Materiały źródłowe

• #1 Tetralogy of Fallot – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK513288/

  Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease, representing 5% to 7% of all congenital heart defects. […] With the advent of fetal echocardiography, the diagnosis can be made prenatally, and in infants who present with severe RVOTO, prompt stabilization can avoid profound cyanosis and rapid deterioration. […] The echocardiogram is the gold standard for the diagnosis of TOF. This noninvasive modality is used at the patient’s bedside to accurately assess the anatomy and severity of the RVOTO, the location and number of VSDs, associated anomalies, aortic arch, and coronary artery variants since RVOT crossing of coronary arteries will complicate the surgical approach. […] Chest radiography, electrocardiogram, and an echocardiogram are the primary imaging studies utilized to diagnose TOF. Typical findings on chest radiography include a normal-size heart silhouette with an upturned apex and a concave or „boot-shaped” main pulmonary artery segment.

• #2 EDUCATIONAL SERIES IN CONGENITAL HEART DISEASE: Tetralogy of Fallot: diagnosis to long-term follow-up

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6301192/

  Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart defect, affecting 3 in 10,000 live births. […] This article will cover the diagnosis of TOF in childhood, the objectives of surveillance through adulthood and the value of multi-modality imaging in identifying and guiding timely surgical and percutaneous interventions. […] Echocardiography is the main modality for diagnosis and follow-up of TOF. Once TOF is suspected in the neonate, a detailed echocardiographic evaluation is undertaken, including 2D, color and spectral Doppler imaging. […] The goals of the initial evaluation can be summarized as follows: Presence or absence of thymus. Visceral and atrial situs. Pulmonary and systemic venous connection and any type of atrial septal defects. AV valves morphology and function (look for AVSD anatomy). VSD morphology and shunting direction. LV and RV size, morphology and function. Cono-truncal anatomy and degree of stenosis of the RV outflow tract. Pulmonary annulus size and valve morphology. Main pulmonary and pulmonary artery branch size. Rule out abnormality of origin or course of a pulmonary artery (sling or disconnected LPA following PDA closure). Aortic arch sidedness and branching pattern. PDA origin and patency or aorto-pulmonary collaterals. Coronary artery anatomy.

• #3 Tetralogy of Fallot – Wikipedia

  https://en.wikipedia.org/wiki/Tetralogy_of_Fallot

  There are three different useful diagnostic tests used for the diagnosis of tetralogy of Fallot. These include a chest radiograph, electrocardiogram, and echocardiogram. The echocardiography determines the final diagnosis and typically offers enough information for surgical treatment planning. About half of all patients are now diagnosed before they are born. Differential diagnosis is when physicians diagnose between two or more conditions for a person’s symptoms and this can include primary pulmonary causes of cyanosis, cyanotic heart lesions, pulmonary stenosis and transposed arterial trunks. […] Before more sophisticated techniques became available, chest X-ray was the definitive method of diagnosis. The abnormal „coeur-en-sabot” (boot-like) appearance of a heart with tetralogy of Fallot is classically visible via chest X-ray, although most infants with tetralogy may not show this finding. The boot like shape is due to the right ventricular hypertrophy present in TOF. Lung fields are often dark (absence of interstitial lung markings) due to decreased pulmonary blood flow.

• #4 Orphanet: Tetralogy of Fallot

  https://www.orpha.net/en/disease/detail/3303

  Tetralogy of Fallot is a congenital cardiac malformation that consists of an interventricular communication, also known as a ventricular septal defect, obstruction of the right ventricular outflow tract, override of the ventricular septum by the aortic root, and right ventricular hypertrophy. […] Useful diagnostic tests are the chest radiograph, electrocardiogram, and echocardiogram. The echocardiogram establishes the definitive diagnosis, and usually provides sufficient information for planning of treatment, which is surgical. […] Approximately half of patients are now diagnosed antenatally.

