The main cause of hypoxic attacks in Tetralogy of Fallot

Written by Yan Xin Liang
Pediatrics
Updated on February 02, 2025
00:00
00:00

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.

Other Voices

doctor image
home-news-image
Written by Chen Guang Yin
Cardiology
44sec home-news-image

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.

doctor image
home-news-image
Written by Yao Li Qin
Pediatrics
50sec home-news-image

Can children with Tetralogy of Fallot be desired?

Tetralogy of Fallot is a relatively severe congenital heart disease. If it is detected during the fetal period, it is not an indication for termination of pregnancy. In other words, one should not choose to not have the baby simply because it has Tetralogy of Fallot. However, it is crucial that the baby undergoes a timely echocardiogram after birth to assess the condition and undergo surgery as soon as possible. Currently, pediatric surgery, particularly cardiothoracic surgery, is developing very rapidly in our country. With multiple surgeries, Tetralogy of Fallot can be surgically cured. Therefore, having a child with Tetralogy of Fallot is not an indication for termination of pregnancy.

doctor image
home-news-image
Written by Tong Peng
Pediatrics
1min 15sec home-news-image

How is Tetralogy of Fallot classified in terms of severity?

Tetralogy of Fallot is a complex congenital heart disease in children, characterized early by cyanosis in the face. The severity of symptoms, which often correlate with the level of pulmonary stenosis, includes cyanosis primarily appearing in regions with abundant capillaries such as the lips, nail beds, and bulbar conjunctiva. This cyanosis worsens with crying or physical activity. Additionally, the presence of squatting behaviors is indicative of more severe conditions. Frequent squatting suggests a substantial disease burden, as bending the legs while squatting reduces the volume of venous return, thereby decreasing the cardiac load and temporarily relieving hypoxic symptoms. In severe cases, symptoms can escalate to paroxysmal respiratory distress and loss of consciousness, often triggered by nursing or vigorous crying. Such difficulties can lead to severe spells including unconsciousness and seizures, primarily due to spasm in the muscular area at the base of the pulmonary artery, causing stenosis. Early detection and treatment of these conditions are crucial to prevent manifestations of heart failure.

doctor image
home-news-image
Written by Hu Qi Feng
Pediatrics
35sec home-news-image

Tetralogy of Fallot's composition and its causes of formation

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.

doctor image
home-news-image
Written by Hu Qi Feng
Pediatrics
59sec home-news-image

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.