Tetralogy of Fallot (TOF) is a congenital heart defect that affects horses. It is characterized by four main abnormalities in the heart: a ventricular septal defect (VSD), obstruction of the right ventricular outflow tract (RVOT), dextroposition of the aorta, and hypertrophy of the right ventricle. These abnormalities result in a reduced oxygen supply to the body and can lead to cyanosis, exercise intolerance, and sudden death. The severity of the condition can vary, and treatment options include surgery and medical management. However, the prognosis for horses with TOF is generally poor, and many affected animals have a poor quality of life or are euthanized.