TETRALOGY OF

Cyanotic congenital heart disease

FALLOT Group 6
Najifa Masdal
 TABLE OF
CONTENTS
01. DEFINITION 02. SIGN AND 03. CHEST
• WHAT IS TOF? SYMPTOMS
• S/Sx EXAMINATION
• X -RAY
• 4 DEFECTS

04. ETIOLOGY 05.PHATOPHYSIO 06. IPPA

• CAUSES LOGY
• ANATOMY • INSPECTION
• CHANGES • PALPITATION
• PERCUSSION
07. TREATMENT & • AUSCULTATION
MANAGEMENT
• THERAPEUTIC AND SURGICAL
MANAGEMENT
• PROCEDURES
 01.
DEFINIT
ION
 CYANOTIC CONGENITAL
HEART DISEASE
TETRALOGY OF
FALLOT
• Is a birth defect that affects normal blood
flow through the heart. It happens when
a baby's heart does not form correctly as
the baby grows and develops in the
mother's womb during pregnancy.
Contd. TETRALOGY OF FALLOT

 It is a rare condition caused by a combination of

four heart defects that are present at birth
(congenital).

 These defects, which affect the structure of the

heart, cause oxygen-poor blood to flow out of
the heart and to the rest of the body. Infants and
children with tetralogy of Fallot usually have
blue-tinged skin because their blood doesn't

carry enough oxygen.

 FOUR ABNORMALITIES OF TOF.
01.PULMONARY
( cyanosis)
STENOSIS
is a narrowing of the pulmonary valve
— the valve that separates the lower
right chamber of the heart (right
ventricle) from the main blood vessel
leading to the lungs (pulmonary
artery).

02. RIGHT VENTRICULAR

HYPERTROPHY
(cyanosis)
is a condition defined by an
abnormal enlargement of the
cardiac muscle surrounding the right
ventricle. The right ventricle is one of
the four chambers of the heart.
 FOUR ABNORMALITIES OF TOF.

03. OVERRIDING OF THE AORTA

which means the artery that

(cyanosis)
carries high-oxygen blood to the
body is out of place.

04. VENTRICULAR SEPTAL

DEFECT
a(late
holecyanosis)
in the heart, is a common
heart defect that's present at birth
(congenital).
 02.
SIGN &
SYMPTOMS
SIGN & SYMPTOMS

 AFTER FEEDING, CRYING OR

WAKING UP AFTER SLEEP THE
BABY SUDDENLY DEVELOPS
BLUE SKIN, NAILS AND LIPS
(TET SPELLS)
 SIGN & SYMPTOMS

CLUBBING OF SQUATTING SLOW WEIGHT

FINGERS POSTURE GAIN
 SIGN & SYMPTOMS

DYSPNOEA ON ‘’BOOT SHAPED’’

EXERTION HEART
 03.
CHEST
EXAMINATION
X-RAY OF
TOF.
 04.
ETIOLO
GY
 ETIOLOGY
(CAUSE)
01.UNKNOWN
02.Maybe associated with:

- Chromosome 22 deletion

- Poor maternal nutrition

- Any maternal illness and addictions

 05.
PATHOPHYSIOL
OGY
 PATHOPHYSIOLOGY
 Pulmonary stenosis and VSD are the most vital
abnormalities in TOF.

 If pulmonary artery resistance is more than

systemic
= right to left shunt

 If systemic vascular resistance is more than

pulmonary artery resistance
= left to right shunt
 Blood from systemic
circulation
Right atrium
Right ventricle (through VSD) and pulmonary artery
resistance

Left ventricle and Aorta

Right to left
shunt
CYANOSIS

Polycythemia (compensation)
Increased viscosity of blood

Slowing down the circulation

CVA
06.
IPPA
Case: TOF (VSD & PDA)

01. INSPECTIO
Inspection N FINDINGS

Trachea Appears central

Precordial bulge Not visible

Apex beat Visible at the left 5th ICS lateral to midclavicular line.

Pulsations Suprasternal pulsations seen.

Shape of the chest Normal & bilaterally symmetrical

Case: TOF (VSD & PDA)

02. PALPATIO
Palpation FINDINGS
Apical impulse
N Confirmed to be in the left 5th ICS

Trachea Confirmed to be central

Precordial bulge Not visible

Hyperdynamic Apex beat Present

Palpable thrill Felt along in the left parasternal region (VSD)

Palpable thrill Felt along at 2nd left ICS (PDA)

Parasternal heave present

Case: TOF (VSD & PDA)

03. PERCUSSION
- Not performed
Case: TOF (VSD & PDA)
04. AUSCULTATI
auscultation ON FINDINGS
Aortic S1 s2 heard
Pulmonary S1 s2 heard
Grade IV continuous murmur best heard with the diaphragm of
the stethoscope
mitral S1 S2 heard
tricuspid S1S2 heard
High pitched, pansystolic murmur of grade IV best heard with
the diaphragm of the stethoscope in the left parasternal region
especially in the 3rd & 4th ICS

infraclavicular S1S2 heard

Grade IV continuous murmur best heard with the diaphragm of
the stethoscope
Left 2nd ICS S1S2
Grade IV continuous murmur best heard with the diaphragm of
the stethoscope
 06.
TREATMENT AND
MANAGEMENT
  THERAPEUTIC MANAGEMENT:

 Oxygen  Propanolol (1mg/kg

administration upto 4times a day)
 Small and frequent meals
 Knee chest and  IV prostaglandin E1
squatting position therapy
 Limit straineous
activities,reduce anxiety and
stress to child
 SURGICAL MANAGEMENT:

 CORRECTIVE  PALLIATIVE
SURGERY SURGERY
 TREATMENT & PROCEDURE:

• Blalock – Taussing shunt • Brock’s procedure

Artificial ductus is created by Pulmonary valvotomy is done to
connecting right or left subclavian correct pulmonary stenosis.
artery to the pulmonary artery on the
same side
• Waterston shunt
• Pott’s procedure
The upper descending aorta is Involves side to side anastomosis of
anastomosed with left pulmonary ascending aorta with right
artery. pulmonary artery.
 TREATMENT & PROCEDURE:

• COMPLETE REPAIR
SURGERY
• Done using circulatory arrest under deep
hypothermia for young infants

• Heart lung bypass machine for older children

 Patch closure for VSD

 Pulmonary valvotomy
 THAN Do you have any questions?

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