PRESENTATION ON

TETRALOGY OF FALLOT

BY GROUP ONE

06/07/2024 1
 Definition

Tetralogy of Fallot is a combination of 4 problems

caused by a birth defect in the structure of the
heart that changes the way blood flows through
the heart.

06/07/2024 2
 INCIDENCE

Tetralogy of Fallot represents approximately 10% of cases of

Congenital Heart Diseases(CHD).It occurs in both male and

female. It occurs in 3-6 infants for every 10,000 births. It is the

most common cause of cyanotic CHD.

06/07/2024 3
 Cont’d.
The child may have:

• Dizziness

• Fainting or seizures

• Higher risk of developing endocarditis which is an infection of the

inner layer of the heart

• Higher pressure in the right side of the heart that can cause an
06/07/2024 4
irregular heart beat called arrhythmia.
 FOUR RELATED PROBLEMS THAT MAKE UP TETRALOGY OF
FALLOT

1. Ventricular Septal Defect (VSD): This is a hole in the

septum or wall, separating the two lower chambers or
ventricles of the heart.

06/07/2024 5
Cont’d
• The septum acts as a barrier that prevents blood from both sides of the
heart from mixing together.

• But when there is a VSD, blood which is high in oxygen from the left
ventricle can mix with blood low in oxygen from the right ventricle.

06/07/2024 6
 Cont’d
2. Pulmonary Stenosis : it is the narrowing or thickening of the valve
that connects the right ventricle to the pulmonary artery which is a
blood vessel that carries low-oxygenated blood from the heart to the
lungs where the blood receives more oxygen and then returns to the
heart .

06/07/2024 7
Cont’d

• With Pulmonary Stenosis, the heart has to work harder

than normal to pump blood to the lungs. Often, the
amount of blood reaching the lungs is below normal.

06/07/2024 8
3. Right Ventricular Hypertrophy : it is a thickening of the muscular wall
of the right ventricle. The thickened wall can block the flow of blood
through the pulmonary valve which allows blood from the heart to flow
into the lungs.

4. An overriding aorta: this means that the artery that carries high oxygen
blood to the body is out of place and arises above both ventricles instead
of the pulmonary artery which would normally take it to the lungs to pick
up oxygen.
06/07/2024 9
Cont’d

• Low oxygen blood circulate to the rest of the body and

insufficient oxygen reaches the body tissues. This is as
a result of these defects allowing insufficient blood to
the lungs for oxygenation

06/07/2024 10
06/07/2024 11
 CAUSES

The cause is not known but mothers who get into contact German
measles or other viral illnesses during their pregnancies are at a higher
risk of giving birth to babies with this condition.

06/07/2024 12
CONT’D
Other risk factors include:
• Uncontrolled diabetes

• Family history

• Alcohol abuse

• Poor nutrition

06/07/2024 13
 CONT’D

• Certain genetic disorder like Down syndrome.

• Certain environmental factors such as air pollution may also

increase risk.

06/07/2024 14
 PATHOPHYSIOLOGY
• In respect to the way shunting occurs, oxygenated and deoxygenated
blood mix together which is pumped into systemic circulation.

• The level of oxygen saturation in systemic circulation is reduced leading

to cyanosis.

06/07/2024 15
 PATHOPHYSIOLOGY CONT’D

• The degree of cyanosis depends on the extent of pulmonary stenosis,

the size of the VSD and vascular resistance of the pulmonary and
systemic circulation.

06/07/2024 16
 CLINICAL FEATURES
• Cyanosis.

• Shortness of breath and rapid breathing.

• Loss of consciousness

• Clubbing of fingers and toe

06/07/2024 17
CONT’D
• Poor weight gain

• Easily fatigued during play and exercise

• Irritability

• Prolong crying
06/07/2024 18
 DIAGNOSIS

• Signs and symptoms

• Chest x-ray : to check for the size, position and structural

abnormalities of the heart

• Echocardiogram or Ultrasound scan : to check for disruptions in

heartbeats and to see how the blood moves through the heart.

• Pulse oximetry test : to measure the oxygen level in the blood

• Auscultation.
06/07/2024 19
 Cont’d.
• checking of the pulse, blood pressure, temperature and number of

breath the baby takes per minute.

• Electrocardiogram : to check electrical activity of the heart

• Cardiac catheterization : to evaluate heart function, pressure of

blood flow and blood oxygen levels within the heart chambers.
06/07/2024 20
06/07/2024 21
 TREATMENT
• MEDICATION
• Children are often managed with medication like diuretics
( furosemide)- to reduce fluid retention ,Alpha-
agonists(phenylephrine) to reduce shunting and increase
oxygenation,antibiotics,anticoagulants,Prostaglandin E1 (PGE1)-
it helps keep the ductus arteriosus open to improve oxygen levels
in the blood,Beta- blockers- to control heart rate and reduce
arrhythmias.
Tetralogy of fallot is repaired through open-heart surgery soon after
birth or later in infancy depending on the baby`s health, weight,
severity of defects and symptoms.

