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Tetralogy of Fallot is a common syndrome of heart defects present from birth, resulting in low blood oxygenation.
To understand this congenital heart defect, let us look at how a normal heart functions.
Heart function: The heart is a pump composed of muscular tissues with four chambers. The two upper chambers are called atria, and the two lower chambers are the ventricles. A wall of tissue called septum separates the chambers. The chambers pump the blood with the help of four heart valves. The opening and closing of valves aid blood flow in one direction.
Blood circulation: The blood flow pattern usually is from the body to heart to lungs to heart to body.
- Body to heart: After circulating throughout the body, dark blue coloured blood that is low in oxygen flows back to the heart. This low-oxygen blood returns to the heart through the veins and enters the right atria. From the right atria, it is emptied through the tricuspid valve into the right ventricle.
- Heart to lungs: The blood is pumped in low pressure by the right ventricle through the pulmonary valve into the pulmonary artery. From there, the blood enters the lungs to take oxygen.
- Lungs to heart: From the lungs, the oxygen-rich red coloured blood returns to the left heart (left atrium) through the pulmonary veins. It then enters the left ventricle.
- Heart to body: The left ventricle pumps the blood at high pressure into the aorta. The aorta takes the blood to the body for circulation.
Now, let us look at what happens in the case of tetralogy of Fallot.
Why is it called tetralogy of Fallot?
Tetralogy refers to a group of four. As four heart defects occur together from birth, it is called tetralogy. The word Fallot refers to the French physician, Etienne-Louis Arthur Fallot, who described this cardiac anomaly.
Defects in tetralogy of Fallot: In Tetralogy of Fallot, the child is born with the following four heart defects:
- Narrow Pulmonary Artery: Pulmonary artery carries low-oxygen blood from the heart to the lungs to get oxygen. The narrowing of the pulmonary artery constricts and reduces blood flow to the lungs.
- Ventricular Septal Defect: Septum is a wall that separates left and right ventricles. A hole in the septum is called a ventricular septal defect. After blood circulation, deoxygenated blood, instead of going to the lungs for oxygen, enters the left ventricle through the hole. In the left ventricle, it mixes with oxygen-rich blood. Therefore, the supply of oxygenated blood to the body is reduced, leading to the weakening of the heart.
- Displacement of aorta: Normally, the aorta lies to the left of the ventricle. In Tetralogy of Fallot, it shifts slightly to the right, lying above the ventricular septal defect. The displacement allows the aorta to receive blood from both the ventricles, resulting in the mixing of oxygenated and deoxygenated blood.
- Thick right ventricle: The right ventricle has to pump more while forcing the blood into the narrow pulmonary artery. The exercise of pumping hard makes the right ventricle muscular and thicker. As a result, the heart can stiffen, weaken and fail.
Causes: The exact cause for Fallot’s tetralogy is not known, though sometimes family history or genes can be a cause. Down syndrome or DiGeorge syndrome (22q11.2 deletion syndrome) can also be a factor in some cases. If, during pregnancy, a woman has diabetes, German measles, alcohol abuse or is above 40 years, the risk factor increases.
- Blue baby: Most babies with Tetralogy of Fallot are blue at birth.
- TET spells: Sometimes, the blue colour can come in sudden spells (TET spells) due to a sudden drop in oxygen levels.
- Crying worsens symptoms: When infants cry, they can turn blue, become breathless or faint.
- Clubbing: Clubbing or rounding of skin or bone around the fingertips.
There is a high success rate for surgical correction, with most children leading near-normal lives.
- The problem begins at the womb because of the narrow pulmonary valve and the hole between the ventricles. While doing an ultrasound during pregnancy, a doctor may spot the defect in the heart.
- A health care provider may hear a heart murmur while listening to your child’s heartbeat through a stethoscope.
Renowned cardiologists in Pune and worldwide order the following tests:
- Chest X-ray: It will show defects in the heart and lungs
- An electrocardiogram or ECG shows abnormal heart rhythms and heart muscle stress.
- An echocardiogram shows structural changes through moving images of the heart and heart valves.
- Cardiac catheterization: A contrast dye is inserted to get a clear view of the heart. It also measures your child’s blood pressure and oxygen in the heart chambers.
All children with Tetralogy of Fallot will need surgery. Left untreated, tetralogy of Fallot will lead to heart failure. With a reputed health card like the bajaj finserv health EMI network card, you can give your child the best treatment.
Open heart Surgery: Open heart surgery is performed soon after birth or later in infancy. The surgery is for repairing the defects of tetralogy of Fallot and normalize heart functioning. The doctor will decide when to perform the surgery based on your baby’s weight and the severity of the defects.
The following treatments are given:
1. Intracardiac repair: The surgery is for widening narrow pulmonary blood vessels by widening or replacing the pulmonary valve. The blood flow to the lungs improves with this surgery, and blood gets oxygenated.
Further, the septum hole is covered by a patch to avoid the mixing of oxygenated and deoxygenated blood. As the right ventricle now doesn’t have to pump hard to force blood into the lungs, it won’t be thick.
The incision made by the surgeon will heal in about six weeks. Some Cardiologists in Pune provide advanced treatment for your child from infancy to adulthood in one place.
2. Temporary surgery: In the past, the practice was to do temporary surgery during infancy and perform corrective surgery in later childhood. With surgery, most of the babies with Tetralogy of Fallot have their defects fully repaired in infancy. It is best to address and treat this defect as early as possible. Your financial worries are taken care of with a health card like the bajaj finserv health EMI network card.
In temporary surgery, a shunt or tube is placed between the artery emanating from the aorta and the pulmonary artery. The surgeon sews one end of the shunt to the aorta’s artery and the other end to the pulmonary artery. The shunt enables blood flow to the lungs for oxygen. When a subsequent surgery is done for complete repair, the shunt is removed.
After temporary surgery, doctors may recommend medicines to keep the shunt open. After the shunt is removed, the medications are stopped.
3. Nutrition: Babies with tetralogy of Fallot may get tired easily while feeding. Small meals at frequent intervals may help them cope better. Your child may need additional nutrition. The doctor will advise whether nutritional needs can be met by supplementing or dietary changes.
4. Treating Tet Spells: Your doctor will advise on techniques to prevent Tet spells. For instance, bringing the child’s knees up against their chest can increase blood flow to the lungs.
5. Activity: Your child’s doctor may impose restrictions on physical activities and sports. The restrictions will vary according to the child’s health condition.
6. Infections: Children with Tetralogy of Fallot may be at a higher risk for IE (infective endocarditis). During surgery or dental cleanings, bacteria enter the bloodstream. Your child will need to be on antibiotics before such procedures. Start brushing your child’s teeth as soon as they begin to emerge. Visit a dentist regularly for a checkup.