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PedsCrit
Tetralogy of Fallot with Pulmonary Stenosis with Dr. Laura Ortmann
Nov 14, 2022
Dr. Laura Ortmann, an associate professor and the Medical Director of the Cardiovascular Intensive Care Unit at Children's Hospital and Medical Center, discusses topics related to Tetralogy of Fallot with Pulmonary Stenosis. The podcast covers surgical procedures, bedside approaches for managing arrhythmias, postoperative care considerations, feeding intolerance, long-term complications, and the historical significance of repairing Tetralogy of Fallot.
39:11
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Quick takeaways
- The severity of pulmonary stenosis in Tetralogy of Fallot determines the degree of cyanosis, with different surgical options ranging from complete repair to palliative procedures depending on the level of cyanosis and comorbidities.
- Post-operative care for Tetralogy of Fallot patients should include monitoring for complications such as arrhythmias and right ventricular dysfunction, optimizing fluid balance and RV preload, considering early extubation to improve RV function, and planning for long-term complications and potential interventions.
Deep dives
Understanding Tetralogy of Fallot
Tetralogy of Fallot is a common and complex cardiac defect characterized by four specific abnormalities related to the right ventricle, pulmonary artery, and aorta. These include pulmonary stenosis, ventricular septal defect (VSD), overriding aorta, and right ventricular hypertrophy. These defects arise from a common embryologic error involving the faulty development of the conal septum, leading to malalignment and resulting in these specific abnormalities. The severity of the pulmonary stenosis determines the degree of cyanosis in affected infants. The surgical options for Tetralogy of Fallot vary based on the degree of cyanosis and comorbidities. Neonates with severe cyanosis may require palliative procedures, such as an arterial-to-pulmonary shunt, before complete repair. In contrast, pink Tetralogy of Fallot infants who are less cyanotic typically undergo complete repair as neonates. The goals of Tetralogy of Fallot repair include creating unobstructed pulmonary blood flow and closing the VSD. In cases where the pulmonary valve annulus is narrow, a transannular patch may be necessary, resulting in pulmonary insufficiency that may require re-operation in the future. Monitoring for complications postoperatively is important, such as right ventricular diastolic dysfunction and arrhythmias like junctional ectopic tachycardia. Extubation can be considered in postoperative Tetralogy patients to optimize cardiac output and reduce RV afterload. Discharge planning should include close monitoring of fluid balance, feeding tolerance, and awareness of potential late-onset RV dysfunction.
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