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>> WHEN WE REPAIR TETRALOGY OF FALLOT,
THERE ARE TWO MAJOR THINGS THAT WE NEED TO DO.
ONE IS TO CLOSE THE VENTRICULAR SEPTAL DEFECT
SO THAT THERE'S NO MIXING BETWEEN THE TWO PUMPING
CHAMBERS, AND THE SECOND IS TO RELIEVE THE BLOCKAGE
TO THE LUNGS.
>> IT'S VERY, VERY IMPORTANT THAT THE FAMILY FEELS
COMFORTABLE WITH YOU, AS AN INDIVIDUAL,
TAKING THEIR CHILD FROM THEM AND THAT THE CHILD
RECOGNIZES THAT NOTHING BAD IS GOING TO HAPPEN TO THEM,
THAT THEY CAN DO THIS WITHOUT BEING AWAKE
FOR ANY PAINFUL EXPERIENCE.
>> THEY'LL GO TO THE OPERATING ROOM.
THE ANESTHESIOLOGIST WILL PUT THEM TO SLEEP.
WE'LL THEN CLEAN, PREPARE EVERYTHING IN THE CHEST
AND ABDOMEN STERILELY SO THAT WE CAN DO THE OPERATION
WITHOUT INFECTION.
>> THE SURGICAL REPAIR OF TETRALOGY OF FALLOT INVOLVES
USING THE HEART AND LUNG MACHINE TO SUPPORT
THE CIRCULATION WHILE THE OPERATION IS DONE.
>> WE'RE BYPASSING THE HEART AND THE LUNGS SO THAT
THE OPERATIVE FIELD, THE AREA WHERE WE'RE WORKING,
IS CLEAN, WE CAN SEE WHAT'S GOING ON.
>> AND THEN THE HEART IS STOPPED,
AND THE UPPER CHAMBER OF THE HEART IS OPENED.
AND WORKING THROUGH THE VALVE THAT ENTERS THE RIGHT
SIDE OF THE HEART, THE HOLE BETWEEN THE TWO PUMPING
CHAMBERS OF THE HEART IS CLOSED WITH A PATCH.
THE PATCH IS MADE OUT OF A SORT OF FUZZY DACRON
MATERIAL, SO THE LINING OF THE HEART GROWS OVER THAT
AND MAKES IT NICE AND SMOOTH.
>> THERE CAN BE BLOCKAGE BELOW THE PULMONARY VALVE,
INSIDE THE VENTRICLE, FROM BIG MUSCLE BUNDLES.
THE PULMONARY VALVE ITSELF CAN ACTUALLY BE BLOCKED.
THE PULMONARY VALVE HAS THREE LEAFLETS WHICH OPEN,
AND IF THEY'RE FUSED TOGETHER,
THAT CAN CAUSE A BLOCKAGE BECAUSE THEY CAN'T OPEN
COMPLETELY.
SOMETIMES, JUST BY SEPARATING THE LEAFLETS,
YOU CAN OPEN THE VALVE.
THE PULMONARY VALVE IS A CIRCLE,
AND THE OUTER LAYER, THAT'S CALLED THE ANNULUS.
IF THAT'S VERY SMALL, EVEN IF YOU OPEN UP THE LEAFLETS,
IT'S LIKE HAVING A SMALL TUBE.
IT MAY BE TOO LITTLE.
AND THEN YOU CAN ALSO HAVE BLOCKAGE OUT
IN THE PULMONARY ARTERIES THEMSELVES.
SO YOU CAN HAVE BLOCKAGE BELOW THE VALVE,
AT THE VALVE, AND ABOVE THE VALVE.
>> SOMETIMES, IF THE ARTERY TO THE LUNGS IS QUITE SMALL,
IT'S ENLARGED BY OPENING IT AND PUTTING A SMALL PATCH
OVER IT TO MAKE IT BIGGER SO BLOOD CAN EASILY GET
TO THE LUNGS.
>> THAT'S CALLED A TRANSANNULAR PATCH.
SOME BABIES WILL TOLERATE THAT VERY WELL.
OTHERS WILL NEED A VALVE PUT IN AT SOME POINT IN THEIR LIFE.
AFTER SURGERY, WE'LL MAKE SURE THAT THE HEART
IS WORKING OKAY, THAT THE BLOOD PRESSURE IS OKAY,
THAT THERE'S ENOUGH OXYGEN IN THE BLOOD,
THAT THERE'S NO BLEEDING.
AND THEN USUALLY WE LEAVE A COUPLE LITTLE TUBES INSIDE
THE HEART TO LET US MEASURE PRESSURES IN THE HEART
AND GIVE DRUGS.
THESE COME OUT THROUGH THE SKIN.
THERE'S ALSO USUALLY TWO LITTLE,
BLUE PACING WIRES WHICH LET US CHANGE THE HEART RHYTHM.
WE THEN LEAVE A DRAINAGE TUBE,
AND ONCE EVERYTHING IS STABLE,
THE BABY WILL COME BACK UP TO THE INTENSIVE CARE UNIT.
>> THAT OPERATION NOWADAYS TAKES ABOUT THREE HOURS
TO DO, FROM START TO FINISH, AND THE ACTUAL TIME IT TAKES
TO DO THE REPAIR INSIDE THE HEART IS ONLY ABOUT
30 MINUTES.
THE RESULTS WITH THAT SURGERY NOW ARE VERY GOOD.
THE RISK OF NOT SURVIVING THAT OPERATION,
WHILE NOT ZERO, IS LESS THAN 1 PERCENT, SO CHILDREN
DO EXTREMELY WELL WITH THAT PARTICULAR SURGERY.