• #5 About Tetralogy of Fallot | Congenital Heart Defects (CHDs) | CDC

  https://www.cdc.gov/heart-defects/about/tetralogy-of-fallot.html

  Tetralogy of Fallot may be diagnosed during pregnancy or soon after a baby is born. […] During pregnancy, screening tests (prenatal tests) check for birth defects and other conditions. An ultrasound, a tool that creates pictures of the baby, may detect tetralogy of Fallot. If the health care provider suspects tetralogy of Fallot from the ultrasound, they can request a fetal echocardiogram confirming the diagnosis. A fetal echocardiogram is a more detailed ultrasound of the baby’s heart. This test can show problems with the structure of the heart and how the heart is working with this defect. […] Tetralogy of Fallot usually is diagnosed after a baby is born. It is often diagnosed after the infant has an episode of turning blue during crying or feeding (a tet spell). Findings on a physical exam may make a healthcare provider suspect a baby has tetralogy of Fallot. This may include bluish-looking skin or hearing a heart murmur. If these findings are present, the health care provider might request one or more tests to confirm the diagnosis. The most common test is an echocardiogram, which is an ultrasound of the heart. […] Tetralogy of Fallot can also be detected with newborn pulse oximetry screening. Newborn screening using pulse oximetry can identify some infants with tetralogy of Fallot before they show any symptoms.

• #6 Tetralogy of Fallot (TOF): Diagnosis & Treatment | NewYork-Presbyterian

  https://www.nyp.org/heart/congenital-heart-disease/tetralogy-of-fallot-tof/treatment

  Tetralogy of Fallot is diagnosed by echocardiography. Diagnosis may occur just after birth when a heart murmur or low oxygen levels are found in a newborn. […] However, many babies are now diagnosed with tetralogy of Fallot even before birth. Standard ultrasound imaging of the babys heart can detect TOF by 18 – 20 weeks, when the heart is large enough to be easily seen. A pediatric cardiologist can confirm the diagnosis with a fetal echocardiogram. […] Additional tests may be done after birth to help determine your babys treatment: EKG – While no longer used to determine a diagnosis, an EKG can be ordered for babies with rhythm problems associated with TOF. Chest X-ray – This test is rarely used to make the diagnosis, though the boot-shaped heart shadow on the X-ray can suggest the diagnosis of TOF and lead to further testing. Cardiac catheterization – A more invasive test in which thin, flexible tubes travel through the blood vessels of the babys leg to take pictures and measure blood pressures in the different chambers of the heart. MRI – In some cases of TOF, an MRI may provide important information about your childs anatomy.

• #7 Tetralogy of Fallot (ToF): Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/22343-tetralogy-of-fallot

  Your healthcare provider can diagnose tetralogy of Fallot during pregnancy or after your baby is born. They usually find ToF in the first few weeks or months of life. […] During prenatal tests, your healthcare provider may use a fetal echocardiogram to look at the fetal hearts structure if the initial ultrasound looks suspicious. […] During a physical exam, a healthcare provider will listen to your childs heart. If they have ToF, their provider will most likely hear a heart murmur. […] Tests a provider may use to diagnose tetralogy of Fallot may include: Pulse oximetry, Echocardiogram, Chest X-ray or cardiac CT (computed tomography), Electrocardiogram (EKG), Cardiac catheterization. […] Your healthcare provider can diagnose tetralogy of Fallot during pregnancy or after your baby is born. They usually find it in the first few weeks or months of life.

• #8 Tetralogy of Fallot (TOF) | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/tetralogy-fallot

  Tetralogy of Fallot may be diagnosed with fetal echocardiogram (ultrasound) before your baby is born. Our Fetal Heart Program will prepare a plan for delivery and care immediately after birth. […] Another common time for diagnosis of tetralogy of Fallot is after birth, but before your newborn leaves the hospital. A doctor may hear a heart murmur or see a blue tint to the skin while examining your child before discharge. […] Diagnosis of tetralogy of Fallot may require some or all of these tests: Pulse oximetry: a noninvasive way to monitor the oxygen content of the blood, Electrocardiogram (ECG): a record of the electrical activity in the heart, Echocardiogram (also called „echo” or ultrasound): sound waves create an image of the internal structure of the heart, Chest X-ray, Cardiac MRI: a three-dimensional image that shows the heart’s structures in detail, Cardiac catheterization: a thin tube (catheter) is inserted into the heart through a large vein in the leg, and guided to the heart to take measurements throughout the heart. […] A number of children with TOF also have genetic syndromes such as DiGeorge syndrome, Trisomy 21 (Down syndrome), Alagille syndrome or chromosome 22q11.2 deletion syndrome. Genetic testing (a blood test) may be part of an evaluation.

