MODERN PALLIATIVE METHODS OF TREATMENT OF THE TETRALOGY OF FALLOT IN INFANTS. PART 1. SURGICAL TREATMENT
This article represents up-to-date status of surgical and endovascular palliative treatment of the tetralogy of Fallot (TF) in infants. The first part describes a surgical approach. Primary repair of TF, well recognized method of treatment, is usually performed in asymptomatic patients and some of the world-famous centers successfully integrated it into their routine practice. In symptomatic patients a stage approach is reliable, when on fits stage various palliative procedures are performed, and on the second stage - primary repair. Most commonly used surgical palliative technique is a formation of anastomosis between subclavian artery and pulmonary artery using synthetic vascular graft. Despite a relative simplicity of this operation, it still followed by mortality and several major complications. Others palliative techniques include formation of conduit between ascending aorta and pulmonary artery, reconstruction of the right ventricular outflow tract without closure of the ventricular septal defect a performed rarely, in cases with severe hypoplasia of the pulmonary arteries. This manuscript presents a treatment algorithm for infants with TF based on their initial clinical status.