A ventricular septal defect is a hole in the septum that causes oxygen-rich blood (left ventricle) and the oxygen-poor blood (right ventricle) to mix. Tetralogy of Fallot | Riley Children's Health More About TOF. Santoro G, et al. Tetralogy of Fallot is one of the commonest forms of cyanotic congenital heart disease, accounting for 7-10% of all congenital cardiac malformations with an incidence of one in 3,500 live births.1 Whilst ToF was recognised as a series of malformations in 1671, it was named after the French physician Etienne-Louis Fallot, who reported the . This heart defect is usually detected weeks or months after birth. 1993;11:643-50. By continuing to browse this site you are agreeing to our use of cookies. Provide patient with calm and quiet environment for relaxation. Your doctor can also diagnose it shortly after birth if they hear a murmur during a heart exam or if the baby's skin color is bluish. Stenosis at or below the pulmonary valve, or pulmonary valve atresia (absent pulmonary valve can occur but is rare). Infants with cyanosis should be evaluated for underlying heart problems. Monitor vital signs, peripheral pulses, capillary refill by comparing measurements at both extremities while standing, sitting and lying down if possible. Symptoms of tetralogy of Fallot. Overriding aorta—An aorta (blood vessel) that lies over the hole in the lower chambers. They kindly shared their personal experience and lessons learned over the years. This book is beneficial for all the professionals working in the prenatal diagnosis. This practical book describes a systematic approach to the ultrasound examination of the fetal heart based on accepted screening recommendations. This book provides comprehensive insights into congenital heart disease from embryonic development through to clinical features, including human genetics and our current knowledge of the underlying molecular pathways. Infants with cyanosis should be evaluated for underlying heart problems. Patients must rely on the personal and individualized medical advice of their qualified health care professionals before seeking any information related to their particular diagnosis, cure or treatment of a condition or disorder. Echocardiography 2013; 30:81. When early repair is not possible, other surgical measures may be taken during infancy or early childhood. This may come in sudden spells, called TET spells. What are the symptoms of tetralogy of Fallot? 2001;104:2565-68. An echocardiographic study of tetralogy of Fallot in the fetus and infant. Tetralogy of Fallot (TOF) is a combination of these four heart defects that are present at birth: Ventricular septal defect (VSD)—A hole between the lower chambers of the heart. Episodes of severe symptoms or “blue spells” (hypoxia) may require the administration of supplemental oxygen, morphine, and/or other drugs that improve oxygen concentration. Learn about the symptoms, life expectancy, surgery, and treatment for this condition. Patients typically present with cyanosis and/or a murmur. Frequently, an EKG is also performed to evaluate the heart's electrical activity, heart rate and rhythm. Last Updated July 1, 2011. http://www.nhlbi.nih.gov/health/health-topics/topics/tof. Philadelphia, PA: W.B. Infants with this disorder usually have a relatively loud murmur over the upper left breastbone. Tetralogy of Fallot (TOF) is a congenital heart defect. In extreme situations, infants may pass out. Tetralogy of Fallot. Antibiotics may be prescribed to infants with tetralogy of Fallot to help prevent infections (prophylaxis) because children with this disorder are susceptible to bacterial infection of the heart (endocarditis). The aorta (the main artery that carries blood from the heart) lies over the hole between the two lower chambers. Babies and children with Tetralogy of fallot usually have blue skin because their blood does not have enough oxygen. Most cases are diagnosed and treated during infancy. renal anomalies and many others) (~15–20%). These may include mild anemia in infants, abnormal increase in the number of red blood cells (polycythemia) in older children, and blood clotting (coagulation) defects. Materials and methods: We evaluated 142 patients in our pediatric heart center and prenatal diagnosis center and prenatal practice . It happens when blood oxygen level drops quickly. As with many congenital heart defects, signs and symptoms of tetralogy of Fallot typically appear right after or within a few weeks of birth. Tetralogy of Fallot symptoms vary, depending on the amount of blood flow that's blocked. Accessed August 18, 2016. Please note that NORD provides this information for the benefit of the rare disease community. Tetralogy of Fallot or TOF is a congenital (present since birth) heart defect that affects the normal flow of blood in the heart. Preoperative management of neonatal tetralogy of Fallot with absent pulmonary valve syndrome. A common genetic condition with tetralogy of Fallot (seen in about 15–20 % of cases) is deletion 22q11, a condition in which a small part of chromosome 22 is missing. 