children s health issues
Tetralogy of Fallot
Treatment of Tetralogy of Fallot
Sometimes a medication, such as a prostaglandin, to keep the ductus arteriosus open in the first week of life For hypercyanotic spells, positioning, calming, oxygen, and sometimes medications and/or fluids given by vein, An oral beta-blocker medication may be used after a hypercyanotic spell resolves until surgery can be done Surgery In infants who depend on an open ductus arteriosus for survival, giving a prostaglandin by vein to maintain an open ductus arteriosus can be lifesaving. Keeping the ductus arteriosus open sends extra blood to the lungs and increases the level of oxygen in the infant's blood. When an infant has a hypercyanotic spell, the infant may breathe more easily when the knees are close to the chest (knee-chest position). Interestingly, older children with tetralogy of Fallot will naturally do the same thing by squatting down, which helps to push more blood to the lungs and makes them feel better. Calming the infant and giving oxygen also help. If these measures do not work,morphine, fluids given by vein (intravenously), and medications such as a beta-blocker (for example,propranolol), orphenylephrinemay be given to improve blood flow to the lungs. Any infant or child experiencing hypercyanotic spells should have heart surgery promptly. A doctor may give the infantpropranololto decrease the risk of future spells if surgery cannot be done immediately. In infants with tetralogy of Fallot, the defects need repair with surgery. If oxygen levels are low or infants have hypercyanotic spells, surgery is done in early infancy. If children have few symptoms, surgery is sometimes delayed until later in infancy. If infants have low birth weight or have complex defects, doctors may use less invasive procedures to keep blood flowing to the lungs until surgery can be done. For example, they may use a synthetic blood vessel (a shunt) to connect the aorta to a lung artery. This procedure routes blood to the lungs so that more blood can obtain oxygen before it goes to the rest of the body. Another option can be done during cardiac catheterization, in which a thin tube (catheter) with an expandable flexible tube (stent) at its tip is passed through a blood vessel in the leg into the heart. The stent is expanded in the heart to enlarge the outflow to the lungs, which helps increase levels of oxygen in the blood. During surgery, the ventricular septal defect is closed, the narrowed passageway from the right ventricle and the narrowed pulmonary valve are widened, and the patent ductus arteriosus is closed. Children need to take antibiotics before visits to the dentist and before certain surgeries (such as on the respiratory tract) before and usually after surgical repair. These antibiotics are used to prevent a serious heart infection called Infective Endocarditis . 