Tetralogy of Fallot

Published on 21/03/2015 by admin

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Last modified 21/03/2015

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Chapter 77 Tetralogy of Fallot



Several medications may be used to medically manage TOF. The specific medication or combination of medications used depends on the child’s phsyiology. Propranolol (Inderal) is a beta-blocker that may be used to prevent or treat hypercyanotic spells and to treat arrhythmias. Diuretics, such as furosemide, may be used to promote diuresis. Though most children with TOF do not develop CHF because the pulmonic stenosis limits pulmonary blood flow, diuretics may be particularly useful in children with large ventricular septal defects and minimal pulmonic stenosis. In these same children, digitalis may be prescribed to improve cardiac performance by improving contractility and decreasing venous pressures. Further, digitalis slows conduction through the atrioventricular node and can therefore be used to treat selected cardiac arrhythmias (rarely given before correction unless shunt is too large).

Hypercyanotic spells are a medical emergency. A child experiencing a hypercyanotic spell should be placed in a knee-chest position and be given 100% oxygen by face mask. The knee-chest position improves venous return to the heart and therefore improves pulmonary blood flow. Oxygen is a potent pulmonary vasodilator and will also improve pulmonary blood flow. There are several medications that may also be helpful. Morphine is a sedative that decreases irritability, suppresses the respiratory center, and abolishes hyperpnea. Children with hypercyanotic spells quickly become acidotic. Therefore sodium bicarbonate, a potent systemic alkalizer, may be used to treat acidosis.

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