Tetralogy of Fallot

• Tetralogy of Fallot

  This condition is characterized by four defects
• Tetralogy of Fallot

  • Main Problem: Pulmonary Stenosis (narrow)
  • Compensatory Mechanism: Right Ventricular Hypertrophy (due to an overworked heart) 
  • Allows Mixing of Blood: Overriding of Aorta (anatomical defect)
  • Keeps the Pt alive: Ventricular Septal Defect (relieves pressure in right ventricle)
• Tetralogy of Fallot S/Sx:

  • Tet spell - pathognomomic sign; group of s/sx that depicts decreased oxygenation (child = squatting)
  • cyanosis (nursing dx: altered tissue perfusion)
  • Polycythemia vera (increased RBC) dt decrease level of O2 = stimulate the bone marrow to produce RBC = Plethora (ruddy skin or redness)
  • Syncope due to decrease O2 in the brain
  • Clubbing- spoon-shaped fingernails = chronic hypoxia
  • Pan-systolic murmur; cardiomegaly
• Tetralogy of Fallot

  2D echo findings: Boot-shaped heart due to right ventricular hypertrophy
• Tetralogy of Fallot

  Management:

  • Positioning - knee-chest or squat
  • Curative Surgery for Tetralogy of Fallot: Brocks Procedure

  Balloon angioplasty - Treats Pulmonary stenosis and Right ventricular hypertrophy 

  Dacron patch - Closes VSD treating overriding of aorta

  • Palliative Surgery for Tetralogy of Fallot: Blalock Taussig shunt (anastomosis of pulmonary artery and aorta using subclavian artery)