eMedicine Specialties > Emergency Medicine > Cardiovascular

Tetralogy of Fallot: Follow-up

Author: Mark Spektor, DO, Medical Director, Department of Emergency Medicine, Maimonides Medical Center
Coauthor(s): David A Donson, MD, Assistant Medical Director, Department of Emergency Medicine, Maimonides Medical Center; Kurt Pflieger, MD, FAAP, Active Staff, Department of Pediatrics, Lake Pointe Medical Center
Contributor Information and Disclosures

Updated: Dec 22, 2008

Follow-up

Further Inpatient Care

  • Palliative surgery
    • Blalock-Taussig shunt
    • Pott procedure
    • Waterston shunt
  • Definitive surgery
    • Total surgical correction with patch closure of the VSD and relief of the ventricular outflow obstruction is preferred (see Media file 4).
Typical findings on postoperative ECG for tetralo...

Typical findings on postoperative ECG for tetralogy of Fallot.

[ CLOSE WINDOW ]
Typical findings on postoperative ECG for tetralo...

Typical findings on postoperative ECG for tetralogy of Fallot.


    • Elective primary repair is usually performed after 3 months and preferably by the age 2 years.
    • Symptomatic patients require immediate surgical repair irrespective of age. These patients have traditionally been managed with initial palliative surgery followed by future correction; however, primary repair has been shown to be a safe and successful alternative.2
    • TOF is a progressive disorder, so repairs at older ages tend to lead to increased complications and long-term morbidity.

Further Outpatient Care

  • Good dental hygiene
  • Endocarditis prophylaxis
  • Arrhythmia prophylaxis, either medical or by AICD placement, may be warranted as directed by a cardiologist

Complications

Complications of tetralogy of Fallot include the following:

  • Erythrocytosis
  • Brain abscess
  • Acute gouty arthritis
  • Infective endocarditis
  • Cerebrovascular thrombosis
  • Delayed puberty
  • Postoperative complications
    • Congestive heart failure (right or left, residual outflow obstruction, VSD, and/or pulmonic regurgitation
    • Atrial flutter, ventricular arrhythmias, right bundle-branch block, or left anterior hemiblock - Arrhythmias were identified in up to 38.9% of patients with symptoms suggestive of rhythm disturbances.
    • Infective bacterial endocarditis

Prognosis

  • If right ventricular outflow tract obstruction is severe, the mortality rate is high without palliative or corrective surgery.

Patient Education

Miscellaneous

Special Concerns

  • Hypoxic tet spells
  • Physical and cognitive growth impairment: Children have been shown to have generally lower scores on intelligence testing, mild motor deficits, and difficulties with language tests.3
  • Brain abscess and stroke, secondary to the right-to-left shunt
  • Infective endocarditis
  • Polycythemia
 


More on Tetralogy of Fallot

Overview: Tetralogy of Fallot
Differential Diagnoses & Workup: Tetralogy of Fallot
Treatment & Medication: Tetralogy of Fallot
Follow-up: Tetralogy of Fallot
Multimedia: Tetralogy of Fallot
References
[ CLOSE WINDOW ]

References

  1. Senzaki H, Ishido H, Iwamoto Y, et al. Sedation of hypercyanotic spells in a neonate with tetralogy of Fallot using dexmedetomidine. J Pediatr (Rio J). Jul-Aug 2008;84(4):377-80. [Medline].

  2. Kantorova A, Zbieranek K, Sauer H, et al. Primary early correction of tetralogy of Fallot irrespective of age. Cardiol Young. Apr 2008;18(2):153-7. [Medline].

  3. Miatton M, De Wolf D, François K, et al. Intellectual, neuropsychological, and behavioral functioning in children with tetralogy of Fallot. J Thorac Cardiovasc Surg. Feb 2007;133(2):449-55. [Medline].

  4. Aboulhosn J, Child JS. Management after childhood repair of tetralogy of fallot. Curr Treat Options Cardiovasc Med. Dec 2006;8(6):474-83. [Medline].

  5. Anderson RH, Weinberg PM. The clinical anatomy of tetralogy of fallot. Cardiol Young. Feb 2005;15 Suppl 1:38-47. [Medline].

  6. Balaji S. Medical therapy for sudden death. Pediatr Clin North Am. Oct 2004;51(5):1379-87. [Medline].

  7. Goldmuntz E. The genetic contribution to congenital heart disease. Pediatr Clin North Am. Dec 2004;51(6):1721-37, x. [Medline].

