Igiene e Sanità Pubblica 2025; 99 (4): 196-207
Chiara Gatti1, Stefano Marcelli2, Gloria D’Angelo3, Cinzia Borgognoni4, Isabella Baglioni5 ,Alessandra Romandini6
1*CORRESPONDING AUTHOR: Incarico di Funzione Organizzativa SOD Cardiochirurgia e Cardiologia Pediatrica e Congenita, AOU delle Marche, (MSN). 3487337277. chiara.gatti2019@gmail.com
2Direttore ADP, UNIVPM CDL Infermieristica AST Ascoli Piceno (MSN)
3Tutor clinico di tirocinio, UNIVPM CDL Infermieristica AST Ascoli Piceno (MSN)
4Incarico di Funzione Organizzativa Dipartimento Scienze Cardiovascolari, AOU delle Marche (PhD)
5Direttore ADP, UNIVPM CDL Magistrale Scienze Infermieristiche e Ostetriche sede Fermo
6Infermiera, UNIVPM CDL Infermieristica Ancona (RN)
ABSTRACT
Background: Tetralogy of Fallot (ToF) is the most common cyanotic congenital heart disease, with an incidence of approximately 1 in 3,500 live births, accounting for 7–10% of all congenital heart defects. Advances in cardiac surgery and intensive care have increased survival into adulthood to over 85%, resulting in a growing population of adults with repaired congenital heart disease and, in resource-limited settings, adults with untreated or previously undiagnosed disease. In this context, specialist nursing care plays a pivotal role throughout the continuum of care.
Objective: To systematically review the available scientific evidence on nursing care for patients with tetralogy of Fallot, with particular emphasis on nursing interventions during the preoperative and postoperative phases and on the competencies required across different clinical settings.
Materials and Methods: A systematic literature review was conducted between November 2025 and March 2026 using PubMed, the Cochrane Library, and CINAHL, following the PRISMA methodology. The search strategy was: care AND tetralogy of Fallot AND nurs*. Of the 56 records initially identified, 33 articles were screened after duplicate removal. Following the application of the eligibility criteria and methodological quality assessment using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist, with an inclusion threshold of ≥75%, four studies were included in the review. The selected studies comprised two case reports and two narrative reviews.
Results: The four included studies collectively addressed the major stages of the care pathway for patients with ToF: neonatal preoperative stabilization (Tran et al., 2022), postoperative management in the pediatric intensive care unit (Forman et al., 2019), nursing management of adults with unrepaired ToF (Araújo et al., 2017), and peri-anesthetic assessment of an adult patient with previously undiagnosed ToF (Edwards et al., 2025). Four principal themes emerged: systematic clinical monitoring as a strategy for preventing complications; management of hypercyanotic (Tet) spells; implementation of the nursing process using the standardized NANDA-I, NIC, and NOC taxonomies; and family support as an integral component of comprehensive nursing care.
Discussion: Comparison of the included studies demonstrated strong consistency regarding the core principles of nursing care for patients with ToF, including systematic monitoring, prevention of complications, individualized care, and family-centered support. These principles are adapted according to the stage of care, patient age, and clinical setting. Particular attention emerged regarding the management of adults with ToF, whether surgically repaired or previously undiagnosed, representing an increasingly important challenge for specialist nursing practice. The expanding population of adults with congenital heart disease requires nurses with advanced competencies in clinical assessment, critical thinking, and cultural sensitivity.
Conclusions: Nurses play a key and irreplaceable role in the care pathway of patients with tetralogy of Fallot. Specialist clinical expertise, an evidence-based systematic approach, early clinical assessment, and family-centered care constitute the cornerstones of high-quality nursing care for this complex condition. The development of specialized educational pathways in adult congenital cardiology nursing should be considered a priority to ensure safe, equitable, and high-quality care for this continuously growing patient population.
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