Medical Management of Hypercyanotic Spells in Fallot’s Tetrology

Abstract

Material and Methods:

The study includes 45 patients with TOF who presented with cyanotic spells from amongst 142 TOF patients seen at the Congenital Heart Clinic at National Institute of Cardiovascular Diseases, Karachi, during one year period between October, 1980 to October, 1981. Infants less than three months of age were admitted in the hospital during initial phase of Propranolol therapy. All children with inadequate response to Prop ranolol were studied by Cardiac Catheterizat ion and subjected to either corrective surger.y or aorto-pulmonary shunt.

Results:

Tetrology of Fallot was present in 142 of 814 new patients seen at the National Institute of Cardiovascular Diseases, Karachi between Octob er, 1980 to October, 1981. Forty Five patients, iuean age 3.4±2.9 years (Range 0.3 -10 years) presented with hypercyanotic spells. Nine patients were older than five years of age (Table I).

Discussion:

The management alternativcs of Patients with Tetrology of Fallot depends upon the individual institution’s surgical expcrtisc8 . There are a few Centres in the World where surgical corr ection of infants with TOF can be sefely undertaken under I year of age10 11• adequate. Presently we increase the dose of Propranolol by increasing the daily frequency of administration to six hourly schedule and when this is achieved individual doses are increased in accordance with the period of the day the spells occur. Our follow up period is short and the study is continuing to determine as to the maximum period of palliation with Propranolol.