A 2-month-old boy who appeared normal at birth has become cyanotic and is found to have a systolic ejection murmur over the pulmonic area and a boot-shaped heart on chest radiograph. The following is/are true:

a. Echocardiography alone is sufficient to confirm the diagnosis of Tetralogy of Fallot

b. Cyanotic spells may be appropriately treated by propranolol

d. Increasing cyanotic spells is the most common indication for operation

In this typical scenario for Tetralogy of Fallot, echocardiography can confirm the diagnosis with no need for cardiac catheterization. Cyanotic spells are treated by supplemental oxygen, sedation with morphine and a beta blocker such as propranolol. For palliative increase in pulmonary blood flow, the Blalock-Taussig shunt is utilized connecting the subclavian artery to the pulmonary artery. Increasing cyanosis and cyanotic spells are the most common indication for operative repair. To correct the right ventricular outflow obstruction in Tetralogy, a transannular patch may be required extending into the pulmonary artery. Fortunately the pulmonary valvar insufficiency that results is well tolerated in the absence of tricuspid insufficiency or ventricular dysfunction.