Another main concern for patients with Tetralogy of Fallot is right heart failure. Physiologically, we should understand that the right side of the heart pumps deoxygenated blood into pulmonary circulation through the pulmonary artery. Whether the issue is a malformation of the heart or some severe form of occlusion, and with proper candidacy, the patient may opt to surgically replace the pulmonary artery with pulmonary valve replacement surgery (Mitropoulos et al., 2017).
On the other hand, based on a case-by-case standpoint, the patient may opt to wait to do neonatal surgery, as a little more time outside of the uterus may allow the newborn to withstand stresses of a very invasive surgery.
The ethical issue considers non-maleficence. Mitropoulos et al. (2017) concludes that the longer one waits to do the pulmonary valve replacement, in instances of Tetralogy of Fallot, increases the likelihood of reoperation. Treatment with bioprosthetic valve replacement lies at the intersection of immediate and long-term care. Unfortunately, with Tetralogy of Fallot, pulmonary valve replacement is just one of the many congenital cardiac issues that will need to be dealt with. Nevertheless, considering what ought to be done, physicians should consider minimizing surgical treatments on newborn with Tetralogy of Fallot by moving to do the pulmonary valve replacement as soon as possible.
References
Mayo Clinic. Tetralogy of Fallot. (2017). Mayo Clinic Foundation for Medical Education and Research.
Mitropoulos, F. A., Kanakis, M. A., Ntellos, C., Loukas, C., Davlouros, P., Kousi, T., & Chatzis, A. C. (2017). Pulmonary valve replacement in patients with corrected tetralogy of Fallot. Journal Of Cardiovascular & Thoracic Research, 9(2), 71-77. doi:10.15171/jcvtr.2017.12
Hello Pat,
ReplyDeleteI found your blog very interesting as I had previously learned that TOF occurs in approximately 10% of all congenital heart defects. The tetra is referred to the four elements of TOF which are a large ventricular septal defect, narrowing at or just below the pulmonary valve, right ventricle hypertrophy, and the overriding aorta that is directly over the ventricular septal defect, all of these contributing to the cyanosis you mentioned in your post. What I find most interesting about TOF is that these children initially lack cyanosis and appear to be oxygenating normally. This is because, as we have learned in anatomy, the baby is able to circulate blood through the fetal ductus arteriosus that is still open up until a few hours after birth, which is when the severe cyanosis is noted. I can see this being an determining factor for pulmonary valve replacement. Since the baby is still able to circulate blood up until a few hours physicians may opt to wait until this happens to operate.
Aehlert, B. (2013). Paramedic practice today: Above and beyond, volume 2. Place of publication not identified: Jones And Bartlett Publis.