• #9 Tetralogy of Fallot (TOF) Diagnosis & Treatments | Mount Sinai – New York

  https://www.mountsinai.org/locations/childrens-heart/conditions/tetralogy-fallot

  Whether your child receives a diagnosis of tetralogy of Fallot before or just after birth, like talk show host Jimmy Kimmel’s son William, or later in life, it can be an emotional experience. Fortunately, Mount Sinai Kravis Children’s Heart Center’s congenital heart disease specialists are here to guide you and treat your child. […] We support you and your family with compassion as we provide an accurate diagnosis and expert treatment. […] If we are able to diagnose tetralogy of Fallot in utero, using a fetal echocardiogram or ultrasound, we will refer you to our Fetal Heart Program so our specialists can manage your delivery and take care of your newborn. […] Diagnosis after birth may require the following tests: Pulse oximetry—a painless way to monitor the oxygen content of the blood, Electrocardiogram (ECG or EKG)—records electrical signals as they travel through your child’s heart allowing us to see if there are abnormal heart patterns, Echocardiogram—uses sound waves to create real-time images of the heart that show abnormal blood flow through the heart, and any holes or abnormal heart valves, Chest X-ray—shows if your child’s heart is enlarged, Cardiac catheterization—uses dye to make the heart structures visible on X-rays. We inject the dye through a catheter (a thin flexible tube) so we can take pictures of the small blood vessels and measure pressure in your child’s heart chambers. […] Our pediatric cardiologists are experienced in diagnosing and treating tetralogy of Fallot. To ensure long-term health, your child will need lifelong follow-up care after surgery with one of our cardiologists trained in congenital heart disease.

• #10 Tetralogy of Fallot Diagnosis & Treatment | Cardinal Glennon

  https://www.ssmhealth.com/cardinal-glennon/fetal-care-institute/fetal-heart-program/heart-conditions/tetralogy-of-fallot

  If your doctor suspects a fetal heart anomaly after reviewing your routine ultrasound, he or she may request a fetal echocardiogram (echo), an ultrasound of the fetus’s heart. This safe, noninvasive test shows the structure of the heart and how it is functioning, which can help us confirm the diagnosis of Tetralogy of Fallot and discuss possible options for treatment after delivery. […] Treatment depends on the severity of the pulmonary stenosis. […] Depending on the oxygen levels, complete repair is typically performed around 4-6 months of age. The surgeon closes the ventricular septal defect with a patch, and relieves the blockage of blood flow to the lungs. […] In most cases, the long-term prognosis after surgery for Tetralogy of Fallot is very good. After total surgical repair, many patients lead normal lives.

• #11 Tetralogy of Fallot | Symptoms, Diagnosis & Treatment

  https://www.cincinnatichildrens.org/health/t/tof

  Tetralogy of Fallot is most often diagnosed in the first few weeks of life due to either a loud murmur or cyanosis. […] When a newborn with significant cyanosis is first seen, they are often placed on supplemental oxygen. The increased oxygen improves the child’s oxygen levels in cases of lung disease, but breathing extra oxygen will have little effect on the oxygen levels of a child with tetralogy of Fallot. […] Once congenital heart disease is suspected, echocardiography can rapidly and accurately demonstrate the four related defects characteristic of tetralogy of Fallot. […] Cardiac catheterization is occasionally required to evaluate the size and distribution of the pulmonary arteries. Catheterization can also demonstrate whether patients have pulmonary blood flow supplied by an abnormal blood vessel from the aorta (aortopulmonary collateral).

