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Tetralogy Of Fallot In Children


  • Tetralogy of Fallot, also called TOF, is a congenital heart disease that causes cyanosis (bluish color of the skin). A congenital heart disease is one that a person is born with. Cyanosis occurs when blood from right side of the heart goes directly to the left side. The blood does not pass through the lungs, and it will not carry enough oxygen to give to the body. With TOF, four different problems happen in your child's heart while inside the womb. The first problem is that the wall separating the two ventricles does not completely close, forming a hole. The second problem is that the blood vessel that connects the heart to the lungs is narrowed. The third problem is that the aorta (major artery) abnormally grows from both ventricles, rather than from the left ventricle only. The fourth problem is that the increased backflow of blood causes the muscles of the right ventricle to enlarge and thicken.

  • Problems in the development of your child's heart while inside the womb are thought to cause TOF. These problems may be as a result of infections or the use of certain medicines and alcohol during pregnancy. TOF is diagnosed by echocardiography, blood tests, heart catheterization, chest x-ray, electrocardiogram (ECG), or doppler test. Treatment may include oxygen, medicines, such as heart medicines or diuretics, and surgery. With treatment such as surgery, your child's quality of life may be improved.


You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child.


  • Surgery used to treat TOF may increase the chance of your child getting a heart infection or bleeding. Medicines may cause your child to have rashes, nausea (upset stomach), vomiting (throwing up), or low blood pressure.

  • Your child's health, quality of life, and ability to function may change depending on his signs and symptoms. If left untreated, he may have an increased risk for endocarditis (swelling of the lining of the heart). He may also develop an abscess (collection of pus), or blood clots in the brain. The signs and symptoms he already has may worsen. His heart may weaken and totally fail. A weakened heart or heart failure decreases blood flow to the organs and other parts of the body. Even after your child has treatment, there is still the chance that his heart will fail. Ask your child's caregiver if you have questions or concerns about your child's condition, medicines, or care.


Informed consent

is a legal document that explains the tests, treatments, or procedures that your child may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your child's medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done to your child. Make sure all of your questions are answered.

Emotional support:

Stay with your child for comfort and support as often as possible while he is in the hospital. Ask another family member or someone close to the family to stay with your child when you cannot be there. Bring items from home that will comfort your child, such as a favorite blanket or toy.


Your child may be given any of the following:

  • Antibiotics: This medicine is given to help prevent or treat an infection caused by bacteria.

  • Diuretics: This medicine may be given to help your child's body and lungs get rid of extra fluid. This can help your child breathe easier. Diuretics may make your child urinate more often.

  • Heart medicine: This medicine may be given to make your child's heart beat stronger or more regularly. There are many different kinds of heart medicines. Talk with caregivers to find out what your child's medicine is and why he is taking it.

  • Iron supplement: This may be given to prevent or treat anemia (low red blood cell count).

Tests and monitoring:

Your child may need any of the following:

  • Blood gases: These tests are also called arterial blood gases (ABGs). Blood is taken from an artery usually in your child's wrist. ABGs may be done if your child has trouble breathing or other problems caused by his illness.

  • Blood tests: Your child may need blood tests to give caregivers information about how his body is working. The blood may be taken from your child's arm, hand, finger, foot, heel, or IV.

  • Cardiac catheterization: A cardiac catheterization is a test to see how well your child's heart is working. It is also used to see how well the blood vessels connected to the heart are doing. A special tube is threaded into your child's heart through a blood vessel in his arm, leg, or neck. Dye may be given so x-ray pictures of your child's blood vessels show up better on a TV-like screen. Your child's caregiver may also measure the pressure inside your child's heart.

  • Imaging tests:

    • Chest x-ray: This is a picture of your child's lungs and heart. A chest x-ray may be used to check your child's heart, lungs, and chest wall. It can help caregivers diagnose your child's symptoms, or suggest or monitor treatment for medical conditions.

    • Doppler test: This test is done to check blood flow in the heart. A small metal disc with gel is placed on your child's chest. Caregivers may hear abnormal sounds when TOF is present.

    • An echocardiogram is a type of ultrasound. Sound waves are used to show the structure and function of your child's heart.

  • 12 Lead EKG: This test helps caregivers see your child's heart activity. It helps caregivers look for changes or problems in different areas of the heart. Sticky pads are placed on your child's chest, arms, and legs. Each pad has a wire that is hooked to a machine or TV-like screen. This machine shows a tracing of your child's heartbeat. This test takes about five to ten minutes. Your child must lie very still during the test.

  • Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your child's blood. A cord with a clip or sticky strip is placed on your child's foot, toe, hand, finger, or earlobe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your child's oxygen level is low or cannot be read.

Treatment options:

Your child may have any of the following:

  • Respiratory support:

    • Oxygen: Your child may need oxygen if his blood oxygen level is lower than it should be. Oxygen will help your child breathe easier. Your child may get oxygen through small tubes placed in his nostrils, or through a mask. He may instead be placed in an oxygen tent. Never take off your child's oxygen tubes or mask or remove him from the tent without asking his caregiver first.

    • ET tube: Your child may need an endotracheal (ET) tube to help him breathe. An ET tube is put in your child's mouth or nose, and goes into the trachea (windpipe). It may be connected to a breathing machine called a ventilator. The ET tube will be taken out when your child is breathing better.

  • Surgery: Surgery is the main treatment for TOF. This may be done by making a cut through your child's chest to correct TOF. Ask your caregiver for more information about surgery for TOF.

    • Early or temporary correction: This is usually done in smaller children to increase blood flow to the lungs for a period of time. Your child's caregiver may connect one blood vessel to another. This may allow your child to grow big enough to prepare him for a complete correction surgery.

    • Complete correction: When your child is ready for a complete surgery, the problems present with TOF are corrected. The hole in the heart ventricle is closed with a patch, and the narrowed blood vessel is widened. These surgical corrections will allow blood to go into the lungs and carry more oxygen to your child's body.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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