Congenital Heart Defect: Tetralogy of Fallot (TOF)

An Annotated Reading

by Princess Angel Lucañas

Title: Tetralogy of Fallot

Author: Patricia O’Brien, MSN, CPNP-AC; Audrey C. Marshall, MD

Summary:
Congenital heart defects result from abnormal changes in the structure of the
heart that usually occurs in early-stage pregnancy and are present at birth. The most
common defect that occurs in about 1 in 125 livebirths is the Tetralogy of Fallot (TOF)
which is a congenital heart defect in which obstruction to the blood flow of blood from
the heart to the lungs results in low oxygen levels in the blood. TOF has 4 combining
anomalies that are all related namely, right ventricular outflow tract obstruction,
ventricular septal defect, overriding of the aorta, and hypertrophy of the right ventricle.
TOF occurs with association with several genetic condition [trisomy 21 (Down
syndrome), and with deletions on chromosome 22] and may occur with other birth
defects (cleft lip palate). It is generally repaired through open heart surgery to correct
the heart defect which is the only treatment that allows most patients to live a normal
lifestyle and offers long-term survival.

Source: Source: O’Brien, P., & Marshall, A. C. (2014). Tetralogy of Fallot. Circulation,
130(4). https://doi.org/10.1161/circulationaha.113.005547.
Critique:
O’Brien and Marshall (2014) published an article entitled “Tetralogy of Fallot” in
order to provide information regarding tetralogy of Fallot, a common congenital heart
defect. This study mainly discusses the nature of the disease, how it is diagnosed, and
the treatment.

In this article, it was mentioned that tetralogy of Fallot (TOF) is the most common
congenital heart defect that results in decreased blood flow to the lungs, thus, causes
low levels of oxygen that may be observe among neonates with blue lips or nail beds
(cyanosis). With this information, as a nurse, it is of utmost importance to conduct a
thorough newborn screening by measuring the oxygen levels with the use of pulse
oximeter before discharge or going home. Moreover, auscultation for presence of heart
murmur (abnormal heart sounds caused by turbulent blood flow) may be heard with a
stethoscope. An echocardiogram, an ultrasound that gives detailed images of the heart,
must be done to confirm the diagnosis of TOF.

Furthermore, the article emphasizes that symptoms of TOF may vary depending
on the severity of obstruction to blood flow to the lungs. Some may appear blue soon
after birth because of severe obstruction, while others with less appear pink but
generally the obstruction may get worse over time which means blue lips may first occur
at several months of age. While others with mild obstruction may never be blue (“pink
Tets”) and may have signs of too much blood flow to the lungs (rapid breathing, poor
feeding, and slow weight gain), much like an infant with only a ventricular septal defect
This clearly showed that as nurses, it our responsibility to thoroughly assess the
symptoms manifested by the newborn and monitor the haematocrit (65-70%) and
platelet count and coagulation factors.

Overall, this article has helped me a lot in understanding the underlying causes,
the nature of the disease, its treatments and how it is diagnosed. It enabled me to have
an idea on how to take care of newborns with TOF if ever I would encounter this kind of
case in LRDR. This article give me a gist on what nursing interventions should be done
in dealing with TOF newborn cases in the future.