Tetralogy of Fallot includes both pulmonary stenosis and VSD.  (The other
two parts of the tetralogy are overriding aorta and right ventricular
hypertrophy [thickening], which are less significant to the baby's ability
to breathe and eat.  TOF is a "cyanotic" heart defect, meaning when he
gets stressed he'll turn blue.  Timing of surgical repair varies depending
on baby's stability, growth rate, etc., but results are usually good.

Since babies don't have to hold their breath to breastfeed, they're less
likely to lower their blood oxygen levels; as opposed to bottle-feeding,
in which they have to hold their breath and guzzle because the flow is so
fast.  This is actually documented in an excellent article:

Marino, B.  et al.  Oxygen saturations during breast and bottle feedings
in infants with congenital heart disease.  J. Pediatric Nursing
1995;10(6):360-364.

The other problem is that these babies can require up to twice the usual
caloric intake just to keep their hearts pumping, because they pump much
less efficiently.  With severe defects like TOF, supplementation of some
sort is usually necessary.  Often tube feedings are given to minimize the
stress associated with bottle feeding.  Having at least a partial diet of
"mother's finest" will help prevent all the infections normally associated
with heart defects, as well as providing the nutritional benefits.  Mom
will need to pump to increase supply (maybe even
bring in supply, if baby's suck is weak due to generalized weakness).

Another aspect that this mom's/baby's doctors need to consider is that
providing milk for this babe, even by pumping is something "only she can
do" which is a major positive way of helping her deal with this from the
emotional perspective.

Becky Saenz, MD
Assistant Professor
University of MS Medical Center
Department of Family Medicine
[log in to unmask]