Surgical treatment of a patient with tetralogy of Fallot can include any of the following except:

B. Banding of the pulmonary artery in an acyanotic patient with tetralogy of Fallot to control pulmonary blood flow and prevent the development of pulmonary hypertension

DISCUSSION: Patients with tetralogy of Fallot who do not appear cyanotic still have mild arterial hypoxemia by arterial blood gas determination. Patients with tetralogy of Fallot rarely have excessive pulmonary blood flow, and the development of pulmonary hypertension is not a concern in this population. Banding of the pulmonary artery is never a consideration in patients with tetralogy of Fallot, since the predominant physiologic effect of the defect results from too little pulmonary blood flow to begin with. Acyanotic patients with tetralogy of Fallot (“pink tets”) can usually be followed for several months and their defects repaired electively as a first-stage procedure (usually by age 6 months). All of the other therapies are appropriate treatment for babies with tetralogy of Fallot. Prostaglandins maintain patency of the ductus arteriosus, providing an anatomic systemic-to-pulmonary artery shunt that sustains pulmonary blood flow until a more permanent surgical solution can be provided. The advent of prostaglandin therapy has enabled numerous critically ill infants to become stabilized enough to reach a tertiary care institution and receive proper surgical therapy who might not otherwise have survived had it not been for the ability of pulmonary blood flow to be maintained through the reversal of duct closing. The choice of palliative shunting or total anatomic correction rests largely with the experience and skill of the surgical team and is dictated in part by the anatomy of the pulmonary arteries. Either of these options is acceptable.