Tetralogy of Fallot is the most common congenital defect. I find it to be a very interesting topic for various reasons. One of them is because the first open heart surgery in America over half a century ago was to fix Tetralogy of Fallot. One of the other reasons is that this is a very complex defect and it is a defect that we cannot prevent from occurring. From the very first surgery to fix Tetralogy of Fallot it was a successful procedure. Over time technology and new research has benefited the development of better techniques and methods. Surgeries have been very successful and this is something to be excited about.
In this article review I will be telling you about Tetralogy of Fallot, some of the key features in detail, as well as how it relates to echocardiography. I will discuss a few of the recent studies relating to echocardiography revealing some very insightful information and well some of the loopholes and shortfalls. In the conclusion I will be highlighting some of the main key factors and some things worth to remember, especially if you are getting into pediatric echocardiography. Tetralogy of Fallot is the combination of four congenital heart disorders including: pulmonic stenosis (subvalvular or infundibular), right ventricular hypertrophy, ventricular septal defect (malalignment type), and overriding aorta (also known as biventricular aorta). …show more content…
Of all congenital heart defects Tetralogy of Fallot accounts to 10% of them. It is the most common cyanotic defect in adults. Pulmonary stenosis is the deciding factor in determining the severity of the defect. Mild pulmonary stenosis would result in left to right shunting and no cyanosis, whereas severe pulmonary stenosis would restrict flow to the lungs resulting in right to left shunting with a degree of cyanosis. Newborns show signs of cyanosis at birth and if left untreated, half will die by age 6. But that does not have to happen. With long developed techniques and technology, patients with Tetralogy of Fallot enjoy quality life and long years of life. There are a few theories why this defect is present. One of them claims that the main problem is the underdevelopment of the infundibulum. This would indicate that the initial problem from which everything else stems from is the ventricular septal defect. Although determining the severity of pulmonary stenosis is the most important factor in determining the severity of the entire defect. In infants some of the signs and symptoms would include: difficulty with feeding, failure to thrive, they can have “tet” spells, which is episodes of bluish skin when they are crying. As they get older, they begin to have difficulty breathing that progressively gets worse with age. Their bodies demand more oxygen and their heart does not provide it. This results in slow growth and at just about 6 months old they have clubbing of their toes and fingers. They tend to be in a squatting position often. This is a compensatory mechanism and relieves their difficulty breathing. Some cases may also have an atrioventricular septal defect present making it Pentalogy of Fallot. To diagnose the disease blood work and different imaging modalities are enough for confirmation. …show more content…
Patients have decreased clotting and coagulation factors, decreased fibrinogen, and prolonged coagulation times. But in imaging, echocardiography has tremendous attributes and often is the only diagnostic modality utilized before surgical repair. Color flow Doppler can detect ventricular septal defects or any other septal defects, and any defects with valves can also be evaluated.
Despite all the advancements there are some limitations in complex cases of Tetralogy of Fallot. The main concern is sudden cardiac death after surgical repair. There has been various studies and research regarding predictive assessment parameters. The evaluation of the right ventricle shows good potential primarily because there is not much known about preserving right ventricular function. “Ongoing surveillance of RV function is a crucial component of clinical assessment. Except for resynchronization with biventricular pacing, no medical therapies have been shown to be effective after RV dysfunction occurs.” “Several methods of assessing global RV function in patients with TOF have been studied. Tricuspid annular peak systolic velocity (S′) (TAPSE) has been utilized as a measure of RV systolic function. TAPSE is a simple and reproducible measure of RV systolic performance. RV fibers are primarily longitudinal (in contrast to those in the LV); TAPSE determines the longitudinal motion of the RV using 2-dimensional or M-mode
In this article review I will be telling you about Tetralogy of Fallot, some of the key features in detail, as well as how it relates to echocardiography. I will discuss a few of the recent studies relating to echocardiography revealing some very insightful information and well some of the loopholes and shortfalls. In the conclusion I will be highlighting some of the main key factors and some things worth to remember, especially if you are getting into pediatric echocardiography. Tetralogy of Fallot is the combination of four congenital heart disorders including: pulmonic stenosis (subvalvular or infundibular), right ventricular hypertrophy, ventricular septal defect (malalignment type), and overriding aorta (also known as biventricular aorta). …show more content…
Of all congenital heart defects Tetralogy of Fallot accounts to 10% of them. It is the most common cyanotic defect in adults. Pulmonary stenosis is the deciding factor in determining the severity of the defect. Mild pulmonary stenosis would result in left to right shunting and no cyanosis, whereas severe pulmonary stenosis would restrict flow to the lungs resulting in right to left shunting with a degree of cyanosis. Newborns show signs of cyanosis at birth and if left untreated, half will die by age 6. But that does not have to happen. With long developed techniques and technology, patients with Tetralogy of Fallot enjoy quality life and long years of life. There are a few theories why this defect is present. One of them claims that the main problem is the underdevelopment of the infundibulum. This would indicate that the initial problem from which everything else stems from is the ventricular septal defect. Although determining the severity of pulmonary stenosis is the most important factor in determining the severity of the entire defect. In infants some of the signs and symptoms would include: difficulty with feeding, failure to thrive, they can have “tet” spells, which is episodes of bluish skin when they are crying. As they get older, they begin to have difficulty breathing that progressively gets worse with age. Their bodies demand more oxygen and their heart does not provide it. This results in slow growth and at just about 6 months old they have clubbing of their toes and fingers. They tend to be in a squatting position often. This is a compensatory mechanism and relieves their difficulty breathing. Some cases may also have an atrioventricular septal defect present making it Pentalogy of Fallot. To diagnose the disease blood work and different imaging modalities are enough for confirmation. …show more content…
Patients have decreased clotting and coagulation factors, decreased fibrinogen, and prolonged coagulation times. But in imaging, echocardiography has tremendous attributes and often is the only diagnostic modality utilized before surgical repair. Color flow Doppler can detect ventricular septal defects or any other septal defects, and any defects with valves can also be evaluated.
Despite all the advancements there are some limitations in complex cases of Tetralogy of Fallot. The main concern is sudden cardiac death after surgical repair. There has been various studies and research regarding predictive assessment parameters. The evaluation of the right ventricle shows good potential primarily because there is not much known about preserving right ventricular function. “Ongoing surveillance of RV function is a crucial component of clinical assessment. Except for resynchronization with biventricular pacing, no medical therapies have been shown to be effective after RV dysfunction occurs.” “Several methods of assessing global RV function in patients with TOF have been studied. Tricuspid annular peak systolic velocity (S′) (TAPSE) has been utilized as a measure of RV systolic function. TAPSE is a simple and reproducible measure of RV systolic performance. RV fibers are primarily longitudinal (in contrast to those in the LV); TAPSE determines the longitudinal motion of the RV using 2-dimensional or M-mode