• Total correction under the age of 1 year when there is no need for an outflow transannular patch. A second-stage total correction can be performed when the child is over the age of 2 years.
• Blalock-Taussig shunting is performed nowadays only if the anatomy is unfavourable for a total correction.
• Modified Blalock-Taussig shunting is the interposition of a tubular graft between the subclavian and pulmonary arteries.
• The Waterston shunt involves anastomosis of the back of the ascending aorta to the pulmonary artery. A Waterston shunt is performed when surgery is required under the age of 3 months because the subclavian artery is too small for a good Blalock-Taussig shunt.
• The Potts shunt involves anastomosis of the descending aorta to the back of the pulmonary artery (JAMA1946; 132: 627).
• The Glenn operation involves anastomosis of the superior vena cava to the right pulmonary artery. The bidirectional Glenn procedure involves anastomosis of the superior vena cava to both pulmonary arteries.
• Pulmonary balloon valvuloplasty is sometimes used as an alternative to surgery.
What do you know about the embryological development of Fallot's tetralogy ?
It arises from the anterior displacement of the canal septum, which leads to unequal partitioning of the
conus at the expense of the right ventricular infundibulum and results in the obstruction of the right
ventricular outflow tract and failure to close the intraventricular foramen.