Tetralogy of Fallot's composition and its causes of formation

Written by Hu Qi Feng
Pediatrics
Updated on September 23, 2024
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Tetralogy of Fallot consists of four abnormalities. First, there is a narrowing at the right ventricular outflow, ranging from the entrance of the right ventricular infundibulum to the branches of the left and right pulmonary arteries. Second, there is a ventricular septal defect, characterized by a deficiency around the membranous part that extends towards the outflow. Third, the aorta overrides, where the base of the aorta is enlarged and rotates clockwise to the right, straddling the septal defect. Fourth, right ventricular hypertrophy, which is a secondary lesion.

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Written by Hu Qi Feng
Pediatrics
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The reason for squatting in Tetralogy of Fallot

The reason for squatting is that when squatting, the lower limbs are bent, which reduces the amount of blood returning to the heart through the veins, thereby reducing the load on the heart. At the same time, the arteries in the lower limbs are compressed, which increases the resistance in the systemic circulation and reduces the right-to-left shunt volume, allowing temporary relief from hypoxia symptoms. Babies who cannot walk often like to be held by adults in a position that bends the lower limbs to reduce the amount of blood returning to the heart. This frequently occurs during walking and playing, often characterized by brief periods of squatting.

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Written by Hu Qi Feng
Pediatrics
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Tetralogy of Fallot symptoms in infants

Infants with Tetralogy of Fallot often exhibit the following symptoms: First, cyanosis, which is most apparent in areas rich in capillaries such as the lips, fingernail beds, and conjunctiva. Cyanosis tends to worsen gradually during crying, emotional distress, or physical exertion. Second, squatting symptoms; infants who cannot walk often prefer to be held by adults in a flexed position of both lower limbs, reducing venous return and easing the cardiac workload. Older children often exhibit squatting during activities such as walking and playing, frequently squatting down momentarily. Third, infants in a prolonged hypoxic environment may develop clubbing, characterized by the enlargement of the fingertips and toes, with capillary expansion and proliferation, resembling drumsticks. Fourth, episodic hypoxia occurs predominantly in infants, triggered by feeding, crying, or emotional distress, manifesting as episodes of respiratory difficulty, with severe cases leading to sudden fainting or convulsions.

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Written by Yao Li Qin
Pediatrics
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Can Tetralogy of Fallot be cured?

Tetralogy of Fallot is a type of congenital heart disease linked to family genetics and is considered quite severe among congenital heart conditions. Generally, within a few months after birth, children will exhibit cyanosis of the skin. It is crucial to perform surgery on the child promptly in such cases. Currently, the level of pediatric cardiothoracic surgery in our country has developed very rapidly. For typical cases of Tetralogy of Fallot, surgical treatment can be curative. Moreover, there are no specific requirements regarding weight and age for children undergoing heart surgery nowadays. Therefore, once Tetralogy of Fallot is diagnosed in young children, it is best to perform surgery as soon as possible. These children can then grow up, develop normally, and attend school like their peers.

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Written by Hu Qi Feng
Pediatrics
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Tetralogy of Fallot in children who prefer squatting is because

Tetralogy of Fallot exhibits squatting symptoms because squatting involves flexing the lower limbs, which reduces the amount of venous return to the heart, thereby decreasing the cardiac workload. At the same time, the arteries of the lower limbs are compressed, increasing systemic vascular resistance, reducing right-to-left shunting, and temporarily alleviating hypoxia symptoms. Infants who cannot walk often prefer to be held with their thighs up, with both lower limbs bent; after they become able to walk, they frequently squat down momentarily during walking or playing.

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Written by Hu Qi Feng
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Tetralogy of Fallot Clinical Symptoms

The clinical manifestations of Tetralogy of Fallot include cyanosis, with cyanosis being the primary symptom. The severity of cyanosis is related to the extent of pulmonary stenosis and is commonly seen in areas rich in capillaries, such as the lips, fingertips, nail beds, and conjunctiva, where it appears more pronounced during physical activity or crying. Secondly, the squatting symptom is observed; children may show squatting behavior during walking or playing, often squatting down voluntarily for a moment. During squatting, the flexion of the lower limbs reduces the venous return to the heart, lightening the cardiac load and decreasing the right-to-left shunting, thereby alleviating hypoxia. Thirdly, clubbing of the fingers occurs due to long-term hypoxia, leading to hypertrophic growth at the fingertip and toe ends. Fourthly, paroxysmal hypoxic attacks occur.