2 Symptoms. What are major problems with TOF with absent pulmonary valve. A fetal echocardiogram is an ultrasound of the . 1) Lots of pulmonary regurgitation. This book, written by internationally recognized experts in fetal echocardiography, is a must-have for physicians and sonographers interested in this field. “subaortic”, “perimembranous”). Tetralogy of Fallot is a rare congenital malformation of the heart that occurs more frequently in males than females. Some infants with tetralogy of Fallot may experience episodes of severe cyanosis and breathing difficulty (paroxysmal hypercyanotic attack or âblueâ or âtetâ spells). Digilio MC, et al. ), Ventricular septal defects (VSDs) are a group of common congenital heart defects characterized by the absence of one ventricle. It is usually below the valve (known as infundibular narrowing or sub-PS)) The muscle of the right ventricle is thicker due to the right side of the heart receiving excessive blood flow from the left side of the heart through the ventricular septal defect and working harder. The physical exam entails assessing the cardiopulmonary system with stethoscopes, assessing for signs and symptoms related to heart failure and the general appearance (Ali et al., 2018). AnläÃlich eines Besuches bei Sir RussELL BROCK in London im Herbst 1956 und während eines Aufenthaltes seines Schülers Donald Ross im Frühjahr 1958 in Marburg a. d. Ann Thorac Surg. Prenatal diagnosis of tetralogy of Fallot. NORD is a registered 501(c)(3) charity organization. Tetralogy of Fallot may be diagnosed with fetal echocardiogram (ultrasound) before your baby is born. Tetralogy of Fallot Epidemiology: Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease in all age groups, constituting approximately 8% of congenital heart disease overall. Information on Clinical Trials and Research Studies, COVID-19 Rapid Response Leadership Series, 5 Myths About Orphan Drugs and the Orphan Drug Act, Congenital Heart Information Network (C.H.I.N. Found inside â Page 826Rowlatt UF: The quantitative anatomy of cyanotic tetralogy of Fallot. Circulation I964;30:53I. 77. DeVore GR. Siassi B, Piatt LD: Fetal echocardiography. VIII: aortic root dilatation â a marker for tetralogy of Fallot. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Poor weight gain. It's also known as "tet." The "tetra" in the name of the condition comes from the four . Heart Disease. Now, about 90% of children with this condition grow to adulthood and lead active lives. The most common symptom is a blue color of the skin, lips, and nail beds. 2003;19:685-89. NORD is not a medical provider or health care facility and thus can neither diagnose any disease or disorder nor endorse or recommend any specific medical treatments. When affected babies cry or have a bowel movement, they may develop a "tet spell" where they turn very blue, have difficulty breathing, become limp, and occasionally lose consciousness. Serve foods that are easily digestible and reduce the consumption of caffeine. {{configCtrl2.info.metaDescription}} This site uses cookies. Echocardiographically guided repair of tetralogy of Fallot. Give a balanced diet high in nutrients to achieve adequate growth. Periodic measurements of systemic blood oxygen saturation and hemoglobin are also advisable. Diagnosis of Tetralogy of Fallot: Echocardiogram: Congenital heart defects are now diagnosed with echocardiography, which is a painless test that uses sound waves to create a moving picture of the heart. Fully 40% more illustrations than the first edition, and 40% more text, reflecting the numerous advances in pediatric radiology over the last several years. Expanded coverage of interventional radiology, trauma and tumours. What are the symptoms of tetralogy of Fallot? http://www.nlm.nih.gov/medlineplus/ency/article/001567.htm. National Heart, Lung & Blood Institute. 2001;10:163-69. In cases of tetralogy of Fallot, always look for other birth defects and signs of genetic syndromes: Look for and document extracardiac birth defects: In deletion 22q11, the heart anomaly can be associated with several internal and external anomalies, including cleft palate, spina bifida, vertebral anomalies, or other defects. J Thorac Cardiovasc Surg. Tetralogy of Fallot (TOF) is a common defect in which obstruction to the flow of blood from the heart to the lungs causes low oxygen levels in the blood. Provide frequent rest periods and periods of uninterrupted sleep. At CHOP, Diana had a fetal echocardiogram through the Fetal Heart Program, which performs more than 3,500 such studies each year. 1993;55:172-74. Symptoms. Other treatment is symptomatic and supportive. Long-term outcome in patients undergoing surgical repair of tetralogy of Fallot. Tetralogy of Fallot is a common syndrome of congenital heart defects. Thorac Surg. This