Unifocalization: Repairing a Fourfold Defect All at OnceA small number of newborns suffer from a complex and potentially fatal congenital defect known as tetralogy of Fallot with pulmonary atresia and major aorto-pulmonary collaterals. In infants with this defect, the blood vessels that should connect the heart to the lungs instead connect the lungs to the aorta, and the heart itself has a hole in the wall separating its lower chambers (ventricles).In the past, surgeons could repair this complex and life-threatening defect only with several separate surgeries, each of which required the chest to be opened and the heart stopped. Unifocalization - developed and pioneered by Children’s Heart Center Director Frank L. Hanley, M.D. - repairs the complete defect with only one surgery, in the majority of patients. In unifocalization, the misdirected blood vessels are rerouted into a single vessel (or into the pulmonary artery if it is present), which is then attached to the right ventricle of the heart through a conduit called a homograft. This restores normal circulation from lungs to heart. Next, the hole in the ventricle wall is repaired. Because unifocalization is complex, the procedure takes six to 10 hours, and is followed by hospitalization of up to 14 days. The benefits of unifocalization to the patient are significant. The procedure decreases overall hospital time for the child, and it reduces the number of major surgeries, anesthesias, and incisions, sparing the child additional pain and trauma. In addition, this procedure makes it more likely that the heart can be repaired before the child’s condition worsens and makes surgery either more difficult or, worst of all, impossible. Back to top Complex Repairs in Premature and Very Small InfantsPremature newborns with both congenital heart disease and very low (less than 1,500 grams, or 3 pounds 4 ounces) or extremely low birth weight (less than 1,000 grams, or 2 pounds 3 ounces) pose a particularly difficult challenge because of their small size and immaturity. Conventional wisdom holds that it is better to wait for the child to develop further before undertaking heart repair. However, waiting entails serious risks, because the heart defect leaves the child highly vulnerable to potentially fatal complications such as infection or lung disease.Since fixing the defect as soon as possible gives the infant the best chance of living normally, the Children’s Heart Center, led by Mohan Reddy, M.D., has developed techniques that allow surgery even in extraordinarily small newborns, including successful repair in the smallest, youngest infant known. As a result of this experience, the Children’s Heart Center is among the world leaders in this demanding specialty. Back to top Heart TransplantationThe Children’s Heart Center is one of the leading heart and heart-lung transplantation programs in the world and the only program in Northern California. To learn more about this treatment option, please visit the program’s Web site and our Health Library.Back to top Innovative Research ProgramsThe Children’s Heart Center is actively involved in exploring new approaches to the surgical repair of pediatric heart disease and developing evidence-based guidelines for clinical care. Current efforts focus on three areas:
Recent PublicationsPlease visit the publications by Children’s Heart Center surgeons page for a list of papers, book chapters, and abstracts published over the past five years.Back to top Lucile Packard Children's Hospital is located in Palo Alto, adjacent to Stanford University Hospital, approximately 20 miles north of San Jose, CA and 40 miles south of San Francisco.
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