Modern therapeutic strategies for tetralogy of Fallot: Basis pediatric heart surgery

Tetralogy of Fallot is one the most common congenital heart diseases. Currently, early primary correction in infancy is the procedure of choice which can be successfully performed even in symptomatic newborns. Palliative procedures are controversially discussed and widely avoided; however, palliation may still be indicated in high-risk patients. In addition to surgical procedures palliative interventional techniques have been developed. Currently, surgical correction is preferentially performed via the transatrial approach, if necessary in combination with a limited right ventriculotomy. Transannular enlargement of the right ventricular outflow tract should be avoided if possible. The prevention of pulmonary valve regurgitation is a major concern because of its deleterious effects on right ventricular function and its relevance on long-term morbidity. Currently developed techniques, such as interventional pulmonary valve implantation and tissue engineered heart valves may reduce the risk and need for re-operations in the future.