Tetralogy of Fallot's composition and its causes of formation

Written by Hu Qi Feng
Pediatrics
Updated on September 23, 2024
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Tetralogy of Fallot consists of four abnormalities. First, there is a narrowing at the right ventricular outflow, ranging from the entrance of the right ventricular infundibulum to the branches of the left and right pulmonary arteries. Second, there is a ventricular septal defect, characterized by a deficiency around the membranous part that extends towards the outflow. Third, the aorta overrides, where the base of the aorta is enlarged and rotates clockwise to the right, straddling the septal defect. Fourth, right ventricular hypertrophy, which is a secondary lesion.

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Written by Yan Xin Liang
Pediatrics
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The main cause of hypoxic attacks in Tetralogy of Fallot

Tetralogy of Fallot is a complex congenital heart disease, characterized by ventricular septal defect, right ventricular outflow tract obstruction, aorta overriding, and right ventricular hypertrophy. When the obstruction of the right ventricular outflow tract is severe, pulmonary artery blood flow significantly decreases. A large amount of unoxygenated venous blood passes through the ventricular septal defect causing a right-to-left shunt, which clinically manifests as severe cyanosis and increased red blood cells, and different degrees of hypoxia in the systemic circulation. Factors that can induce hypoxic episodes in these infants include feeding, crying, emotional agitation, anemia, infection, etc. These can suddenly lead to fainting, convulsions, or even death. The main reason is generally due to a sudden muscle spasm at the narrow pulmonary artery infundibulum on top of pre-existing stenosis, causing temporary pulmonary artery obstruction and exacerbating cerebral hypoxia, thus leading to severe hypoxic attacks.

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Written by Chen Guang Yin
Cardiology
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Can someone with Tetralogy of Fallot have a second child?

Tetralogy of Fallot is a congenital cardiac defect that has not been found to have a definite genetic relationship, meaning no chromosomal abnormalities have been discovered. However, congenital heart disease does tend to occur within families to a certain extent, indicating some level of familial predisposition. The primary cause, however, is believed to be related to viral infections during the first three months of pregnancy or the use of certain medications. Therefore, we believe that parents of a child with Tetralogy of Fallot can consider having a second child.

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Written by Hu Qi Feng
Pediatrics
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Tetralogy of Fallot Clinical Symptoms

The clinical manifestations of Tetralogy of Fallot include cyanosis, with cyanosis being the primary symptom. The severity of cyanosis is related to the extent of pulmonary stenosis and is commonly seen in areas rich in capillaries, such as the lips, fingertips, nail beds, and conjunctiva, where it appears more pronounced during physical activity or crying. Secondly, the squatting symptom is observed; children may show squatting behavior during walking or playing, often squatting down voluntarily for a moment. During squatting, the flexion of the lower limbs reduces the venous return to the heart, lightening the cardiac load and decreasing the right-to-left shunting, thereby alleviating hypoxia. Thirdly, clubbing of the fingers occurs due to long-term hypoxia, leading to hypertrophic growth at the fingertip and toe ends. Fourthly, paroxysmal hypoxic attacks occur.

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Written by Hu Qi Feng
Pediatrics
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Management of Hypoxic Episodes in Children with Tetralogy of Fallot

In the treatment of hypoxic episodes in children with Tetralogy of Fallot, mild cases can be alleviated by positioning the child in a knee-chest position, while severe cases should receive immediate oxygen therapy, along with appropriate medication to correct acidosis. It is important to regularly eliminate factors that may trigger hypoxic episodes, such as anemia and infections, and to maintain a calm environment for the child. If these measures do not effectively control the episodes, emergency surgical repair should be considered.

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Written by Chen Guang Yin
Cardiology
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Can Tetralogy of Fallot receive oxygen therapy?

Tetralogy of Fallot is a congenital heart defect that includes abnormalities such as ventricular septal defects, pulmonary valve stenosis, and stenosis of the right ventricular outflow tract. Due to these congenital defects, the ejection of blood from the heart is affected, which in turn impacts the blood supply to various systems and organs throughout the body. The patient may exhibit symptoms of cyanosis and hypoxia, especially after physical activity, hence the use of supplemental oxygen is advisable. While oxygen therapy can temporarily alleviate these hypoxic symptoms, it does not address the underlying issue. Surgery is necessary for a definitive resolution.