What is the Tetralogy of Fallot?
Tetralogy of Fallot (TOF) is a congenital heart defect. TOF is described as 4 abnormalities that occur together. Presence of a ventricular septal defect, overriding aorta, right ventricular outflow tract obstruction and right ventricular hypertrophy. Tetralogy of Fallot is one of the commonest cyanotic heart defects. The severity of cyanosis is determined by the degree of obstruction to pulmonary blood flow.
What are the causes of the Tetralogy of Fallot?
The exact cause of TOF is unknown. There are some genetic syndromes that can be seen with TOF, like Down syndrome or DiGeorge syndrome. However, most people with TOF do not have genetic syndromes. All babies with TOF will be checked before or after birth for genetic syndromes. TOF does not typically run in families, but congenital heart defects in general are slightly more common if there is a close relative with any kind of congenital heart defect.
What are the signs & symptoms of ToF
- Cyanosis or blueness on the lips and tongue.
- Abnormal heart sound upon regular screening
- Older children may squat on their haunches during an attack.
- Advent of fetal echocardiography (ultrasound scanning of the unborn child’s heart)
| Procedure Name | Tetralogy of Fallot (TOF) |
|---|---|
| Type of Surgery | Major |
| Type of Anesthesia | General Anesthesia/Sedation |
| Duration of Surgery | Approximately 2 hours (depends on the location and nature of the defect) |
| Recovery Time | Few weeks to months for complete recovery |
Tetralogy of Fallot (TOF): Pre-Op & Post-Op Care
Pre-operative Assessment:
Clinical assessment: The degree of cyanosis is the most important aspect of clinical evaluation. Measuring oxygen saturation by pulse oximeter is recommended at each follow-up examination. ECG determines the and chest X-rays are taken to evaluate the overall shape of the heart. An echocardiogram stands as a vital tool for the diagnosis of TOF.
Surgical Procedure:
- Complete corrective Tof surgery is usually performed before 6 months of age as open intracardiac surgery performed under cardiopulmonary bypass conditions in one operation.
- During surgery, the heart is exposed via a median sternotomy and a RVOT reconstruction with a patch to close the defect at the time of initial repair.
- The tetralogy of fallot repair surgery involves patch closure of the VSD (ventricular septal defect), septating the aorta back to the left ventricle, resection of RVOT (right ventricular outflow tract) muscle bundles, and reduction of the degree of RVOT valvular stenosis.
- A transannular patch may be required to sufficiently enlarge the RVOT and the patch may be used at multiple levels to facilitate the repair.
Post Operative Care & TOF Repair Recovery:
- After repair, early postoperative management is in paediatric intensive care.
- The postoperative course is variable depending on the age of the child, duration of cardiopulmonary bypass, the type of ToF repair, and other associated co-morbidities.
- All children and adults will be under lifelong follow-up with congenital heart disease services. However, it is recognised that compliance with follow-up can be poor, and some patients can be unaware of their diagnosis.
- On emergency presentation or before elective surgery, consultation should be had with the regional paediatric or adult congenital cardiac centre.
Benefits of Tetralogy of Fallot (TOF) at Yashoda Hospitals
- Correcting ToF allows better blood flow to the lungs
- Surgery repairs structural defects in the heart, ensuring efficient circulation and reducing strain on the heart muscle.
- Addresses the stunted growth and delayed development due to low oxygen levels
- helps restore normal growth patterns and activity levels.
- After successful repair, children can engage in regular activities without experiencing fatigue or breathlessness.
- Timely surgical intervention reduces the risk of severe complications like heart failure, arrhythmias, and brain abscesses.
- Early surgical correction significantly improves life expectancy and quality of life, allowing children to lead healthy, active lives.
- Repairing ToF lowers the likelihood of frequent hospital visits and emergency interventions due to heart-related distress
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