The main cause of hypoxic attacks in Tetralogy of Fallot

Written by Yan Xin Liang
Pediatrics
Updated on February 02, 2025
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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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Written by Yan Xin Liang
Pediatrics
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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.

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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 Tong Peng
Pediatrics
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Does Tetralogy of Fallot easily lead to heart failure?

Tetralogy of Fallot often leads to symptoms of heart failure because it is a severe congenital disease. Affected children tend to present with cyanosis of the lips, impaired growth and development, and a simple echocardiography can reveal specific indicators such as aorta overriding, pulmonary stenosis, right ventricular hypertrophy, and ventricular septal defect. These children have limited lung and heart function, making them prone to increased cardiac load and symptoms of heart failure following infections or physical activity. Therefore, early surgical treatment is necessary for these children to prevent recurrent infectious diseases and heart failure, which can affect their normal growth and development. Additionally, it is crucial to enhance nutrition and exercise in their daily lives to boost their immune system. For Tetralogy of Fallot, early detection and treatment are essential.

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Written by Chen Guang Yin
Cardiology
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Can someone with Tetralogy of Fallot have a second child?

Tetralogy of Fallot is a congenital cardiac defect that has not been found to have a definite genetic relationship, meaning no chromosomal abnormalities have been discovered. However, congenital heart disease does tend to occur within families to a certain extent, indicating some level of familial predisposition. The primary cause, however, is believed to be related to viral infections during the first three months of pregnancy or the use of certain medications. Therefore, we believe that parents of a child with Tetralogy of Fallot can consider having a second child.

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Written by Yan Xin Liang
Pediatrics
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Is Tetralogy of Fallot serious?

Tetralogy of Fallot is the most common cyanotic congenital heart disease in children, accounting for about 10% of congenital heart diseases. It is a complex type of congenital heart condition, consisting of four defects: a ventricular septal defect, right ventricular outflow tract obstruction, overriding aorta, and right ventricular hypertrophy. Due to these four malformations, children will experience cyanosis, poor exercise tolerance, and may quickly become fussy or emotionally disturbed with physical activity. This can lead to noticeable worsening of dyspnea and cyanosis. They may also exhibit a preference for squatting, as squatting can decrease the return blood volume to the heart, increase systemic vascular resistance, and temporarily relieve hypoxic symptoms. Other symptoms include clubbing, paroxysmal hypoxia attacks which are more common in infants. These attacks can be triggered by crying, emotional excitement, anemia, infections, etc., and suddenly manifest as paroxysmal breathing difficulties. In severe cases, there can be fainting, convulsions, and even death. Therefore, these clinical manifestations are very serious, making this disease a significantly dangerous condition.