Certain environmental factors, such as air pollution, also may increase a mother's chances of having a baby with TOF.
Doctors might do several tests to find out if a baby has tetralogy of Fallot and to get more details about the baby's heart and blood vessels, including:. Doctors repair tetralogy of Fallot through open-heart surgery soon after birth or later in infancy, depending on the baby's health and weight and severity of defects and symptoms. Most babies whose tetralogy of Fallot is repaired do very well, but will need regular follow-up visits with a heart specialist. Reviewed by: Gina Baffa, MD. Larger text size Large text size Regular text size.
If tetralogy of Fallot isn't treated, a child may have: cyanosis that gets worse spells where the blood oxygen levels become very low dizziness, fainting, or seizures a higher risk of endocarditis, an infection of the inner layer of the heart high pressure in the right side of the heart that can cause an irregular heartbeat an arrhythmia Children whose TOF isn't fixed usually become increasingly blue over time and have difficulty participating in physical activities like playing sports.
The four problems of tetralogy of Fallot are: Ventricular septal defect VSD , which is a hole in the septum, or wall, separating the two lower chambers, or ventricles, of the heart. The septum normally acts as a barrier that prevents blood from both sides of the heart from mixing. But when there is a VSD, the high-oxygen blood from the left ventricle and the low-oxygen blood from the right ventricle can mix.
This can lead to either too little or too much blood flow going to the lungs. Pulmonary stenosis , a narrowing or thickening of the valve that connects the right ventricle to the pulmonary artery, the blood vessel that carries low-oxygen blood from the heart to the lungs. When in the lungs, blood normally soaks up the oxygen that we breathe and becomes red, oxygen-rich blood. This red blood returns to the heart, and then is pumped to the body.
You may need to limit your activity if there is leftover obstruction or a pulmonary valve leak, which is common after repair. This limitation may be especially necessary for competitive sports. Patients with decreased heart function or rhythm abnormalities may need to limit their activity more. Your cardiologist will help decide if you need limits. See the Physical Activity section for more information. If you've had tetralogy of Fallot repaired, you'll need regular lifelong regular follow-up with a cardiologist who's had special training in congenital heart defects.
Another problem can be a leaky pulmonary valve and enlargement of the heart's right side. Patients with repaired tetralogy of Fallot have a higher risk of heart rhythm disturbances called arrhythmias. Generally, the long-term outlook is good, but some patients may need medicines, heart catheterization or even more surgery. People with tetralogy of Fallot are at increased risk for developing endocarditis.
People with unrepaired and partially repaired tetralogy will need antibiotics to prevent endocarditis before certain dental procedures. If your tetralogy of Fallot has been repaired, your cardiologist will let you know if you need to continue to receive these routine antibiotics.
In the long-term postoperative period, your heart muscle function may decrease and you'll need medication. This usually reflects weakening function of the right side of the heart, but in rare instances decreased function of the left ventricle may also occur.
Medicines that may be needed include diuretics water pills , drugs to help your heart pump better and drugs to control your blood pressure.
People with repaired tetralogy of Fallot have a higher risk of heart rhythm disturbances called arrhythmias. These can originate from the atria or the ventricles. Sometimes they may cause dizziness or fainting. You may need medicine to control them. In rare cases, you may need a procedure in the cardiac catheterization laboratory or the operating room to eliminate these arrhythmias and control symptoms. See the Arrhythmias section for more information.
Some patients need pacemakers or implantable defibrillators to treat their arrhythmias. In many cases, women with repaired tetralogy of Fallot have successful, full-term pregnancies. Some woman with significant residual heart problems may be at risk for a difficult pregnancy. See the section on Pregnancy for more information. Once tetralogy of Fallot has been repaired, the pregnancy risk is low unless the woman has some side effects or residual effect like irregular heart rhythms or persistent narrowing of the pulmonary valve.
Any woman considering pregnancy should have a complete physical examination by her cardiologist in consultation with a multi-disciplinary team before becoming pregnant to find out what, if any risk there might be with the pregnancy. Pregnancy is considered to be high-risk and not recommended for women with unoperated tetralogy of Fallot who remain "cyanotic" blue. After the first complete repair, residual problems may require you to have more open-heart surgeries or procedures in the cardiac catheterization laboratory.
Written by American Heart Association editorial staff and reviewed by science and medicine advisers. See our editorial policies and staff. Congenital Heart Defects.
About Congenital Heart Defects. Tet spells are most common in young infants, around 2 to 4 months old. Toddlers or older children might instinctively squat when they're short of breath. Squatting increases blood flow to the lungs. If your baby becomes blue cyanotic , place your baby on his or her side and pull your baby's knees up to his or her chest.
This helps increase blood flow to the lungs. Call or your local emergency number immediately. Tetralogy of Fallot occurs as the baby's heart is developing during pregnancy. Usually, the cause is unknown. Some children or adults who have tetralogy of Fallot may have other heart defects such as a hole between the heart's upper chambers atrial septal defect , a right aortic arch or problems with the coronary arteries.
While the exact cause of tetralogy of Fallot is unknown, some things might increase the risk of a baby being born with this condition. Risk factors for tetralogy of Fallot include:. A possible complication of tetralogy of Fallot is infection of the inner lining of the heart or heart valve caused by a bacterial infection infective endocarditis. Your or your child's doctor may recommend taking antibiotics before certain dental procedures to prevent infections that might cause this infection.
People with untreated tetralogy of Fallot usually develop severe complications over time, which might result in death or disability by early adulthood. While most babies and adults do well after open-heart surgery to repair tetralogy of Fallot defects intracardiac repair , long-term complications are common. Complications may include:. This is from the low oxygen levels in their blood. Genes and family history may play a part in TOF. It may also be caused by Down syndrome or 22q Most of the time, this heart defect occurs by chance, with no cause.
Symptoms can show up a bit differently in each child. The most common symptom is a bluish color of the skin, lips, and nail beds. This may come on in sudden spells, called TET spells. It happens when blood oxygen level drops quickly. During the spell, babies may have a hard time breathing.
They may also be tired and fussy. In the most severe cases, they may lose consciousness. The symptoms of TOF may be similar to symptoms caused by other problems. Make sure that your child sees a healthcare provider for a diagnosis.
Your child will need to see a heart doctor cardiologist. They will check your baby and listen to their heart and lungs.
Tests may be done to confirm the diagnosis. This test records the electrical activity of the heart. It also shows abnormal rhythms arrhythmias or dysrhythmias and spots heart muscle stress.
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