• #12 Tetralogy of Fallot – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/tetralogy-of-fallot/diagnosis-treatment/drc-20353482

  Tetralogy of Fallot is often diagnosed soon after birth. Your baby’s skin may look blue or gray. A whooshing sound may be heard when listening to the baby’s heart with a stethoscope. This is called a heart murmur. […] Tests to diagnose tetralogy of Fallot include: […] Oxygen level measurement. A small sensor placed on a finger or toe quickly checks the amount of oxygen in the blood. This is called a pulse oximetry test. […] Echocardiogram. This test uses sound waves to create pictures of the heart in motion. It shows the heart and heart valves and how well they are working. […] Electrocardiogram, also called ECG or EKG. This test records the electrical activity of the heart. It shows how the heart is beating. […] Chest X-ray. A chest X-ray shows the shape and condition of the heart and lungs. A common sign of tetralogy of Fallot on an X-ray is a boot-shaped heart. That means the right lower chamber is too big.

• #13 Tetralogy of Fallot – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/701

  Tetralogy of Fallot (TOF) is a ventricular septal defect with over-riding aorta and right ventricular (RV) outflow tract obstruction and resulting RV hypertrophy. […] Diagnosed by echocardiography. […] Key diagnostic factors: hypercyanotic episodes, harsh systolic ejection murmur, cyanosis, tachypnoea. […] 1st tests to order: pulse oximetry, echocardiogram, ECG, CXR, hyper-oxygenation test. […] Tests to consider: cardiac CT angiography or MRI, cardiac catheterisation.

• #14 Tetralogy of Fallot (ToF): Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/22343-tetralogy-of-fallot

  If your baby has tetralogy of Fallot, your provider will most likely hear a heart murmur when listening to your babys heart. They can easily check your newborn babys oxygen level with pulse oximetry (pulse ox). If it shows a low oxygen level, your provider can do an echocardiogram (ultrasound of the heart). […] To diagnose tetralogy of Fallot in a child or adult, a provider may use the above methods, as well as an electrocardiogram (EKG) and cardiac catheterization.

• #15 Tetralogy of Fallot – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/701

  Diagnosed by echocardiography. […] Key diagnostic factors: hypercyanotic episodes, harsh systolic ejection murmur, cyanosis, tachypnea. […] 1st tests to order: pulse oximetry, echocardiogram, ECG, CXR, hyperoxygenation test. […] Tests to consider: cardiac CT angiography or MRI, cardiac catheterization.

• #16 Tetralogy of Fallot (TOF) | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/tetralogy-fallot

  Tetralogy of Fallot can be detected during an ultrasound exam during pregnancy. If your clinical team suspects your baby may have TOF, they will order a fetal echocardiogram (cardiac ultrasound) to further evaluate the structure of the heart and how it’s functioning with this condition. […] Once your baby is born, a pediatric cardiologist will listen to your babys heart and lungs, feel the babys pulses, measure the oxygen level in the blood through pulse oximetry (a non-invasive test), and use other several tests to help clarify the diagnosis, including: […] Electrocardiogram (EKG or ECG) […] Echocardiogram (echo) […] Cardiac magnetic resonance imaging (MRI) […] Chest X-ray: A conventional chest X-ray will evaluate the size and spatial relationships of the heart within the childs chest. […] Cardiac catheterization: In this procedure, a catheter (a long, flexible tube) is inserted into a blood vessel and guided into the heart.

• #17 Multimodality Imaging Assessment of Tetralogy of Fallot: From Diagnosis to Long-Term Follow-Up

  https://www.mdpi.com/2227-9067/10/11/1747

  Cardiovascular imaging has a pivotal role in the diagnosis and management of these patients, including initial diagnosis, risk stratification, pre-interventional planning, and long-term follow-up. The aim of this review is to provide a comprehensive overview of the role, advantages, and limitations of each imaging modality in TOF patients, from diagnosis to long-term follow-up. […] The TTE data acquisition protocol should incorporate standard echocardiographic views from the subcostal, parasternal, apical, and suprasternal windows in combination with full sweeps and selected single planes. […] TTE allows for the detailed visualisation and measurement of cardiac structures, providing essential information on the severity of the pulmonary stenosis, size, and morphology of the ventricular septal defect (VSD), aortic override, and right ventricular outflow tract (RVOT) obstruction.

• #18 Tetralogy of Fallot – Wikipedia

  https://en.wikipedia.org/wiki/Tetralogy_of_Fallot

  An electrocardiogram (ECG) is one of the most basic procedures for assessing the heart. Electrocardiography shows right ventricular hypertrophy (RVH), along with right axis deviation. RVH is noted on EKG as tall R-waves in lead V1 and deep S-waves in lead V5V6. […] Congenital heart defects are now diagnosed with echocardiography, which is quick, involves no radiation, is very specific, and can be done prenatally. Echocardiography establishes the presence of TOF by demonstrating a VSD, RVH, and aortic override. Many patients are diagnosed prenatally. Color Doppler (type of echocardiography) measures the degree of pulmonary stenosis. Additionally, close monitoring of the ductus arteriosus is done in the neonatal period to ensure that there is adequate blood flow through the pulmonary valve.

• #19 Tetralogy of Fallot (TOF) (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/tetralogy-of-fallot.html

  How Is Tetralogy of Fallot (TOF) Diagnosed? 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: […] pulse oximeter: a small sensor that clips onto the fingertip, toe, or ear and measures how much oxygen is in the blood. In many newborn nurseries, all babies have a pulse oximeter test before going home to make sure that their oxygen level is normal. […] electrocardiogram (EKG): a test that records the electrical activity of the heart […] echocardiogram (echo): an ultrasound picture of the heart. It records the motion of the blood through the heart and can measure the direction and speed of blood flow. […] chest X-ray […] cardiac catheterization: a thin, flexible tube called a catheter is inserted into the heart, usually through a vein in the leg or arm, and provides information about the heart as well as blood pressure and blood oxygen levels. Sometimes, a device is inserted into the heart or blood vessels through the heart catheter. […] imaging tests, such as a CT scan or MRI, to help with surgical planning.

• #20 Tetralogy of Fallot | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/tetralogy-of-fallot?lang=us

  Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart condition with many cases presenting after the newborn period. It has been classically characterized by the combination of ventricular septal defect (VSD), right ventricular outflow tract obstruction (RVOTO), overriding aorta, and late right ventricular hypertrophy. […] Echocardiography allows direct visualization of the abnormal anatomy and remains the primary modality for the diagnosis of tetralogy of Fallot. […] CT is useful in demonstrating the complex cardiovascular morphology of tetralogy of Fallot, especially the anatomy of the pulmonary and coronary arteries as well as identification of major aortopulmonary collateral arteries (MAPCAs). […] MRI has the great advantage of providing both exquisite anatomical detail and functional information without ionizing radiation. A detailed assessment of the pulmonary artery is of particular importance because the repair of the cardiac defects without addressing pulmonary artery hypoplasia or stenosis has a poor outcome. […] Primary repair (total correction (a.k.a. repair) of tetralogy of Fallot) is now the preferred treatment and is usually performed at the time of diagnosis.

• #21 EDUCATIONAL SERIES IN CONGENITAL HEART DISEASE: Tetralogy of Fallot: diagnosis to long-term follow-up

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6301192/

  In the preoperative TOF patient, if echocardiography has not permitted an exhaustive evaluation of the intracardiac and extra-cardiac structures, cardiovascular magnetic resonance (CMR) represents an alternative to provide the missing information for diagnosis and surgical planning. […] Recent advances in acquisition techniques including radiation exposure reduction make CT a real alternative to CMR in addition to the first-line echocardiographic evaluation. […] Angiography had been, for decades, the imaging gold standard for the preoperative assessment of TOF. Advances in cross-sectional imaging currently allow non-invasive definition of the anatomic details of intracardiac and extra-cardiac structures, including pulmonary branch anatomy or coronary artery pattern. […] All patients with repaired TOF need lifelong clinical reviews and serial, often multi-modality, cross-sectional imaging to allow for timely management of the long-term sequelae.

• #22 Multimodality Imaging Assessment of Tetralogy of Fallot: From Diagnosis to Long-Term Follow-Up

  https://www.mdpi.com/2227-9067/10/11/1747

  In recent times, there has been a growing emphasis on utilising advanced imaging methods to achieve a comprehensive and more precise assessment of cardiac function in TOF patients. […] CMR is an advanced technique for imaging the cardiovascular system that can assess the structure, function, and blood flow without the use of radiation. […] CCT has emerged as a valuable tool for providing detailed anatomical information and functional assessment of cardiac structures. […] CCT is invaluable in pre-surgical planning, enabling surgeons to obtain a clear roadmap of the heart’s complex anatomy before corrective surgery. […] After surgical correction, CCT can be used for postoperative follow-up to assess the success of the procedure and detect any potential complications or residual defects.

• #23 Tetralogy of Fallot in the fetus — from diagnosis to delivery. 18-year experience of a tertiary Fetal Cardiology Center | Grzyb | Polish Heart Journal (Kardiologia Polska)

  https://journals.viamedica.pl/polish_heart_journal/article/view/KP.a2022.0129

  Genetic testing with array comparative genomic hybridization should be offered in all cases. […] Prenatal diagnosis of TOF, feasible already in the first trimester of pregnancy, allows cardiologists to fully appreciate these associations, including the most severe forms of the disease, unseen in the postnatal period. […] The leading reason for referral to the echocardiographic examination was an abnormal heart scan during the screening ultrasound (88%); 162 patients (50%) had more than one reason for referral. […] The predominant indication for referral to the fetal echocardiographic examination and time of diagnosis in our study were similar to other reports. Even though TOF may be diagnosed already in the first trimester of pregnancy, a detailed examination is difficult at that time, which may result in an incorrect diagnosis or underestimation of the disease severity.

• #24 Tetralogy of Fallot (TOF) in Adults Differential Diagnoses

  https://emedicine.medscape.com/article/2035949-differential

  When an adult with tetralogy of Fallot (TOF) presents, a wide variation exists in their clinical signs and symptoms, primarily owing to differences in the basic anatomic morphology of the heart and the types of surgical repair performed in infancy. Moreover, the pathophysiology of this condition primarily depends on the severity of the right ventricular outflow tract obstruction (RVOTO). In turn, RVOTO determines the severity of the right-to-left shunting, which is typical. […] Two key reasons for why some individuals with tetralogy of Fallot present much later in life are 1) the perimembranous ventricular septal defect is small (whereas it is usually quite large in children) and 2) the RVOTO is mild. For those who already underwent surgery in childhood, the most common reason for later presentation is pulmonary valve regurgitation. However, other disorders that also should be considered when evaluating an adult patient with tetralogy of Fallot include the following: Endocarditis, Cerebral embolism, Cardiogenic shock, Pulmonary atresia, Ventricular septal defect, Lung disorders (eg, asthma, reactive airway disease), Right heart failure.

• #25 Tetralogy of Fallot – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/tetralogy-of-fallot/symptoms-causes/syc-20353477

  Tetralogy of Fallot is usually diagnosed during pregnancy or soon after a baby is born. […] If the heart changes and symptoms are mild, tetralogy of Fallot may not be noticed or diagnosed until adulthood. […] People who are diagnosed with tetralogy of Fallot need surgery to fix the heart. […] The optimum treatment approach remains controversial, but in general, complete repair is advised in the first three to six months of life. […] The surgical goal is complete repair, which consists of ventricular septal defect closure and relief of right ventricular outflow tract obstruction, which is ideally performed with preservation of pulmonary valve function. […] In general, a residual gradient of 20 to 30 millimeters of mercury across the pulmonary valve is usually well tolerated and permissible.

• #26 Tetralogy of Fallot – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/tetralogy-of-fallot/symptoms-causes/syc-20353477

  In the modern era, repair of tetralogy of Fallot can be performed with very low mortality, in the neighborhood of 1%, and the late survival and quality of life are excellent for the majority of patients. […] The need for diligent lifelong surveillance cannot be overemphasized, so that proper timing of any potential subsequent interventions can be optimized.

• #27

  https://www.pted.org/?id=tetralogyfallot4

  In addition to these non-invasive tests, a cardiac catheterization procedure is often performed to accurately determine the anatomy of the pulmonary artery and coronary arteries so that a repair strategy can be devised. […] Patients after primary surgical repair of Tetralogy in childhood will often require further surgical repairs, especially replacement of the pulmonary valve as a young adult to minimize right ventricular volume overload as a result of the complete pulmonary insufficiency that is a consequence of the Tetralogy repair.

