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Congenital Heart Defect: Hole in the Heart

Tetralogy of Fallot, is a congenital heart defect that negatively impacts the heart’s structure leading to poor supply of oxygen and blood to the heart and other parts of the body. This defect can be detected at the infancy stage of a child. Such infants have an unusual skin color, ranging from blue to violet tinge, which is caused by improper supply of oxygen to the body.

The 4-in-1 Condition

In acute medical terms, Tetralogy of Fallot is a combination of 4 heart defects collaged together. To understand Tetralogy of Fallot better it is important to know about these heart defects.

  • Ventricular Septal Defect (VSD): The heart has an inner wall which keeps the blood from the left side chambers mixing with blood in the right side chambers. This wall is known as the Septum. Under this heart defect there is a hole in this wall, between the two lower chambers and the ventricles. This allows the oxygen containing blood from the left ventricle to mix with the blood from right ventricle.
  • Pulmonary Stenosis: This heart defect causes the narrowing of pulmonary valve and the route between right ventricle and pulmonary artery. Under normal process, the oxygen poor blood from the right ventricle flows to the pulmonary valve and then to the pulmonary artery. The blood then travels to the lungs to procure oxygen. But when a person is suffering from Pulmonary Stenosis, the pulmonary valve does not open completely. As a result , the heart has to work harder to pump sufficient blood.
  • Right Ventricular Hypertrophy: This heart defect causes the abnormal thickening of right ventricle. Such abnormality occurs as a result of the heart working harder than normal to move blood through a narrowed down pulmonary valve.
  • Overriding Aorta: Aorta in any healthy person is located near the left ventricle, and provides oxygen rich blood to the body. But under this defect the aorta is abnormally placed between the left and right ventricles. As a result the oxygen poor blood flows into the aorta from the right ventricle rather than flowing into the pulmonary artery.

The Symptoms

As the effects of this heart defect can be prominently seen in infants, so the parents have to keep an eye on some of the distinct symptoms.  Depending on the level of obstruction in blood flow from right ventricle to the lungs, the symptoms may vary. However, keep an watch for the below mentioned signs:

  • When the baby develops deep blue skin immediately after feeding or crying it is known as Tet Spells. These spells are common for infants between 2-4 months old.
  • Abnormal coloration of the skin, from bluish to violet, caused by supply of blood that is low in oxygen.
  • Rapid breathing or shortness of breath during feeding or exercising.
  • Frequent loss of consciousness or fainting.
  • Abnormally rounded shape nail beds.
  • Lower than normal weight gain.
  • Tendency to tire out quickly during exercises or play time.
  • Signs of irritability
  • Heart murmurs
  • Prolonged crying sessions

Diagnosing the Problem

Before you see the doctor, stay prepared with certain answers such as: details about the symptoms, family history, and time frame of the Tet Spells or fainting, among many other associated details. Answering such questions accurately would allow the doctor to proceed with the proper treatment. After primary physical evaluation, the doctor would prescribe some of the below mentioned tests.

  • Echocardiography: It allows the doctors to understand the Ventricular Septal defect and its location, abnormalities in the pulmonary valve and artery, functioning of right ventricle and positioning of aorta.
  • Electrocardiogram: The test will ascertain whether the baby has Right Ventricular Hypertrophy.
  • Chest X-ray: It shows the structure of your baby’s lungs and heart. A common sign of Tetralogy of Fallot is a boot shaped heart with enlarged right ventricle.
  • Pulse Oximetry: A small sensor is placed on the finger or toe to measure the amount of oxygen in the baby’s blood.
  • Cardiac Catheterization: Before proceeding with the surgical treatment, the doctors use this test to understand the structure of your baby’s heart. In the process, a thin tube is inserted through the artery or vein in the baby’s arm, neck or groin and is routed to the heart. There is a special dye injected through the catheter to allow doctors see the heart structures on X-ray images.

The Surgical Cure

Once the doctors are sure that your baby is suffering from Tetralogy of Fallot, a surgical treatment will be suggested. Intracardiac repair is the most popular surgery to cure the defect. However, depending on the situation, Temporary surgery (using the shunting process) may also be used.

  • Intracardiac Repair: It is an open heart surgery that is done within the first year after the baby’s birth. In this process a surgeon would place a patch that closes hole between lower heart chambers (causing the Ventricular Septal defect). After this, the surgeon also repairs the narrowed down pulmonary arteries, widening them and increasing the passage of blood into the lungs. Once the surgery is done, the oxygen level in the baby’s blood will improve and the symptoms will gradually go away.
  • Temporary Surgery: If your baby had premature birth or has underdeveloped pulmonary arteries, then the doctors might conduct a temporary surgery before the intracardiac repair. Through this surgery the surgeon would create a bypass between the large artery (spanning between the aorta and pulmonary artery). This bypass would improve blood flow to the lungs. When the surgeon feels that the baby is ready for the intracardiac repair, he/she will remove the shunt.

Life after the Surgery

In maximum cases, the surgery cures babies with Tetralogy of Fallot. But after the surgery, you need to visit the consulting doctor with the baby for routine check-ups that would evaluate the success of the surgery as well as detect any new complications. Certain drugs have to be taken by the baby. The doctor might also limit your baby from certain physical activities.

Many babies detected with Tetralogy of Fallot are today leading a healthy and happy life. So, you need not worry if your baby has this congenital heart defect.

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Beating Heart Bypass Surgery – Things You Should Know


Coronary Artery Bypass Grafting is a treatment or surgical procedure which is done to normalize the blood flow. It happens around the blockage or narrowed section in the major arteries that somehow barred a normal blood and oxygen flow to the heart. In heart bypass surgery in Delhi, a cardiac surgeon performs the same in two ways.

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Heart Bypass Surgery vs Angioplasty – Which is better?

If the patient has any cardiac disease, it becomes really important to understand the difference between the heart bypass surgery and angioplasty to treat coronary artery disease. The treatment depends on many hard facts and different things.

Who has the option of choosing angioplasty?

Be it heart bypass surgery in Delhi or coronary angioplasty in Delhi, choosing a right treatment is something that your doctor should make. But there is a small but essential role of yours:

Heart Bypass Surgery


If you have a mild heart disease, then there is not much narrowing of arteries.

If you have stable angina, then this is the period which occurs with emotional or physical stress.

You need to talk to your doctor about angioplasty before you have a coronary angiogram.

Risks Of Angioplasty

  • Heart attack
  • Stroke
  • Death

The probability of facing such situations increases with the increase of age.

Depending on the bio-system of the people, some of them recover quicker than expected. They can also return to their normal activities within a few days as per their comfort level.

The Need Bypass Surgery

Not everyone needs heart bypass surgery and can be helped by angioplasty with stents only. Some people get medical therapy which includes lifestyle changes and medicinal prescription. And there are people who take both the treatments. The doctor only recommends bypass surgery when you are getting benefits from it. Your age, health and pedigree chart determines the best treatment for you.

Risks Of Bypass Surgery

The surgery has been practised for more than 40 years. But there are some noted risks:

  1. Too much bleeding.
  2. Stroke.
  3. Heart attack.
  4. Death.

There are some other risks as well which includes angina, anaesthesia, and infections at the site of the chest incision. In some cases, memory loss and trouble thinking also have been noted, though these are observed in old aged people.

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