A boot shaped heart
An 18 month old female child presented with a history of dyspnoea on exertion. She often gets cyanosed after feeding or crying and sometimes becomes apnoeic. On examination, there was cyanosis and digital clubbing. Auscultation of the heart showed a loud ejection systolic murmur in the pulmonary area. Her chest x ray film is shown in fig 1.
The definitive treatment of tetralogy of Fallot is the total surgical correction of the anatomical defects. This is usually done in the third year of life and ideally before the child reaches school age. The prognosis after total correction is good, especially if the operation is done in childhood. The mortality associated with the operation is 5%. Regular follow-up is needed to identify the patients with postoperative complications, such as residual outflow obstruction, residual ventricular septal defect, pulmonary regurgitation, rhythm disorders, and infective endocarditis.