condition gets in the way of the heart's ability to pump oxygen-rich blood to the body. Surgery for tetralogy of Fallot at less than six months of age. Assess patient’s general condition to note for any abnormalities and deformities present within the body. Tetralogy of Fallot (TOF), historically and appropriately referred as Steno-Fallot tetralogy, was first described by the Danish physician/anatomist Dane Niels Stensen, also referenced as Nicoulas Steno in Latin, a pioneer in anatomy and geology. Infants with the complete form of the defect usually develop congestive heart failure. The first book of its kind, this reference describes current diagnostic and treatment strategies for acute and chronic heart failure in the fetus, neonate, child, and young adult-encompassing every aspect of pediatric heart failure ... It happens when a baby's blood oxygen level drops quickly. A computer converts the sound waves into pictures . There is a hole between the lower chambers of the heart (the "ventricles"). Other symptoms may include a heart murmur, easy fatigability, poor appetite, slow weight gain, heart murmurs, an abnormal increase in the numbers of red blood cells (polycythemia), fingers and toes with wide, enlarged tips and overhanging nails (clubbing), and/or delayed physical growth. Childhood is the ideal time for operation. Tetralogy of Fallot is a rare, complex congenital (present at birth) heart defect. Cardiol Clin. NORD gratefully acknowledges Mary C. Mancini, MD, PhD, Department of Surgery, Louisiana State University Health Sciences Center, for assistance in the preparation of this report. A congenital heart defect is a problem with the heart's structure that's present at birth. Fully revised and updated, the book includes sections considering the changes in pathophysiology with growth into adulthood and the effects of various treatment approaches. Clinically, the classic presentation is a newborn who becomes progressively cyanotic (blue tinge most evident in the lips, nose and extremities), either constantly or intermittently, and continues to decompensate. Allow the child to organize his own space and limitation of activity because the child will rest when tired. During the spell, babies may have a hard time breathing. Educate the family about the disease process. Birth Defects Encyclopedia. It is made up of four anatomical malformations, hence the prefix tetra, which denotes a four part event. When tetralogy of Fallot is present, x-ray studies usually reveal a normal-sized heart that is characteristically boot-shaped (coeur en sabot). 1) Classic. Diagnosis is mainly by echocardiogram. History. The most severe form of tetralogy of Fallot is known as pseudotruncus arteriosus. McKusick VA, ed. Comparisons may be useful for a differential diagnosis: Atrial septal defects (ASDs) are common congenital heart defects characterized by the presence of a small opening between the two atria of the heart. The exact cause of tetralogy of Fallot is not known. Medscape. A diagnosis can be made by an echocardiogram, which is an ultrasound that shows the structural abnormalities associated with tetralogy of Fallot. truncus arteriosus). Manage the time and procedures to be done on the patient at one time to provide enough rest for the patient. 1-ranked heart program in the United States - Cleveland Clinic The goal of this book is to help general cardiologists, but also pediatricians and related care providers in the management and diagnosis of adult CHD. The blood returns to the heart through pulmonary veins and enters the left ventricle. The diagnosis of tetralogy of Fallot is confirmed by clinical evaluation and physical examination. Although tetralogy of Fallot is not preventable, timely management can prevent complications and improve the quality of life in babies. It may also be valvular, supravalvular, or, frequently, a combination of levels of obstruction. The discovery of the constellation of findings that hallmark . The second edition of the well respected Nadas' Pediatric Cardiology includes all tools for diagnosis and management of the pediatric patient with heart disease. Tests to diagnose tetralogy of Fallot include: Oxygen level measurement (pulse oximetry). These defects lead to an increase in the workload on the right side of the heart as well as excessive blood flow to the lungs. Tetralogy of Fallot involves a defect in the heart structure that arises while the baby is still in the mother's womb. Therefore, whenever possible it is wise to postpone operation until childhood.An infant with a tetralogy of Fallot may not be cyanotic at birth. This book presents a systematic overview of the most common cardiovascular defects as they are observed in adults, with a particular focus on the long-term effects and issues that may arise following surgical or interventional repair. Therefore, researchers suspect that something may affect the genes in the developing fetus, causing this birth defect, but the exact nature of this trigger is not known. Evaluations for tetralogy of Fallot are based on the signs and symptoms of the baby, physical examination results, and tests and procedures. While tetralogy of Fallot can be suspected prenatally, it can be easily missed or misdiagnosed; therefore, postnatal confirmation is imperative. Children are born with this condition. 