Tetralogy+of+Fallot

=Tetralogy of Fallot=

What it is
Tetralogy of Fallot is a congenital heart defect that changes the normal flow of blood through the heart. This rare and complex heart defect occurs in about 5 out every 10,000 babies. It affects boys and girls equally. It is classified as a cyanotic heart defect because the condition causes low oxygen levels in the blood, which leads to cyanosis.

The cause of most congenital heart defects is unknown. Multiple factors seem to be involved. Prenatal factors associated with higher than normal risk for this condition include maternal rubella or other viral illnesses during pregnancy, poor prenatal nutrition, maternal alcoholism, mother over 40 years old, and diabetes. There is a high incidence of chromosomal disorders in children with tetralogy of Fallot, such as Down Syndrome and Di George's syndrome (a partial gene deletion that results in heart defects, low calcium levels, and immune deficiency.)
 * Risk factors**

Symptoms
The classic form of Tetralogy includes 4 defects within the heart structures: At birth, infants may not show the signs of the cyanosis, but later may develop sudden frightening episodes (called "Tet spells") of bluish skin from crying or feeding.
 * Ventricular septal defect (hole between the right and left ventricles)
 * Narrowing of the pulmonary outflow tract (tube that connects the heart with the lungs)
 * An aorta (tube that carries oxygenated blood to the body) that grows from both ventricles, rather than exclusively from the left ventricle
 * A thickened muscular wall of the right ventricle (right ventricular hypertrophy)

How to Treat
Tetralogy of Fallot is treated surgically. A temporary operation may be done at first if the baby is small. Complete repair comes later. Sometimes, the first operation is a complete intracardiac repair.

In small and very blue infants, a shunt operation may be done first to provide adequate blood flow to the lungs. This lets the baby grow big enough to have a full repair. The shunt is built between the aorta and the pulmonary artery. The shunt is removed when a complete intracardiac repair is done later. Complete repair tends to be done early in life. Once it was more common to do a temporary operation first and a complete repair later in childhood. To do a complete repair, the surgeon closes the ventricular septal defect with a patch and opens the right ventricular outflow tract by removing some thickened muscle below the pulmonary valve, repairing or removing the pulmonary valve and enlarging the peripheral pulmonary arteries that go to both lungs. Sometimes a tube is placed between the right ventricle and the pulmonary artery. This is sometimes called a Rastelli repair.
 * Temporary Operation**
 * Complete Repair**

Other advice
__Medical__ If you've had tetralogy of Fallot repaired, you'll need regular follow-up with a cardiologist who's had special training in congenital heart defects. You may need to take medicine after your operation to help your heart muscle contract or to control heart rhythm abnormalities. Your cardiologist will follow your progress with various tests. These include electrocardiograms, Holter monitors, exercise stress tests and echocardiograms. This will help determine if you need another procedure such as a cardiac catheterization or more surgery.
 * Ongoing Care**

__Activity Restrictions__ You may need to limit your activity, particularly for competitive sports. If you have decreased heart function or rhythm disturbances, you may need to limit your activity more. Your cardiologist will help decide if you need limits.

__Endocarditis Prevention__ People with tetralogy of Fallot are at increased risk for developing endocarditis. People with unrepaired and partially repaired tetralogy will need antibiotics to prevent endocarditis before certain dental procedures. If your tetralogy of Fallot has been repaired, your cardiologist will let you know if you need to continue to receive these routine antibiotics. __Heart Function__ In the long-term postoperative period, your heart muscle function may decrease and you'll need medication. This may include diuretics, agents to help your heart pump better and drugs to control your blood pressure.
 * Problems You May Have**

__Heart Rhythm Disturbances__ People with repaired tetralogy of Fallot have a higher risk of heart rhythm disturbances called arrhythmias. These can originate from the atria or the ventricles. Sometimes they may cause dizziness or fainting. You may need medicine to control them. In rare cases, you may need a procedure in the cardiac catheterization laboratory or the operating room to eliminate these arrhythmias and control symptoms.

__Pregnancy__ In many cases, women with repaired tetralogy of Fallot may have successful, full-term pregnancies. Some may be at risk for a difficult pregnancy.

Additional Resources
[|AmericanHeart.org - Tetralogy of Fallot] [|National Heart Lung and Blood institute - Tetralogy of Fallot] [|MedlinePlus - Tetralogy of Fallot]