Tetralogy of Faliot: Management Review

Abstract

Material and methods:

Three hundred and twenty eight patients were included in the study.These children were seen at the pediatric outpatient clinic or admitted to the children’s ward at the institute, from October 1980 to December 1983. The hospital charts of all the patients were reviewed in October 1985 in order to evaluate the course of each patient. Clinical examination and investigations of each clinic visit were record ed on a separate examination sheet. Electrocardiogram and chest X-ray were routinely obtained in all patients. The follow up of each patient was concluded at the last clinic visit but prior to October 1985.Those patients in whom pulmonary artery was not adequately imaged by echocardiography underwent cardiac catheterization. Complet correction was undertaken after the age of 4 years of at more than 15 kg body weight, provided pulmonary arteries and left ventricle were of adequate size (2).

Results:

Tow hundred and ninety eight of 328 patients were less than 14 years age and 20 patients were greater than 14 years (mean age 17.5 ± 3 years) at the time of presentation. In 10 of 328 patients ages were not known. Fifty eight patients were less than 1 year of age, mean 0.6 ± 0.3 years, and 240 patients were between 144 years age, mean 6.4± 3.7years,Table. I. Thus of 328 registered patients over the three- year period, 271 (82.4 per cent) survived, including 65 patients who were alive at the last examination but are lost to follow up and fifty seven patients (11.4 per cent) had died. One hundred and twenty six patients (38.4 per cent) survived surgery with greatly improved exercise capacity and 145 (44.2 per cent) survived medical follow up until the time of observation, Table VIII

Discussion:

Analysis of the incidence of various types of heart diseases in children has shown that tetralogy of Fallot is the second most common congenital cardiac malformation encountered at the National Institute of Cardiovascular Diseases, at Karachi (1). Thus pediatric cardiology service management needed to be appropriately modified and expanded to meet the demands of this group of patients. Our date showed that majority of patients who were seen at the cardiovascular institute were significantly symptomatic so that majority of children required surgical correction.   In summary our study has brought the problems of management of this group of children and has radically affected our management policies. It has brought home to us the realization that infrastructure of pediatric cardiology must be built. A great deal of love, care and dedication is required if we are to care for our children.