Tetralogy of Fallot: the heart condition

Everyone hopes and prays for a healthy, strong baby once that stick on the counter turns positive and a fetus starts to grow. No one wishes to have a baby with a defect of any kind, but the unfortunate truth is that approximately 3.5% of babies born present with the congenital heart disease called Tetralogy of Fallot (Shinebourne, 2006). Tetralogy of Fallot (ToF) is a rare heart condition that affects the structure of the heart causing altered blood flow through the heart and to the rest of the body (Mayo Clinic, 2021). ToF is the most common form of cyanotic congenital heart disease (Apitz et al., 2009). Complications include irregular heartbeats, changes in heart chamber sizes, swelling of the aorta, and sudden cardiac death. This condition has four problems: pulmonary valve stenosis, ventricular septal defect, shifting of the aorta, and right ventricular hypertrophy, all essentially leading to poor oxygen perfusion. This results in the physical presentation of ToF to be described as a blue or gray skin discoloration. Pulmonary valve stenosis is the narrowing of the valve between the heart and lungs, while a ventricular septal defeat changes how the blood flows due to a hole between the bottom two heart chambers. In ToF, the aorta is out of place shifted to the right disrupting the flow from the aorta to the lungs. Right ventricular hypertrophy is the thickening of the right chamber of the heart increasing the work load of the heart causing overtime weakness and ultimately failure. All of the symptoms together will historically create a “boot shaped heart” under imaging. Other physical symptoms that could be see in infants or adults are difficulty breathing, seizures, weakness, or increased irritability. This type of condition can be caught in pregnancy with the fetus presenting with severe right ventricular outflow tract obstruction (RVOTO) (Shinebourne, 2006). Some cases may not even be severe enough to be noticed or diagnosed until adulthood, but for the babies that have the condition at birth, they require surgery and close follow up for the rest of their lives. Fortunately, there has been a noticeable increase of surgery repair success rate with babies diagnosed with ToF. A study indicated that there was a 97% survival rate one year after the operation, while others reported if the patient survived 30 days after the surgery there is a 98% 20 year survival and those operated on as children there is a 90% 30 year survival (Shinebourne, 2006). Equally there was noted a decrease in clinical knowledge and an increase of unpredicted medical complications throughout the years (Apitz et al., 2009). Treatment is ever evolving which will continue to show a positive outcome especially in adults who weren’t diagnosed with ToF as an infant. The key to successfully beating this disease is to receive the proper prenatal care while pregnant to include eating right, not drinking alcohol, taking a folic acid prenatal vitamin, and controlling blood sugar, as well as catching it early can result ToF successfully being repaired with surgery. Maintaining close medical follow up to e

Shinebourne, E. A. (2006). Tetralogy of Fallot: from fetus to adult. Heart, 92(9), 1353–1359. https://doi.org/10.1136/hrt.2005.061143

Apitz, C., Webb, G. D., & Redington, A. N. (2009). Tetralogy of Fallot. The Lancet, 374(9699), 1462–1471. https://doi.org/10.1016/s0140-6736(09)60657-7

Mayo Clinic. (2021, August 17). Tetralogy of Fallot – Symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/tetralogy-of-fallot/symptoms-causes/syc-20353477