TheHealthReport25: “Lazy Child” - All you must know about Tetralogy of Fallot (TOF)

During the assessment, the parents shared their child's symptoms. The child started showing symptoms at 18 months old. These symptoms worsened as he grew older.

He often had trouble breathing and would squat with minimal activity. His lips and fingers darkened, which can appear blue in babies and Caucasians. He also experienced frequent fainting spells during exertion. At one point, he was misdiagnosed as epileptic due to these spells.

When he collapsed, his parents would try to revive him with water. A physical exam showed clubbing of his fingers and dark/blue lips. His conjunctiva appeared unusually red, indicating high hemoglobin levels.

His oxygen saturation was very low at 65% on room air. A heart murmur was detected near the left upper sternal edge of his chest. His hemoglobin level was high at 22 g/dL, with a hematocrit of 66%.

Low oxygen levels cause rapid red blood cell production in children like him. A chest X-ray showed a "boot-shaped" heart. An echocardiogram revealed features consistent with Tetralogy of Fallot (TOF).

TOF is a complex heart condition with four components:

1. Narrowing of the right ventricle outlet or small pulmonary arteries.
2. Enlargement of the right ventricular muscles.
3. A large hole between the heart's pumping chambers.
4. The aorta positioned over this hole, allowing oxygen-poor blood to flow into it.

Tetralogy of Fallot falls under cyanotic congenital heart diseases. In Ghana, TOF is the most common type among these conditions.

Children with TOF are chronically deprived of oxygen due to structural defects in their hearts. They often learn to squat or assume a knee-chest position when they need more oxygen.

This position increases blood flow to their lungs through a complex mechanism. Our team discussed the child's condition extensively with his parents and emphasized surgery's urgency.

Without treatment, there is a high risk of sudden death for these children. Studies show that untreated children face significant mortality rates by various ages: 25% by age 1; 40% by age 2; and so on up to 95% by age 40.

The child also faced risks like right heart failure and brain abscesses from strokes or kidney failure/destruction.

Fortunately, a philanthropist sponsored his surgery, which was successful. Months after surgery, this once "Lazy Boy" is now very active again.

His parents, neighbors, and schoolmates are thrilled about his recovery. Many children with heart diseases are labeled "lazy" because they tire easily during activities.

This label persists until parents seek medical help—like in this boy's case.

Recommendations:

Parents should watch for fatigue in children during sports or playtime. Children who refuse activities may be misidentified as “sicklers.” Such cases should be reported for evaluation at health facilities.

Early detection of congenital heart diseases is crucial through antenatal scans and newborn screenings.

Mandatory pre-school medical examinations can help detect conditions like TOF early on.

Ghana’s cardiothoracic centers are equipped to manage TOF effectively but need more funding for screening programs accessible to all Ghanaians.

Byline:
Dr (Med) Gordon Offei-Larbi (BSc., MB ChB, MGCPS, FWACS)
Cardiothoracic surgeon and acting Head of Cardiothoracic Surgery at UGMC
Contact: [email protected]

Credit: National Cardiothoracic Centre, Korle-Bu Teaching Hospital; University of Ghana Medical Centre; Boston Children's Hospital