CHDFNigeria
Tetralogy of Fallot, TOF as it popularly called is a combination of 4 anomaly that a child is born with. They are Ventricular Septal Defect, Pulmonary Stenosis, Right Ventricular Hypertrophy, Overriding Aorta. TOF is characterized by the low oxygen saturation and sometimes Tet spells. Surgery is advised in the first year for a great outcome. TOF may require palliate surgery before the definitive one based on the severity level. It is the most common Cyanotic CHD globally.
Signs and symptoms
Low oxygen saturations or SpO2
Mild to profound cyanosis (Blue lips and extremities)
Heart murmur
Failure to gain weight
Laboured breathing
Retarded growth
Finger clubbing
Squatting
Polycythaemia, which is an increase in red blood cells due to the hypoxia associated with TOF. This increase production leads to high viscosity (thickness) and the patient may require treatment such as Exchange Blood Transfusion (EBT). Polycythemia is associated with stroke and other complications.
Tet-Spells: A period of crisis commonly seen in critical TOF.
Watch for more information about TOF
Diagnosis and Investigations
Physical examination and auscultation: Here the child is examined physically from head to toe for features of CHD. The practitioner will also listen to the chest for murmur.
Pulse oximetry: Which is a simple bed side test where a pulse oximeter is connected to a finger to take the oxygen level. Sats levels are usually less than 92%
Chest X-ray: This is a radiological examination that looks into the chest organ. This service is usually available in most general, private, and tertiary hospitals in Nigeria.
Electrocardiogram: This is a non-invasive test to check the electrical activity of the heart at the point of care. It is readily available in diagnostic centres and teaching hospitals.
Echocardiography: This uses soundwaves to visualize the heart. The cardiologist or sonographer take images, pictures, flow, pressure or volume across the heart chambers. It is available in teaching hospitals like LUTH,FMC, UPTH, diagnostic centres like Afri-global, top private hospitals in Nigeria.
Cardiac catheterization: Done by trained cardiologist, it helps to further examine the heart in order to arrive at definitive conclusions. Paediatric cardiac catheterization service is available in less than or about 5 centres in Nigeria.
Cardiac CT angiogram: Readily available in cardiac centres and a few top-level private hospitals and diagnostic centres in Nigeria.
Management of Tetralogy of Fallot
TOF can be managed medically with medications, conservatively, with EBT as needed, or with palliative procedures like BT-Shunt, and definitive surgery called TOF repair.
N.B: Ideal treatment of TOF is based on child’s unique lesion, age and time of diagnosis. Feel free to discuss, question and talk to your cardiologist and surgeons while assessing treatments.
Medical treatment
Your child’s paediatric cardiologist may prescribe medications like betablockers and ant failures to your child. Propranolol is common with TOF.
Remember to always administer your child’s medications as prescribed.
Surgical Treatment
BT shunt: Palliative surgery before child is ready for TOF correction.
TOF repair: Open Heart Surgery done to correct the TOF. It is one of the commonly performed in Nigeria. Surgical success rate and cost of surgery vary from centre to centre in Nigeria. Please search the Nigeria Heart Registry for centre profile.