2002;12:549-53. AU - Yamamura, Yasuko. During the spell, babies may have a hard time breathing. Diagnosis of Tetralogy of Fallot (TOF) Sometimes, a doctor will diagnose TOF while the baby is still in the mother's uterus when a fetal ultrasound displays a heart abnormality. The information in NORD’s Rare Disease Database is for educational purposes only and is not intended to replace the advice of a physician or other qualified medical professional. Outflow reconstruction of tetralogy of Fallot using a Gore-Tex valve. Tetralogy of Fallot is the most common form of cyanotic congenital heart disease, and one of the first to be successfully repaired by congenital heart surgeons. Tetralogy of Fallot (TOF or "TET") is a combination of four congenital heart defects, including: Ventricular septal defect (VSD) - an opening in the ventricular septum, or dividing wall between the two lower chambers of the heart known as the right and left ventricles. Accessed August 18, 2016. His work made significant contributions to the field of cardiac anatomy and pathology. Goal: Families can face a child with positive symptoms. cleft palate, spina bifida) and internally (e.g. Procedure – specify whether the cardiac findings are from a prenatal or postnatal echocardiogram, or from other investigations (e.g. Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. Some people with ASDs may be at increased risk for the formation of blood clots that can travel to the major arteries (embolism), blocking blood circulation. MedlinePlus. TOF is usually diagnosed in infancy or early childhood, however patients with mild abnormalities ("pink" Tets) may be diagnosed later, as adolescents or adults. Symptoms can occur a bit differently in each child. The VSD is large, and the pulmonary stenosis is most commonly subvalvular or infundibular. These blood abnormalities may lead to the formation of blood clots that can travel through the blood stream (embolisms). Symptoms of the following disorders can be similar to those of tetralogy of Fallot. A patient with a tetralogy of Fallot may be greatly improved by operation. Circulation. Objectives: To correlate prenatal echocardiographic findings with infant outcome in a large screening population affected by tetralogy of Fallot. History. ; There is an obstruction or narrowing of the pulmonary artery that goes from the heart to . Patients typically present with cyanosis and/or a murmur. This atlas of echocardiography presents more than 100 cases of adult congenital heart disease, from diagnosis to treatment follow-up. Co-oximetry, ABG paired with pulse oximetry. Serum methemoglobin levels. Tetralogy of Fallot is a group of 4 congenital heart defects. Infants with these defects may have 2 atria and 1 large ventricle. Your baby's skin may appear blue. Tetralogy of Fallot (TOF) is a combination of these four heart defects that are present at birth: Ventricular septal defect (VSD)—A hole between the lower chambers of the heart. Tetralogy of Fallot is a congenital heart condition, meaning children are born with it. During the spell, babies may have a hard time breathing. Tetralogy of Fallot is the most common heart defect in children which ultimately leads to the child's blood not being fully oxygenated. The pulmonary veins, returning blood from the lungs, drain into this extra âthird atrium.â The symptoms of cor triatriatum vary greatly and depend on the size of the opening between the chambers. Teach families to recognize the signs of complications. The primary aim in the surgical management of heart disease is an accurate diagnosis. This is achieved by a thorough clinical examination combined with the appropriate special investigations. 2) TOF with pulmonary atresia. A chest radiograph and a careful clinical examination might suggest the diagnosis; however, a definitive diagnosis is done by echocardiography. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Affected infants may have difficulty breathing (dyspnea); as a result, they tend to play for short periods and then rest. Temporary surgery may be recommended babies are too weak or small to have the full repair surgery; the full repair surgery will be performed when the baby is stronger. TOF occurs in approximately 0.19‐ 0.26/1,000 live births. ), Centers for Disease Control and Prevention. Tetralogy of Fallot is a common congenital heart disorder that is a combination of four different heart defects: . 