A 7-year-old patient with a history of surgically repaired Tetralogy of Fallot requires routine dental treatment including extractions. What is the most appropriate first action?

Tetralogy of Fallot (TOF) is a complex congenital heart defect. While surgical repair often corrects the hemodynamic abnormalities, patients may retain residual defects such as ventricular septal defects, pulmonary insufficiency, arrhythmias, or right ventricular dysfunction — all of which may have implications for dental management. The American Heart Association guidelines require cardiologist consultation to determine: (1) whether antibiotic prophylaxis for infective endocarditis is indicated (it IS indicated for repaired CHD with residual defects or within 6 months of repair), and (2) whether the patient's cardiac status allows for planned procedures. Proceeding without cardiologist clearance for invasive dental procedures in a complex CHD patient is inappropriate.