06/07/2024 22
The two major surgical repairs are:

1. Complete repair : the surgeon widens the passageway

between the right ventricle and the pulmonary artery to improve

blood flow to the lungs. The ventricular Septal Defect is patched
to stop the mixing of high-oxygenated blood with low-
oxygenated blood between the ventricles.

06/07/2024 23
CONT’D

• This repair also fixes the two remaining defects(overriding

aorta and right ventricular hypertrophy) because the right
ventricular doesn’t have to work hard to pump blood into the
lungs, the thickness of the ventricle wall will decrease and the
patched VSD prevents blood with low oxygen from flowing
into the aorta .
06/07/2024 24
 TEMPORARY OR PALLIATIVE SURGERY

Minor repairs are made to improve blood flow to the lungs. This usually
occurs only when the baby is too weak or small to undergo full surgery. In
the temporary surgery, the surgeon creates a secondary route for blood to
travel to the lungs for oxygen. This is done by placing a small tube called
Blalock-Thomas -Taussig shunt between a large artery branching off the
aorta and the pulmonary artery. This operation is carried out through the
right side of the chest and the heart doesn’t have to be stopped.
06/07/2024 25
• Balloon dilation is also another way of increasing blood to the lungs
and this is achieved by using a balloon catheter. A balloon catheter is
inserted into the narrow part of the pulmonary artery and it is then
inflated, and this stretches the pulmonary valve and part of the artery
below it.

06/07/2024 26
 NURSING MANAGEMANT
Rest and sleep

• Ensure adequate rest and sleep by nursing the baby in a quiet

environment with good ventilation.

• Restrict visitors to promote sleep.

• Perform all nursing activities at a go to prevent wearing the child

out.

• Restrain baby from any vigorous activity to reduce fatigue.

06/07/2024 27
 OBSERVATION

• Strictly monitor baby`s vital signs to detect any deviation.

• Monitor baby`s weight daily at the same time, same cloth and
same scale to know whether there is a weight gain or loss.

• Monitor the level of consciousness.

• Observe child`s breathing pattern to intervene early and also

to prevent further complication.

06/07/2024 28
Cont’d

• Observe child for cyanosis.

• Monitor fluid intake and output.

• Monitor oxygen saturation level.

• Monitor blood circulation level.

• Observe for signs of tet spell such as bluish discolouration of the

lips, the fingers and the toes.
06/07/2024 29
Diet

• Serve child with easily digestible food.

• Continue breastfeeding if the child is less than

6months.

• Serve food in bits and at frequent intervals.

• Serve prescribed intravenous fluids.

06/07/2024 30
 COMPLICATIONS

• Infective endocarditis

• Neurological problems such as brain abscess and cerebrovascular

accidents

• Cyanotic spell

• Haematological problems such as polycythaemia

• Hyperuricemia

• Exercise intolerance
06/07/2024 31
 Prevention
• Pregnant women should ensure that they receive a vaccine to prevent
themselves against the rubella virus.

• Pregnant women should avoid the intake of alcohol.

• They should also take in nutritious diet to improve on their nutritional

status.

• Pregnant women should also avoid inhalation of harmful substance in

their community or if possible, they should relocate to a different
setting for their safety.
06/07/2024 32
Cont’d

• They should seek early treatment whenever their baby

starts to exhibit some of the above features.

• Education should be given at the antenatal clinic for

the mothers to know the possible risk factors of
Tetralogy Of Fallot.
06/07/2024 33
References
• www.healthline.com
• www.heart.org
• www.mayoclinic.com

06/07/2024 34
GROUP 1 MEMBERS.
• Williams Nana Tandoh- 0313000323

• Titaataah Derick Lilibe- 0313009123

• Respah Steve-Corquaye – 0313007223

• Cedonia Anatua Adda – 0313003023

• Djan Ingrid Odom – 0313001523

• Aziebu Esinam Linda – 0313005223

• Bridget Boakye Ansah – 0313016523

• Esther Aboagyewaa Mintah- 0313025223

• Samiratu Abdul Aziz-0313008623

• Vivian Boadu- 0313008923

• Esther Armoo-Manza –0313006023

• Cynthia Ntow-0313003323

• Katherine Aniah- 0313007123

• Nana Kobi Agyemang-Duah – 0313009723

• Bangee Salifu Amina – 0313017623

• Millicent Akosua Anderson- 0313002123

• Paulina Gyimatey- 0313011423

• Sampana Samuel Yenbila – 0313028223

06/07/2024 THANK YOU. 35