Tetralogy Of Fallot

Tetralogy Of Fallot - Components

• VSD
• RV outflow tract obstruction (valvular and/or infundibular)
• RVH
• Over-riding of the aorta

Presentation

cyanosis, squatting and cyanotic spells

Physical Examination:

• Cyanosis and Clubbing
• RV tap (Lower Left Sternal Border)
• S2 single
• Intensity of the Systolic murmur depends on the degree of obstruction

A long SEM at the middle and upper LSB and a loud, single S2 are characteristic auscultatory findings of TOF.

Investigations

ECG:RAD, RAE, RVH

Chest Xray: Boot- shaped heart, Decreased pulmonary vascularity

Treatment Of Cyanotic Spells

• knee-chest position
• morphine sulfate 0.1-0.2 mg/kg/SC or IM
• NaHCO2 + O2
• Vasoconstrictors (Neo-synephrine)
• Propranolol

Treatment of Anemia: Iron (As TOF is prone to Cardiovascular Accidents)

Tetralogy of Fallot - Surgical

Palliation

• Blalock-Taussig
• Waterston shunt
• Pott's operation
• Gore-Tex shunt

Palliative procedures that can be used in patients with cyanotic cardiac defects with decreased pulmonary blood flow.

The Glen procedure (anastomosis between the Superior Vena Cava and the right PA) may be performed in older infants with hypoplastic RV, such as is seen with tricuspid atresia.

Corrective surgery: