Tetralogy of fallot
Patient (condition)
 
Aliases:
Tetralogy of Fallot (TOF)
TOF

Topic aliases are alternate phrasings for a particular topic.


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Characterised by the presence of :
1. a ventricular septal-defect (VSD),
2. an overriding aorta,
3. right ventricular-outflow-tract-obstruction (RVOT), and
4. right ventricular hypertrophy (RVH).
This is a consequence of the Truncus Arteriosis dividing unevenly into the pulmonary artery and aorta. The pulmonary artery/valve is small, and the aorta extends (overides) over into RV resulting in the VSD.
The elevated RV pressures due to the RVOT obstruction results in RVH.

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Dec 18, 2012
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Enquire about the frequency or severity of cyanotic spells (tet spells)

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Sep 28, 2011
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Ensure regular medication (eg beta blocker) is taken on day of surgery

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Oct 21, 2011
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Book first on list to minimise fasting time and minimise reduction in preload

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Oct 21, 2011
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Avoid factors that increase pulmonary vascular resistance (hypoxia, hypercapnia, acidosis)to avoid reducing the fraction of blood passing through the lungs.

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Feb 20, 2012
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Avoid stressing the baby with Tetralogy of Fallot at induction of anaesthesia to avoid precipitating a sympathetic surge and "tet spell".
If need be use some nitrous to stun the child before turning on the sevoflurane.
#BT

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Dec 13, 2012
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If a cyanotic spell occurs peri-operatively, increase the afterload immediately to favour venous return into the pulmonary circulation.

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Sep 28, 2011
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To rapidly increase the afterload in a child undergoing a cyanotic spell, compress both femoral arteries simultaneously manually, or by flexing the child's hips fully.

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Dec 13, 2012
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Have metaraminol or phenylephrine (1-2mcg/kg boluses) drawn up, as along with fluid bolus, this is a good way to raise systemic pressure and reduce right to left shunting and improve sats. Beta blocker (esmolol) should also be in the room.

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Oct 22, 2011
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Rocuronium is used safely for these cases. Sick Kids (in Toronto) has no vecuronium, and pancuronium is safe with a high dose fentanyl technique since the latter offsets the tachycardia.

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Dec 19, 2011
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Consider avoiding nitrous oxide as this has the potential to exacerbate hypoxia which would raise PVR #ref

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