UNIT-4

CARDIOVASCULAR DISORDERS
TETRALOGY OF FALLOT

 PRESENTED BY PRESENTED TO
 NEETU THAKUR Post basic 1st year
 ASST PROFESSOR
 CHILD HEALTH
NURSING
 TETRALOGY OF FALLOT
 Tetralogy of fallot is the most common
type of cyanotic heart disease. There are
four lesions that are:
 Overriding aorta

 Right ventricular hypertrophy

 Ventricular septal defect

 Right ventricular outflow tract

obstruction (Pulmonary stenosis)
TETRALOGY OF FALLOT
 PATHOPHYSIOLOGY
Blood returns from systemic circulation to right
atrium and right ventricle

Outflow of blood from right ventricle is resisted by

pulmonary stenosis

The blood flows through the ventricular septal

defect into the aorta

Causes cyanosis, right ventricular Hypertrophy as

a result of the pressure exerted against the
pulmonary stenosis
 CLINICAL MANIFESTATION
 Cyanosis (lips, mouth,  Gasps for breath
fingernails, toenails)  Weak cry
 Severe Dyspnea  Unconsciousness
 Entire skin surface is  Convulsions
dusky, bluish color  Hemiparesis
 Clubbing of fingers and  Metabolic acidosis
toes occurs by 1 to 2
years of age  Growth
retardation
 Knee-chest position
(squatting position)  Mental slowness
may result from
 Paroxysmal dyspneic chronic hypoxia
attacks (anoxic blue of brain
spells)
 DIAGNOSIS
 History
 Physical examination
 On auscultation a loud, harsh systolic murmur may
be heard at the left middle to lower sternal border
 Radiography of heard shows right ventricular
hypertrophy, large aorta and decrease in the size of
the pulmonary artery.
 Boot shaped heart or wooden shoe.
 ECG shows left ventricular hypertrophy
 Echocardiogram shows evidence of aortic override
 Cardiac catheterization reveals systolic
hypertension in the right ventricle
 Laboratory tests shows polycythemia and arterial
oxygen unsaturation
 MANAGEMENT
 Palliative procedure – does not correct the
deformity. Surgical procedure is done to increase the
pulmonary blood flow.

 Waterston shunt – a side to side anastomosis of the

ascending aorta and pulmonary artery.

 Blalock-taussing procedure – an artificial ductus is

created by anastomosis of a branch of aorta
(subclavian artery) to the pulmonary artery.

 Pott’s procedure - anastomosis of the upper

descending aorta and left pulmonary artery.
 MANAGEMENT
 Brock procedure – pulmonary valvotomy for the
pulmonary stenosis, increases the pulmonary
blood flow.

 Medical treatment – prostaglandin E1 keeps the

ductus open until the infant is stabilizes and
strong enough to undergo surgery.

 Corrective procedure - correct the deformity by

cardiopulmonary bypass.
 VSD is closed with patch
 MANAGEMENT
 Pulmonary valve opened when
stenosed
 Obstructing RV muscle is removed

 All other outflow tract abnormalities are

corrected.
 Early repair, unless patient is premature
or low birth weight
 SUMMARY

 DEFINITION
 CAUSES OF TOF
 PATHOPHYSIOLOGY
 CLINICAL MANIFESTATIONS
 DIAGNOSTIC EVALUATION
 MANAGEMENT
 QUESTION

 DEFINE TETRALOGY OF FALLOT ALONG

WITH CLINICAL MANIFESTATIONS AND
EXPLAIN MANAGEMENT OF PATIENT
HAVING TOF
 BIBLIOGRAPHY

 Essential of pediatric nursing for Bsc and

postbasic students ,Rimple sharma,jaypee
publications:pg -424-428
 Dutta parul,textbok of pediatric
 nursing,jaypee publishers page -430-432
 Dorathy and marlow,textbookof pediatrics
nursing edition,elsevier publications page-
432-435