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Effective management of tetralogy of Fallot necessitates prevention and treatment of complications, measures to relieve cyanosis, and palliative or corrective surgery. During cyanotic spells, the knee-chest position and administration of oxygen and morphine improve oxygenation. Propranolol (a beta-adrenergic blocking agent) may prevent blue spells.
Palliative surgery is performed on infants with potentially fatal hypoxic spells. The goal of surgery is to enhance blood flow to the lungs to reduce hypoxia; this is often accomplished by joining the subclavian artery to the pulmonary artery (Blalock-Taussig procedure). Supportive measures include prophylactic antibiotics to prevent infective endocarditis or cerebral abscess administered before, during, and after bowel, bladder, or any other surgery or dental treatments. Management may also include phlebotomy in children with polycythemia.
Complete corrective surgery to relieve pulmonary stenosis and close the VSD, directing left ventricular outflow to the aorta, requires cardiopulmonary bypass with hypothermia to decrease oxygen utilization during surgery, especially in young children. An infant may have this corrective surgery without prior palliative surgery. It’s usually done when progressive hypoxia and polycythemia impair the quality of his life, rather than at a specific age. However, most children require surgery before they reach school age.
Source: Professional Guide to Diseases (Eighth Edition), 2005
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