2014;98:1399–404.CrossRefGoogle Scholar
  3. 3.
    Bacha EA, Scheule AM, Zurakowski D, et al. Long-term results after early primary repair of tetralogy of Fallot. J Thorac Cardiovasc Surg. 2001;122:154–61.CrossRefGoogle Scholar
  4. 4.
    Geva T, Gauvreau K, Powell AJ, et al. Randomized trial of pulmonary valve replacement with and without right ventricular remodeling surgery. Circulation. 2010;122(11 Suppl):S201–8.CrossRefGoogle Scholar
  5. 5.
    Hickey EJ, Veldtman G, Bradley TJ, et al. Late risk of outcomes for adults with repaired tetralogy of Fallot from an inception cohort spanning four decades. Eur J Cardiothorac Surg. 2009;35:156–64.CrossRefGoogle Scholar
  6. 6.
    Robinson JD, Rathod RH, Brown DW, et al. The evolving role of intraoperative balloon pulmonary valvuloplasty in valve-sparing repair of tetralogy of Fallot. J Thorac Cardiovasc Surg. 2011;142:1367–73.CrossRefGoogle Scholar
  7. 7.
    Anagnostopoulos P, Azakie A, Natarajan S, Alphonso N, Brook MM, Karl TR. Pulmonary valve cusp augmentation with autologous pericardium may improve early outcome for tetralogy of Fallot. J Thorac Cardiovasc Surg. 2007;133:640–7.CrossRefGoogle Scholar
  8. 8.
    Sen DG, Najjar M, Yimaz B, et al. Aiming to preserve pulmonary valve function in tetralogy of Fallot repair: comparing a new approach to traditional management. Pediatr Cardiol. 2016;37:818–25.CrossRefGoogle Scholar
  9. 9.
    Sung SC, Kim S, Woo JS, Lee YS. Pulmonic valve annular enlargement with valve repair in tetralogy of Fallot. Ann Thorac Surg. 2003;75:303–5.CrossRefGoogle Scholar
  10. 10.
    Bacha E. Valve-sparing or valve reconstruction options in tetralogy of Fallot surgery. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2017;20:79–83.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Cardiothoracic SurgeryColumbia University Vagelos College of Physicians and SurgeonsNew YorkUSA

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