• #28 Tetralogy of Fallot: Nursing Diagnoses & Care Plans | NurseTogether

  https://www.nursetogether.com/tetralogy-of-fallot-nursing-diagnosis-care-plan/

  Tetralogy of Fallot is commonly diagnosed when the child is still a newborn or shortly after. It can sometimes go undetected until adulthood, depending on the severity of the abnormalities and symptoms. […] MRI, ECG, CT scan, and echocardiograms are practical tests for the diagnosis and evaluation of TOF. […] A pediatrician, cardiologist, cardiac surgeon, radiologist, and nurse work as an interprofessional team to diagnose and treat TOF. […] Echocardiography is the gold standard for identifying the location and number of ventricular septal defects, the structure and severity of right ventricular outflow obstruction, and any related abnormalities with the coronary arteries and aortic arch. This test will determine the defects that may affect tissue perfusion in the body. […] Following a complete repair patients must follow up with a pediatric cardiologist regularly. Long-term complications after TOF repair include arrhythmias, leaking valves, and aneurysms. Adults should receive a cardiac evaluation every 1-2 years and tests such as ECGs, stress tests, and MRIs.

• #29

  https://www.pted.org/?id=tetralogyfallot4

  Tetralogy patients after surgical repair usually have a murmur of pulmonary insufficiency (diastolic murmur) and residual pulmonary stenosis (systolic). There may also be a murmur of a residual VSD. Besides the evaluation of the murmur, if present, diagnosis is based on an electrocardiogram (ECG), chest x-ray, MRI (Magnetic Resonance Imaging), echocardiogram, and/or angiography. […] The chest x-ray will usually reveal a normal-sized heart with a distinctive shape, which is caused by right ventricular hypertrophy. The ECG also shows signs of right ventricular hypertrophy, as well as distinctive conduction abnormalities. The overall anatomy of the heart and the defect itself may be seen on the echocardiogram. Angiograms of the two ventricles and aorta will show important details of blood flow.

• #30 Tetralogy of Fallot: Ben’s Story | Children’s Hospital of Philadelphia

  https://www.chop.edu/stories/tetralogy-fallot-bens-story

  Dianas doctor told them there was something wrong with their babys heart. […] A few days later, the couple came to Childrens Hospital of Philadelphia to meet with the clinicians of the world-renowned Fetal Heart Program, who are experts in diagnosing and managing congenital heart disease (CHD) before a baby is born. […] While a prenatal diagnosis of CHD is an incredibly stressful event for expectant parents, it provides them with an opportunity to understand more about the diagnosis, and to learn about treatment options and outcomes. […] In addition, infants who receive a prenatal diagnosis of CHD have been found to be more stable and have better outcomes than those whose CHD is not detected before birth. […] At CHOP, Diana had a fetal echocardiogram through the Fetal Heart Program, which performs more than 3,500 such studies each year.

• #31 Tetralogy of Fallot: Ben’s Story | Children’s Hospital of Philadelphia

  https://www.chop.edu/stories/tetralogy-fallot-bens-story

  She and Corey met with program coordinator as well as pediatric cardiologist Stanford Ewing, MD, who confirmed that their baby had a type of congenital heart disease called tetralogy of Fallot (TOF). […] Ewing explained that their babys left pulmonary artery was not connected to his lung. […] When we first got the diagnosis, says Diana, we had no idea what it was, no idea what it meant. […] Luckily, the couple had the support of the experts in the Fetal Heart Program, who provided them with all of the information they needed. […] Ben was born January of 2006, at the Hospital of the University of Pennsylvania. […] When Ben was 2 days old, Thomas Spray, MD, chief of cardiothoracic surgery at CHOP, repaired the baby’s tetralogy of Fallot and connected his left pulmonary artery to his lung during an intricate open-heart surgery.

• #32 Multimodality Imaging Assessment of Tetralogy of Fallot: From Diagnosis to Long-Term Follow-Up

  https://www.mdpi.com/2227-9067/10/11/1747

  Cardiopulmonary exercise testing (CPET) is currently recommended as part of the follow-up of patients with TOF to monitor patients and support treatment decisions, such as pulmonary valve replacement. […] In conclusion, cardiovascular imaging is crucial to the diagnosis, risk stratification, and short- and long-term management of TOF patients. Several imaging modalities have an established role in this context.

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