  8. He GW. Current Strategy of Repair of Tetralogy of Fallot in Children and Adults: Emphasis on a New Technique to Create a Monocusp-Patch for Reconstruction of the Right Ventricular Outflow Tract. J Card Surg. Sep 5 2008;[Medline].

  9. Hövels-Gürich HH, Konrad K, Skorzenski D, et al. Long-term behavior and quality of life after corrective cardiac surgery in infancy for tetralogy of Fallot or ventricular septal defect. Pediatr Cardiol. Sep-Oct 2007;28(5):346-54. [Medline].

  10. Khairy P, Harris L, Landzberg MJ, et al. Implantable cardioverter-defibrillators in tetralogy of Fallot. Circulation. Jan 22 2008;117(3):363-70. [Medline].

  11. Kirklin JW, Barrett-Boyes BGF. Ventricular septal defect and pulmonary stenosis or atresia. Cardiac Surgery. 1993;2:861-1012.

  12. Nadas AS. Tetralogy of fallot. In: Nadas Pediatric Cardiology. Hanley & Belfus; 1992:471-93.

  13. Park MK. Tetralogy of fallot. In: Pediatric Cardiology for Practitioners. 3rd ed. Mosby-Year Book; 1996:168-75.

  14. Silverman NH. Tetralogy of fallot and related lesions. In: Pediatric Echocardiography. Lippincott Williams & Wilkins; 1992:195-214.

  15. Snider AR, Serwer GA. Defects in cardiac septation. In: Echocardiography in Pediatric Heart Disease. Mosby-Year Book; 1990:150-3.

  16. Tanel RE. ECGs in the ED. Pediatr Emerg Care. Jun 2007;23(6):428-9. [Medline].

  17. Woods WA, Schutte DA, McCulloch MA. Care of children who have had surgery for congenital heart disease. Am J Emerg Med. Jul 2003;21(4):318-27. [Medline].

  18. Zuberhuler JH. Tetralogy of Fallot. In: Heart Disease in Infants, Children and Adolescents. 2nd ed. 1995:998-1026.

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

tetralogy of Fallot, TOF, Fallot tetrad, Fallot's tetrad, right ventricular outflow tract obstruction, congenital heart disease, maldevelopment of right ventricular infundibulum, subaortic ventricular septal defect, right ventricular infundibular stenosis, aortic valve positioned to override the right ventricle, right ventricular hypertrophy, right-to-leftshunting, cyanosis, hypertrophy of the infundibular septum, dyspnea, retarded growth, aortic ejection click, systolic thrill, systolic ejection murmur, clubbing, scoliosis, squatting position, retinal engorgement, hemoptysis, conotruncal abnormalities, DiGeorge syndrome, branchial arch abnormalities, fetal hydantoin syndrome, fetal carbamazepine syndrome, fetal alcohol syndrome, maternal phenylketonuria birth defects

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Mark Spektor, DO, Medical Director, Department of Emergency Medicine, Maimonides Medical Center
Mark Spektor, DO is a member of the following medical societies: American College of Emergency Physicians, American College of Physician Executives, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

David A Donson, MD, Assistant Medical Director, Department of Emergency Medicine, Maimonides Medical Center
David A Donson, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Kurt Pflieger, MD, FAAP, Active Staff, Department of Pediatrics, Lake Pointe Medical Center
Kurt Pflieger, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Emergency Physicians, American Heart Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Theodore J Gaeta, DO, MPH, FACEP, Clinical Associate Professor, Department of Emergency Medicine, Joan and Sanford Weill Medical College at Cornell University; Vice Chairman and Program Director of Emergency Medicine Residency Program, Department of Emergency Medicine, New York Methodist Hospital; Academic Chair, Adjunct Professor, Department of Emergency Medicine, St George's University School of Medicine
Theodore J Gaeta, DO, MPH, FACEP is a member of the following medical societies: American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, New York Academy of Medicine, New York Academy of Medicine, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Gary Setnik, MD, Chair, Department of Emergency Medicine, Mount Auburn Hospital; Assistant Professor, Division of Emergency Medicine, Harvard Medical School
Gary Setnik, MD is a member of the following medical societies: American College of Emergency Physicians and National Association of EMS Physicians
Disclosure: Intellicare Salary Management position; South Middlesex EMS Consortium Salary Management position

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

David FM Brown, MD, Assistant Professor, Department of Medicine, Division of Emergency Medicine, Harvard Medical School; Associate-Chief, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital
David FM Brown, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine
Disclosure: Schering  Honoraria Speaking and teaching

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.