Editing Tetralogy of Fallot (section)

=== Total surgical repair ===
Total surgical repair of TOF is a curative surgery. Different techniques can be used in performing TOF repair. One method to permit pulmonary blood flow post-birth is the stenting of the ductus arterious (DA) through the inducement of a systemic-to-pulmonary shunt. This surgical approach has an 83% success rate. <ref>{{cite journal |last1=van der Ven |first1=Jelle P.G. |last2=van den Bosch |first2=Eva |last3=Bogers |first3=Ad J.C.C |last4=Helbing |first4=Willem A. |title=Current Outcomes and Treatment of Tetralogy of Fallot |journal=F1000Research |date=2019 |volume=8 |pages=F1000 Faculty Rev-1530 |doi=10.12688/f1000research.17174.1|doi-access=free |pmid=31508203 |pmc=6719677 }}</ref> However, a transatrial, transpulmonary artery approach is used for most cases.<ref name = "Mavroudis_2015">{{cite book| vauthors = Mavroudis C, Backer CL, Idriss RF |title=Atlas of pediatric cardiac surgery |isbn=9781447153191|location=London |oclc=926915143 |date=2015}}</ref>{{rp|153}} The repair consists of two main steps: closure of the VSD with a patch and reconstruction of the right ventricular outflow tract.<ref name="Corno_2009" />

This open-heart surgery is designed to relieve the right ventricular outflow tract stenosis by careful [[Segmental resection|resection]] of muscle and to repair the VSD.<ref name = "Mavroudis_2015" />{{rp|154}}The right ventricle outflow tract can be reconstructed using mainly 2 procedures: a transannular patch (TAP) or a pulmonary valve-sparing procedure (PVS). The decision on the type of the procedure depends on individual anatomy (especially the size of the pulmonary valve). PVS showed better overall survival, event-free survival and less pulmonary regurgitation at 10, 20 and 30 years after the operation.  PVS  can be performed with or without [[Ventriculotomy (cardiac)|ventriculotomy]]. A study found similar overall and event-free survival and pulmonary regurgitation rate between patients who underwent PVS with ventriculotomy and the ones who did not.<ref>{{Cite journal |last1=Ono |first1=Yoshikazu |last2=Hoashi |first2=Takaya |last3=Imai |first3=Kenta |last4=Okuda |first4=Naoki |last5=Komori |first5=Motoki |last6=Kurosaki |first6=Kenichi |last7=Ichikawa |first7=Hajime |date=2022-03-01 |title=Impact of right ventriculotomy for tetralogy of Fallot repair with a pulmonary valve–sparing procedure |url=https://www.jtcvsopen.org/article/S2666-2736(22)00005-5/abstract |journal=JTCVS Open |language=English |volume=9 |pages=191–205 |doi=10.1016/j.xjon.2021.10.061 |pmid=36003424 |pmc=9390402 |issn=2666-2736}}</ref>

Additional reparative or reconstructive surgery may be done on patients as required by their particular cardiac anatomy.<ref name="Mavroudis_2015" />{{rp|153}} 

Timing of surgery in asymptomatic patients is usually between the ages of two months to one year.<ref name="Munoz_2010" />{{rp|201–202}} However, in symptomatic patients showing worsening blood oxygen levels, severe tet-spells (cyanotic spells), or dependence on prostaglandins from early neonatal period (to keep the ductus arteriosus open) need to be planned fairly urgently<ref name="Munoz_2010" />{{rp|201–202}}

Potential surgical repair complications include residual ventricular septal defect, residual outflow tract obstruction, complete atrioventricular block, arrhythmias, aneurysm of right ventricular outflow patch, and pulmonary valve insufficiency.<ref name="Corno_2009" />{{rp|59}} Long-term complications most commonly include pulmonary valve regurgitation, and arrhythmias.<ref name="Chessa_2012" /> Adults with repaired TOF require lifelong surveillance to monitor for such complications, with frequency of monitoring varying according to age, diagnostic methods, and the severity of the condition. <ref>{{Cite journal |last1=Geva |first1=Tal |last2=Wald |first2=Rachel M. |last3=Bucholz |first3=Emily |last4=Cnota |first4=James F. |last5=McElhinney |first5=Doff B. |last6=Mercer-Rosa |first6=Laura M. |last7=Mery |first7=Carlos M. |last8=Miles |first8=Andrea Leann |last9=Moore |first9=Jeremy |last10=on behalf of the American Heart Association Council on Lifelong Congenital Heart Disease and Heart Health in the Young; Council on Cardiovascular Surgery and Anesthesia; Council on Clinical Cardiology; and Council on Cardiovascular and Stroke Nursing |date=2024-11-21 |title=Long-Term Management of Right Ventricular Outflow Tract Dysfunction in Repaired Tetralogy of Fallot: A Scientific Statement From the American Heart Association |url=https://www.ahajournals.org/doi/10.1161/CIR.0000000000001291 |journal=Circulation |volume=150 |issue=25 |pages=e689–e707 |language=en |doi=10.1161/CIR.0000000000001291 |pmid=39569497 |issn=0009-7322|url-access=subscription }}</ref>

Total repair of tetralogy of Fallot initially carried a high mortality risk, but this risk has gone down steadily over the years. Surgery is now often carried out in infants one year of age or younger with less than 5% perioperative mortality.<ref name="Munoz_2010" />{{rp|205}} Post surgery, most patients enjoy an active life free of symptoms.<ref name="Munoz_2010" />{{rp|205}} Currently, long-term survival is close to 90%.<ref name="Munoz_2010" />{{rp|167}} Today the adult TOF population continues to grow and is one of the most common congenital heart defects seen in adult outpatient clinics.<ref name="Roos-Hesselink_2017" />{{rp|100–101}}