1993;329:593- 99. Monitor vital signs ; respiration rate, pulse rate and blood pressure to obtain as baseline data to detect any change. Aorta overriding (sitting above the) ventricular septal defect. Maternal pregestational diabetes is a modifiable risk factor for tetralogy of Fallot and other conotruncal conditions (e.g. Tetralogy of Fallot (TOF) is a congenital heart defect that can be fatal if it's left untreated. Infants with this form of the disorder experience severe symptoms that relate to the profound obstruction of the right ventricular blood flow and severe underdevelopment of associated blood vessels and valves related to the lungs (pulmonary atresia). Pulmonary stenosis is when the pulmonary valve cannot open fully, making the heart work harder and results in a lack of blood reaching the lung. catheterization, MRI) and are used in specific, more complex cases to help with management. A pilot study of exercise training in adult patients with repaired tetralogy of Fallot. These defects, which affect the structure of the heart, cause oxygen-deficient blood to flow from the heart to the rest of the body. Individuals may print one hard copy of an individual disease for personal use, provided that content is unmodified and includes NORD’s copyright. Leading heart surgeons (including the President of the Royal College of Surgeons) bridge the ever-widening gap between the "student" (both pre- and post-graduate) and an increas- ingly remote group of medical and surgical specialists in ... This book is targeted to trainees and established interventional cardiologists alike, and is intended as a comprehensive reference for the clinical practice of diagnostic and interventional cardiology in pediatric and congenital heart ... After surgery, most children will live healthy lives. Includes updated illustrations throughoutânearly 1,000 echocardiograms, Doppler tracings, anatomic drawings, and flow charts for diagnostic approachesâas well as hundreds of echo video clips keyed to images in the text. A Textbook of Cardiovascular Medicine. Signs and symptoms may include: A bluish coloration of the skin caused by low blood oxygen levels (cyanosis) Shortness of breath and rapid breathing, especially during feeding or exercise. Echocardiography is the definitive investigation for diagnosis of TOF and should be ordered in any newborn with a suspected diagnosis of congenital heart disease. 4) TOF with AV canal defect. This book provides a concise yet comprehensive source of current information on Down syndrome. Research workers, scientists, medical graduates and paediatricians will find it an excellent source for reference and review. The Social Security Administration (SSA) uses a screening tool called the Listing of Impairments to identify claimants who are so severely impaired that they cannot work at all and thus immediately qualify for benefits. Baltimore. Because large amounts of oxygen-poor (blue) blood can flow to the body under certain circumstances, one of the symptoms of tetralogy of Fallot is blueness (blue color of the skin, lips and nail beds) that occurs with such . Collaboration in the examination serial ECGs, chest radiographs, administration of anti dysrhythmias. Tetralogy of Fallot is the most common form of cyanotic congenital heart disease. Tetralogy of Fallot (TOF) is a congenital cardiac malformation. Goal: Children can maintain adequate cardiac output. The key morphological abnormality is anterior and cephalad deviation of the muscular outlet of the ventricular septum, which causes the 4 classic findings: (1) a mal-alignment ventricular septal defect (VSD), (2) aorta over-riding the VSD, (3) right ventricular outflow tract obstruction, (4) secondary concentric right ventricular . A patch covers the hole in the septum to repair the ventricular septal defect. Babies with Tetralogy of Fallot may have bluish skin because of decreased oxygen in the blood. Tetralogy of Fallot (TOF) is a congenital heart defect. N Engl J Med. In some cases, the connection between the aorta and the pulmonary artery, which normally closes before birth, may remain open (patent ductus arteriosus). The tube is removed during the full repair surgery. Other symptoms may include a bluish discoloration of the skin (cyanosis), poor feeding habits, abnormally rapid breathing (tachypnea) and heart rate (tachycardia), and/or excessive sweating (hyperhidrosis). Signs and Symptoms of Tetralogy of Fallot. It happens when a baby's blood oxygen level drops quickly. Ventricular septal defects are usually severe in this form of the disorder. 