Fallo tetrad in children

If a baby is diagnosed with some kind of heart disease, this cannot but cause anxiety and anxiety in the parents. Especially if the diagnosis sounds incomprehensible and threatening, for example, Fallot's tetrad. What pathology is hidden behind this name and is it dangerous for a child?

What is it

Fallot's tetrad is one of the congenital heart pathologies, which is a combination of four abnormalities in the development of the heart at once. For the first time such a complex of defects was described by the French doctor Fallot, and therefore the disease bears his name. The tetrad includes such anomalies:

Narrowing of the area through which blood leaves the right ventricle. It can be represented by stenosis of the valves, narrowing under the valves, as well as narrowing of the pulmonary trunk or stenosis of the pulmonary arteries.
Severe defect of the septum separating the ventricles. As a rule, it is tall, that is, located close to the aorta. Due to such a defect, the right parts of the heart connect with the left and the blood mixes.
Displacement of the aorta to the right side, which is called dextraposition. Due to this altered position, the vessel can partially move away from the right ventricle.
A thickening of the right ventricle called hypertrophy. It develops as a result of the difficulty in ejection of blood from this chamber of the heart.

Fallot's tetralogy is diagnosed in every tenth child with congenital heart disease. This pathology occupies about 50% of all defects with blood discharge to the left.

Causes

Fallot's tetralogy is a congenital malformation, since the abnormalities observed with it are formed in utero. The appearance of such a pathology is associated with a violation of the laying of the heart in the first 8 weeks of fetal development, which can provoke:

Infection such as rubella or measles.
Heredity.
Ionizing radiation.
Taking medication, such as sleeping pills or hormonal medications.
Alcohol consumption.
Harmful working conditions.
Drug use.
Chromosomal disease.

Symptoms

The main clinical manifestation of Fallot's tetrad is cyanosis, due to which this pathology is referred to as "blue" heart defects. The time of occurrence of such a symptom and its severity is influenced by the degree of narrowing of the pulmonary artery. If cyanosis appears in the first days of life, this defect is extremely difficult. Most often, cyanosis develops slowly by the age of three months to a year, and in mild cases, its appearance is observed at the age of 6-10 years.

The skin tone of a child with Fallot's tetralogy can be different - both light blue and dark blue or blue-crimson. There is also an acianotic form, in which the skin remains pale. Blue discoloration is first observed on the lips, then on the mucous membranes and fingertips. Further, the child's face turns blue, after which cyanosis spreads to the skin of all limbs and trunk. The shade increases with the activity of the baby.

Another constant symptom of Fallot's tetrad is shortness of breath. The child breathes deeply and arrhythmically, while the breathing rate practically does not increase. Shortness of breath in crumbs with such a pathology is noted at rest, and with any load, even the most minimal, it increases very sharply.

Children with such a defect are gradually lagging behind in physical development. They quickly develop changes in the fingers, which are called "watch glasses" (change in the shape of the nails) and "drumsticks" (change in the shape of the phalanges).

With a severe defect in babies under 2 years old, they are diagnosed with attacks of shortness of breath and cyanosis, the occurrence of which provokes severe brain hypoxia. During these attacks, children lose consciousness and the risk of coma and death increases. The duration of an attack ranges from 10 seconds to several minutes. After the attack, the baby is lethargic and weak. Sometimes cerebral ischemia or hemiparesis develops.

Phases

In the clinical course of Fallot's tetrad, the following stages are distinguished:

Phase 1 - lasts from birth to 6 months of age. Since the child is feeling well, this phase is called the state of relative well-being. Developmental delays are not observed at this age.
Phase 2 - lasts from 6 months to 2 years of age and is characterized by the appearance of attacks of shortness of breath and cyanosis. During this phase, frequent cerebral complications and deaths are noted.
Phase 3 - starts at 2 years of age. Seizures become less and less frequent and disappear due to the development of collaterals.

Diagnostics

Examination of a child suspected of having Fallot's tetrad begins with an examination. The chest of such babies is often flattened, and there is no hump. Listening to the heart of the crumbs, the doctor diagnoses a gross murmur in systole to the left of the sternum. Additional methods for detecting a defect are:

Ultrasound of the heart. Anatomical defects are identified, which are referred to as a tetrad.
Chest X-ray. The shadow of the heart in the picture resembles a shoe or felt boot.
ECG. The axis of the heart deviates to the right, signs of an increase in the right heart and conduction disturbances are revealed.
Heart sounding. An increase in pressure in the cavity of the right ventricle is revealed, as well as a low oxygen saturation of arterial blood.
Aortography. Displacement of the vessel and the presence of collaterals are detected.

Treatment

When Fallot's tetrad is detected, the child is shown only surgical treatment, which is:

Palliative surgery. It is performed in the first stage for babies under three years old to relieve their condition and increase blood flow to the lungs. For this, anastomoses can be created or the valve leaflets can be dissected.
A radical operation. It is carried out 2-6 months after the first, connecting the baby to an artificial blood flow and cooling his body. During the intervention, the stenosis in the right ventricle is eliminated and a patch is sewn to the interventricular septum.

In the postoperative period, attention is paid to strengthening the myocardium and reducing the load on the heart. The child is prescribed remedial gymnastics and a diet that allows him to quickly recover from surgical treatment.

Forecast

If the severe tetrad of Fallot is not treated, 25% of children with this pathology die before the age of one year. The rest of the kids live on average 12 years and only about 5% of patients with this defect live up to 40 years. The most common cause of death is brain damage due to the formation of a blood clot or abscess.

Surgical treatment at an early age is highly effective. Children after surgery are active and tolerate physical activity well. They should be monitored by a cardiologist, and for any surgical and dental manipulations such children are given antibiotics to prevent the appearance of endocarditis.