TETRALOGY OF FALLOT: ESPECIALLY THE CARE OF THE CYANOTIC INFANT AND CHILD

Abstract

A patient with a tetralogy of Fallot may be greatly improved by operation. Childhood is the ideal time for operation. In infancy the mortality rate is high and the long-time results are less satisfactory. Therefore, whenever possible it is wise to postpone operation until childhood. An infant with a tetralogy of Fallot may not be cyanotic at birth. Difficulty in feeding may be the initial complaint. Digestion is difficult; small and frequent feedings are usually indicated. Attacks of cyanosis and paroxysmal dyspnea are prone to occur as the ductus arteriosus undergoes obliteration. Paroxysmal dyspnea is best treated by placing the child in a kneechest position. If this does not give immediate relief, morphine should be used. A dose of 1.0 mg./5 kg. body weight is almost specific for the relief of paroxysmal dyspnea. Anemia is treated by blood transfusions. Cerebral thromboses when they occur in an infant with polycythemia should be treated with oxygen, venesection and the replacement of blood by plasma, 5% glucose or saline solution. Heparin may be a great help in the prevention of residual cerebral thrombosis. If an infant is in great danger of dying of anoxemia, surgery holds the possibility of tremendous benefit. Two such cases are cited.