TETRALOGY OF FALLOT

(a congenital heart disease)

Submitted by
Sunil Kumar Sahu
Roll No-418LS2069
What is tetralogy of Fallot(TOF)?
• Tetralogy of Fallot (TOF) is a serious, congenital heart defect, affecting
about two in 10,000 babies. In TOF, the abnormal connections prevent
enough oxygen-poor (blue) blood from flowing to the lungs as it
should. As a result, a person with TOF has a lower-than-normal
amount of oxygen in the blood and typically, surgical correction is
necessary. Historically, children with TOF were called “blue babies.”
• In a normal heart, oxygen-poor blood returns to the right atrium from
the body and travels to the right ventricle. Then, it is pumped through
the pulmonary artery into the lungs, where it receives oxygen.
Oxygen-rich (red) blood returns to the left atrium from the lungs,
passes into the left ventricle and then is pumped through the aorta
out to the body.
• Children born with TOF have a combination of four
cardiac anatomic characteristics:
• Ventricular septal defect: There is a hole between
the right and left pumping chambers (ventricles) of
the heart.
• Right ventricular outflow tract obstruction: The
connection between the right ventricle and lung
(pulmonary) artery is narrowed, and blood flow to the
lungs is blocked. This is what causes babies to be
blue.
• Overriding aorta: The artery that connects the left
ventricle to the body is positioned too far to the right.
• Right ventricular hypertrophy: The right ventricle
is thicker than normal, because it’s pumping against
a blockage. It’s working too hard.
Development of TOF
What are the symptoms of tetralogy of Fallot?

• Cyanosis, which is a blue color of the skin, is often the first sign of tetralogy
of Fallot (TOF). This happens when the amount of oxygen in the blood is
lower than normal. In other cases, a heart murmur is the first sign.
• Even after a baby is diagnosed with TOF, there may be no symptoms for
weeks or even months. Some babies will show signs of failure to thrive —
becoming tired with feeding, poor weight gain — if the amount of lung
blockage is mild. Typically, babies start with mild symptoms that worsen over
time.

Tet spells

Tet spells, also known as hypercyanotic episodes, are a more severe symptom
of TOT. These spells can occur after feeding, bathing or crying. They result
from a further decrease in blood flow to the lungs, making the baby more blue.
How is tetralogy of Fallot diagnosed?
Before birth
• Before a child if born, prenatal tests are performed to check for birth defects and other
conditions. Tetralogy of Fallot might be seen during an ultrasound. If your doctor
suspects your baby may have tetralogy of Fallot, a fetal echocardiogram (cardiac
ultrasound) will be ordered to evaluate any issues with the structure of the heart and
how it's functioning with this defect.

After birth
• A pediatric cardiologist will listen to your baby’s heart and lungs, feel the baby’s
pulses, measure the oxygen level in the blood (non-invasively) and use several tests to
determine the diagnosis, including:
 electrocardiogram (EKG or ECG)
 cardiac magnetic resonance imaging (MRI)
 chest x-ray: A conventional chest x-ray will evaluate the size and spatial relationships of the
heart within the child’s chest.
 cardiac catheterization
 pulse oximetry: A non-invasive test that measures the amount of oxygen in the blood
 How is tetralogy of Fallot treated?
Essentially all children with tetralogy of Fallot (TOF) will need surgery. Many children can be
managed medically until their complete repair. More severe forms may require early intervention,
including hospitalization. 

Cardiac catheterization
• Most babies with TOF do not need heart catheterization, but sometimes this procedure helps
clarify the diagnosis. In severe circumstances, some children benefit from placing a stent in the
blocked connection to the lung artery.

Surgery
Children with TOF typically undergo surgery between three and six months of age. For most, a full
repair surgery is performed as the initial operation. Rarely, children require a staged approach
with the initial operation being a Blalock-Taussig (BT) shunt. A BT shunt is a tube placed between
the body artery and the lung artery to increase blood flow to the lungs.
• Full surgical repair of TOF consists of:
• closing the ventricular septal defect (VSD) between the right and left ventricles.
• relieving the narrowing between the right ventricle and pulmonary artery