1997;34:188-90. Other symptoms may include poor feeding habits, abnormally rapid breathing (tachypnea), and/or an abnormally rapid heartbeat (tachycardia). Prenatal. Many babies with Tetralogy of Fallot (TOF) will not have symptoms. Since the first procedures in the 1950s, advances in the diagnosis, perioperative and surgical treatment, and postoperative care have been such that almost all those born with tetralogy of Fallot can now expect to survive to adulthood. Although tetralogy of Fallot is not preventable, timely management can prevent complications and improve the quality of life in babies. Children usually show symptoms of the condition and are diagnosed shortly after . Echocardiography is the definitive investigation for diagnosis of TOF and should be ordered in any newborn with a suspected diagnosis of congenital heart disease. The definitive text on fetal cardiology, and already the standard reference work in the subject, this book is edited by a transatlantic team of extremely well-known and highly respected fetal cardiologists, with individual chapters written ... Tetralogy of Fallot is a structural heart anomaly characterized clinically by cyanosis, and anatomically by an obstructed right ventricular outflow tract associated with a ventricular septal defect (see Fig. Tetralogy of fallot is a rare condition caused by a combination of four congenital heart defects. Written by Dr. Filip Kucera, a pediatric cardiology consultant at Great Ormond Street Hospital, Atlas of Pediatric Echocardiography provides "next level" guidance for clinicians who want to improve their echocardiographic skills. The normal heart has four chambers. However, even if you were treated as a child, you'll require lifelong monitoring for future complications. Tetralogy of Fallot might be seen during an ultrasound (which creates pictures of the body). catheterization, MRI), surgery, or autopsy. Tetralogy of Fallot is due to abnormal septation of the truncus arteriosus into the aorta and pulmonary artery that occurs early in gestation (3-4 weeks). T1 - Fetal Diagnosis of Tetralogy of Fallot with Absent Pulmonary Valve Syndrome: Role of Fetal MRI. Recurrence risk figures for isolated tetralogy of Fallot after screening 22q11 microdeletion. ), Cor triatriatum is an extremely rare congenital heart defect characterized by the presence of an extra chamber above the left atrium of the heart. Pulmonary congestion may lead to difficulty breathing (dyspnea). Children should be given antibiotics at times of predictable risk (e.g., tooth extractions and surgery). 3) TOF with absent pulmonary valve. Cases should be confirmed by a cardiologist with expertise on congenital heart disease. highly variable, from mild stenosis to cases in which pulmonary valve atresia is present. ), Genetic and Rare Diseases (GARD) Information Center. This latest edition features completely updated content, including new information for nurses and nurse practitioners who, now more than ever, are playing an important role in the care of adults with CHD. Approximately 25 percent of infants with tetralogy of Fallot also have other congenital birth defects that are not related to the function or structure of the heart. New in this edition are chapters on exercise testing, MRI, EP studies and catheter ablation of arrhythmias, extracorporeal circulatory support and paediatric lung transplantation. Walker WT, et al. This may occur while the child is at rest or crying. AU - Aldoss, Osamah. Certain genetic syndromes are associated with an increased incidence of TOF, such as DiGeorge and Down syndromes. Tetralogy of Fallot (TOF) is a heart defect that occurs when a child is born with four different heart problems. The Visual Guide to Neonatal Cardiology is a comprehensive, highly illustrated, reference covering the evaluation, diagnosis and management of cardiac disease in the newborn. Tetralogy of Fallot (TOF) is the most common 1 cyanotic congenital heart disease thus it's important to have a good understanding of the condition. The original text and illustrations are enhanced by color prints of fifty-five specimens in the Abbott Collection of the McGill Pathology Museum. AU - Holm, Tara L. AU - Narasimhan, Shanti L. PY - 2018. A characteristic squatting position may be assumed to help assist breathing. The drug propranolol may be given to help prevent future spells and to reduce their severity. Diagnosis. Tetralogy (teh-TRAL-o-je) of Fallot (fah-LO) is a congenital heart defect. Heinemann MK, et al. TEXTBOOKS Buyse ML, ed. Breathing faster than usual. Cor triloculare biatriatum is an extremely rare congenital heart defect characterized by the absence of one ventricle. As the name implies, it is a tetrad of: TOF occurs in up to 10% of all congenital heart diseases (CHD) 1 with a prevalence of 3-6 per 10,000 births 4. Yamagishi M, et al. Difficulty in feeding may be the initial . Diagnosis of Tetralogy of Fallot. Tetralogy of Fallot is in fact a spectrum of diseases and might be clinically severe or mild, depending on the degree of obstruction in the right ventricular outflow tract. Pulmonary stenosis—A narrowing or thickening of the valve that connects . It is characterized by the abnormal narrowing of the opening of the mitral valve. This may come in sudden spells, called TET spells. In some situations, it may be associated with certain genetic syndromes like DiGeorge syndrome, also known as 22q11.2 Deletion Syndrome.
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