Management of Hypoxic Episodes in Children with Tetralogy of Fallot

Written by Hu Qi Feng
Pediatrics
Updated on September 04, 2024
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In the treatment of hypoxic episodes in children with Tetralogy of Fallot, mild cases can be alleviated by positioning the child in a knee-chest position, while severe cases should receive immediate oxygen therapy, along with appropriate medication to correct acidosis. It is important to regularly eliminate factors that may trigger hypoxic episodes, such as anemia and infections, and to maintain a calm environment for the child. If these measures do not effectively control the episodes, emergency surgical repair should be considered.

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Tetralogy of Fallot is a common cyanotic congenital heart disease in children after the age of one. It consists of four abnormalities: ventricular septal defect, obstruction of the right ventricular outflow tract, overriding aorta, and right ventricular hypertrophy. Once Tetralogy of Fallot is diagnosed, the ultimate treatment is surgical. With the development of pediatric cardiothoracic surgery, there are no specific requirements regarding the birth month or weight of the child for the surgery, so the success rate of Tetralogy of Fallot surgery is now very high. If a child has Tetralogy of Fallot, it is crucial to seek active treatment and not to give up.

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The main cause of hypoxic attacks in Tetralogy of Fallot

Tetralogy of Fallot is a complex congenital heart disease, characterized by ventricular septal defect, right ventricular outflow tract obstruction, aorta overriding, and right ventricular hypertrophy. When the obstruction of the right ventricular outflow tract is severe, pulmonary artery blood flow significantly decreases. A large amount of unoxygenated venous blood passes through the ventricular septal defect causing a right-to-left shunt, which clinically manifests as severe cyanosis and increased red blood cells, and different degrees of hypoxia in the systemic circulation. Factors that can induce hypoxic episodes in these infants include feeding, crying, emotional agitation, anemia, infection, etc. These can suddenly lead to fainting, convulsions, or even death. The main reason is generally due to a sudden muscle spasm at the narrow pulmonary artery infundibulum on top of pre-existing stenosis, causing temporary pulmonary artery obstruction and exacerbating cerebral hypoxia, thus leading to severe hypoxic attacks.

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Tetralogy of Fallot shadow on the radiograph

Tetralogy of Fallot is the most common cyanotic heart disease in children over the age of one, accounting for about 10 percent of all congenital heart diseases. Tetralogy of Fallot includes four anatomical abnormalities: a ventricular septal defect, right ventricular outflow tract obstruction, an overriding aorta, and right ventricular hypertrophy. In patients diagnosed through X-ray, the heart size is often within normal limits, typically appearing boot-shaped, with markedly reduced pulmonary vascular markings. The aortic arch may be located on the right side, and the ascending aorta is usually dilated. Patients with rich collateral circulation display prominent pulmonary markings.