Tetralogy of Fallot�is a congenital heart defect which is classically understood to involve four anatomical abnormalities. TOF is classified as a cyanotic heart defect and causes too little oxygen levels in the�blood, which leads to cyanosis (a bluish-purple coloration to the skin).

The classic form of Tetralogy includes 4 malformations which are present together

• A�Ventricular Septal Defect (VSD): a hole between the two bottom chambers (ventricles) of the heart.
• Pulmonary stenosis: a narrowing of the right ventricular outflow tract and can occur at the pulmonary valve (valvular stenosis) or just below the pulmonary valve (infundibular stenosis). Infundibular pulmonic stenosis is mostly caused by overgrowth of the heart muscle wall (hypertrophy of the septoparietal trabeculae),
• Overriding aorta: An aortic valve with biventricular connection, that is, it is situated above the ventricular septal defect and connected to both the right and the left ventricle. The degree to which the aorta is attached to the right ventricle is referred to as its degree of "override." The aortic root can be displaced toward the front (anteriorly) or directly above the septal defect, but it is always abnormally located to the right of the root of the pulmonary artery. The degree of override is quite variable, with 5-95% of the valve being connected to the right ventricle.
• Right ventricular hypertrophy: The right ventricle is more muscular than normal, causing a characteristic boot-shaped (coeur-en-sabot) appearance as seen by chest X-ray.

Symptoms

Infants with this condition usually have a heart murmur that can be heard at birth, or shortly thereafter.�They have a bluish-purple color to the skin, a condition called cyanosis. The child is cyanotic because the blood circulating through the body does not have enough oxygen. Between the ages of 2 months and 2 years, children with Tetrology of Fallot may experience "blue" spells. These spells may be brought on by crying, straining to have a bowel movement, or fever.

A child who has tetrology of Fallot tends to develop slowly, eat poorly, and grow slowly. He or she may get short of breath, especially when exercising. A change in the shape of the fingertips, called clubbing, is another sign of this condition.

Diagnosis

After a complete history and physical exam are done, a variety of imaging tests can confirm the diagnosis.

• An�electrocardiogram�traces electrical activity in the heart muscle. It usually reveals enlargement in the muscles of the right ventricle of the heart, which pumps blood to the lungs.
• A�chest X-ray�shows a characteristic boot-shaped heart of fairly normal size.
• An�echocardiogram�uses sound waves to see a hole in the wall between the two sides of the heart. Narrowing of the pulmonary valve through which blood must pass on its way to the lungs can also been seen with this test.

Treatment

Surgical intervention is required to repair heart defects and is preferred when the patient is very young. A successive surgery may be needed at a later date to widen part of the narrowed pulmonary tract and close the Ventricular Septal Defect.

The other major Cardiac procedures are:

• Coronary Angioplasty
  
• Heart Valve replacement�
  
• VSD (Ventricular Septal Defect Closures) Closures�... etc

Few Major Hospitals for TOF are:

• Narayana Hrudayalaya�
  
• Asian Heart Institute and Research Center
  
• Piyavate Hospital
  
• Florence Nightingale Hospital
  

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