Tetralogy of Fallot (TOF) is a congenital heart defect (CHD) consisting of 4 anatomical abnormalities:
- Ventricular septal defect (VSD), which is a hole in the wall that separates the right and left ventricles.
- Pulmonary valve stenosis, which is a narrowing of the blood vessel valve to the lungs (pulmonary valve) so that blood from the heart to the lungs is reduced.
- The position of the aorta is abnormal, namely it has shifted to the right following the VSD that has formed.
- Right ventricular hypertrophy or thickening of the right ventricle of the heart muscle due to the heart working too hard to pump blood.
Tetralogy of Fallot is one of the most common forms of cyanotic congenital heart disease, accounting for 7–10% of all congenital heart defects with an incidence of one in 3,500 live births. ToF defects allow mixing of blood between the pulmonary and systemic circulations. This mixing usually occurs in VSDs, where the right side leads to the left side of the heart and adds impure (deoxygenated) blood to the systemic circulation, causing cyanosis.
The Role of Physiotherapy in Tetralogy of Fallot Cases
Physiotherapy plays an important role in the management of patients with Tetralogy of Fallot, although it does not directly address the heart defect itself. Here are some of the roles of physiotherapy in cases of Tetralogy of Fallot:
- Conducting an Inspection
Physiotherapy needs to perform several examinations related to the condition of patients with tetralogy of fallot. Some examinations that need to be performed by physiotherapy are the background of the disease, vital signs, general appearance of the patient, pain, use of assistive devices, skin examination, thoracic and respiratory examination, musculoskeletal examination, muscle strength, functional mobility, aerobic capacity and endurance. - Post-Operative Rehabilitation
Many patients with Tetralogy of Fallot undergo corrective heart surgery. Physiotherapy can assist in post-operative rehabilitation to speed recovery, improve mobility, and optimize cardiorespiratory function. - Cardiorespiratory Exercise
A physical therapist can design an appropriate cardiorespiratory exercise program to improve the patient's cardiorespiratory endurance. This may include light to moderate aerobic exercise, breathing exercises, and exercises to increase lung capacity. - Patient and Family Education
Physiotherapists can provide education to patients and families about condition management, signs and symptoms to watch for, and the importance of appropriate physical activity. - Pain Management
Some patients with Tetralogy of Fallot may experience pain related to their condition. Physiotherapy can help patients manage their pain through methods such as manual therapy, exercise therapy, and the use of modality devices.
Physiotherapy Interventions in Tetralogy of Fallot Cases
There are several interventions that can be carried out by physiotherapy, especially post-surgery, such as:
- Positioning
Providing and promoting certain positions will allow physiotherapy to achieve goals related to preventing musculoskeletal disorders, improving respiratory ability. Proper positions can help provide body orientation, prevent contractures, and improve early development. - Postural education
Most therapeutic exercises and activities can begin with postural training and education to minimize thoracic kyphosis and increasingly rounded shoulders. - Flexibility exercises
Flexibility exercises should also be started early and are patient-specific. These exercises typically include muscle stretching, including the pectoralis major group, achilles/gastrocnemius/soleus group, hip flexors, hamstrings, upper extremities, and chest expansion for thoracic cage mobility. - Breathing exercises
Breathing exercises should be incorporated into the intervention to encourage deep breathing, help maintain ventilation, assist with pain control, and promote coordinated breathing patterns. - Aerobic endurance training
Aerobic exercise should be tailored individually based on previous assessment during physical therapy. - Strengthening exercises
Strength training is an important component of physical therapy for children of appropriate age. After heart surgery, children are typically placed on several chest restrictions for 6 to 8 weeks, which may include a ban on lifting more than 10 pounds. With these caveats, strength training is a valuable tool in the treatment of children with CHD both before and after surgery. - Functional mobility
Mobility training, gait training, balance training, and stair climbing are functional tasks that should be included as needed in physical therapy interventions. Mobility training should include ways of moving that reduce discomfort and increase independence. The role of physical therapy in Tetralogy of Fallot is to support and improve the patient’s quality of life by maximizing cardiorespiratory function and addressing associated physical problems. While it does not cure the heart condition itself, physical therapy can help patients live as well as possible with their condition.
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Reference :
- Bangde SS, Thakre VM, Fating T, Dandekar A. Rehabilitation in a Pediatric Patient Who Underwent Correction Surgery for Tetralogy of Fallot: A Case Report. Cureus. 2023 Dec 13;15(12):e50442. doi: 10.7759/cureus.50442. PMID: 38222209; PMCID: PMC10784764. https://www.cureus.com/articles/207688-rehabilitation-in-a-pediatric-patient-who-underwent-correction-surgery-for-tetralogy-of-fallot-a-case-report#!/
- Wilson R, Ross O, Griksaitis MJ. Tetralogy of Fallot. BJA Educ. 2019 Nov;19(11):362-369. doi: 10.1016/j.bjae.2019.07.003. Epub 2019 Oct 14. PMID: 33456859; PMCID: PMC7807827.
- Tecklin, Jan S. 2008. Pediatric Physical Therapy fourth edition. Philadelphia : Lippincott Williams & Wilkins
