Tetralogy of Fallot

Table of Contents

Tetralogy of Fallot (ToF) is a condition caused by a combination of four congenital heart defects. ToF affects the structure of the heart, causing the blood that is pumped throughout the body to not contain enough oxygen. Tetralogy of Fallot is a rare condition and occurs in 1 in 2,500 births. The combination of heart defects are:

  • Ventricular septal defect (VSD); refers to a condition where there is a hole between the walls of the heart chambers
  • Pulmonary stenosis; causes the pulmonary heart valves to become rigid, stiff and narrows blood flow to the heart
  • Overriding aorta; when the main blood vessels from the left ventricle are positioned in the ventricular septal opening / walls between chambers
  • Right ventricular hypertrophy; thickening and enlargement of the muscles in the right ventricle

Causes of Tetralogy of Fallot

Tetralogy of Fallot develops since pregnancy. The exact cause of this congenital heart disease is unknown. However, there are several risk factors that can lead to the development of Tetralogy of Fallot:

  • Measles (Rubella) virus that infects the mother during pregnancy
  • Maternal age over 40 years
  • Pregnant women with diabetes
  • Alcohol consumption during pregnancy
  • Family members who suffer from similar congenital heart diseases
  • Born with a congenital disorder such as Down Syndrome
  • Malnutrition during pregnancy

When to See a Doctor for Tetralogy of Fallot?


The diagnosis of Tetralogy of Fallot is often made when a baby is 8-16 weeks old. Tetralogy of Fallot can be detected shortly after the baby is born. A baby with this condition usually experiences shortness of breath and bluish coloration of the skin (fingernails and toes). To provide the diagnosis of Tetralogy of Fallot, a pediatrician will conduct a detailed interview regarding the mother’s medical history during pregnancy and the family’s health history of hereditary diseases. A physical test and additional tests will also be required to establish a diagnosis of Tetralogy of Fallot.

Physical test involves reviewing the patient’s clinical condition. Babies with Tetralogy of Fallon have blue-tinged skin, shortness of breath, and growth & development disorders. In addition, a cardiologist will listen to the baby’s heartbeat through a stethoscope. Babies with this condition will produce a heartbeat alongside extra heart sounds.

Additional tests for Tetralogy of Fallot are:


Echocardiography is a test using sound waves (ultrasound) to detect abnormalities in the valves and heart muscle.

Electrocardiography (EKG)

EKG aims to determine the flow of electricity in the heart and detect abnormalities in heart rhythm and structure.

Chest X-Ray

This examination can help doctors observe the condition of the lungs and heart.

Blood Tests

This blood test is performed to determine the patient’s clinical condition. The blood gas analysis is to describe the patient with a hypoxic condition (lack of oxygen).

Symptoms of Tetralogy of Fallot

The symptoms of Tetralogy of Fallot in infants are: 

  • Shortness of breath during feeding and when crying
  • Clubbing of fingers and toes (drumstick-shaped fingers)
  • Bluish cheeks, lips, fingernails and toes
  • Slow growth
  • Poor weight gain

Treatment for Tetralogy of Fallot

Treatment for Tetralogy of Fallot is done through a surgical procedure. However, surgery can only be done after the baby turns one year of age to reduce complications later as an adult. In general, babies who undergo surgery can live normally, but this does not rule out minor complications or even death risks. The following complications can occur:

  • Arrhythmia
  • Ventricular septal defect
  • Coronary heart disease
  • Enlarged aorta
  • Sudden cardiac arrest
  • Blood flows from the lungs to the right ventricle.

Treatment Cost for Tetralogy of Fallot

The treatment cost for Tetralogy of Fallot is often determined after the pediatrician understands the patient’s condition. Smarter Health can help you find specialist doctors and hospitals within your treatment budget.

Prevention of Tetralogy of Fallot

Preventive measures that can be undertaken include:

Maintain health during pregnancy

Staying healthy during pregnancy is very important to maintain the health of the fetus. To reduce the risk of developing Tetralogy of Fallot, avoid medications that are not recommended by your doctor. Radiation exposure during pregnancy can also increase the risk of your baby developing congenital heart disease.

Get comprehensive vaccinations

Getting a health screening and vaccination for the TORCH virus (Toxoplasma, Rubella, Cytomegalovirus and Herpes) can help prevent viral infections that cause heart defects in infants.

Check family’s medical history

Pregnant women need to pay attention to their sugar consumption. The blood sugar levels must be within normal limits during pregnancy. In addition, mothers over the age of 40 are at greater risk of giving birth to children with congenital heart defects. Another factor to consider is family health history – such as diabetes, genetic disorders, Down syndrome, and heart disease.

Get Fetomaternal Ultrasound

Fetomaternal ultrasound serves to identify heart defects in the fetus. 

Prevention is better than cure – thus, get regular check ups for you and your child to identify your current health condition. The sooner you know, the earlier you can take necessary steps for you to stay healthy. 

Home Care for Patients Diagnosed with Tetralogy of Fallot

Caring for a family member with Tetralogy of Fallot may not be an easy task. You must be able to regulate a healthy lifestyle such as adjusting a healthy diet, constantly monitoring breathing patterns, advising the patient to reduce strenuous activities, as well as reminding and taking the patient to regularly consult with a pediatric cardiologist (pediatric cardiology).

A healthy lifestyle can help patients with heart defects get adequate nutrition. Families must also protect patients from exposure to polluted air, which will interfere with breathing patterns.

Patients with heart defects can easily feel tired and experience shortness of breath. Therefore, patients with heart defects need to be monitored to prevent them from doing strenuous activities that can trigger shortness of breath.

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