Tetralogy Of Fallot

N C Joshi
Consultant Pediatrician, Nanavati Hospital, Mumbai, India
First Created: 01/08/2001 

Tetralogy Of Fallot - Components

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


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.

Auscultatory findings of TOF



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


  • 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.

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:

At 1-5 years of age

Tetralogy of Fallot Tetralogy of Fallot https://www.pediatriconcall.com/show_article/default.aspx?main_cat=pediatric-cardiology&sub_cat=tetralogy-of-fallot&url=tetralogy-of-fallot-introduction 2001-01-08
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