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Latest revision as of 04:22, 26 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Abdul-Kareem Lukan, M.D.

Overview

Pentalogy of Fallot is defined as the occurrence of Tetralogy of Fallot plus an atrial septal defect.

Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa. paolo.pazzi@up.ac.za.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3984729/

Historical Perspective

Tetralogy of fallot was first discovered by Niel Stenson, a Denish physician Anatomist, in 1671. ^[1]
The association between right ventricular outflow tract obstruction and a large ventricular septal defect and tetralogy of fallot was made in 1888 by Etinne-Louise.^[2]
In 1924, Canadian, Maude Abbott was the first to discover the association between ventricular septal defect , pulmonary stenosis, overriding aorta and right ventricular hypertrophy and the development of tetralogy of Fallot.^[2]

Classification

There is no established system for the classification of the pentalogy of Fallot.

Pathophysiology

It is thought that conotruncal diseases like tetralogy of fallot and pentalogy of Fallot occur as a result of:^[3]

Neural crest migration defect.
Underdevelopment of right ventricular infundibulum

Causes

The cause of the pentalogy of Fallot has not been identified.
To review risk factors for the development of pentalogy of Fallot, click here.

Differentiating pentalogy of Fallot from other Diseases

Pentalogy of Fallot must be differentiated from other diseases that cause:^[1]

Right to left shunt

Transposition of great arteries with Pulmonic stenosis
Double outlet right ventricle including Taussig-Bing anomaly
Tricuspid atresia
Ebstein Anomaly
Pulmonary atresia with intact ventricular septum
Respiratory diseases
- Bronchiolitis
- Viral and bacterial Pneumonia
- Pneumothorax because when they are in heart failure they present with signs of respiratory distress, cyanosis and failure to thrive.

Bidirectional shunt diseases

Epidemiology and Demographics

The epidemiology of the pentalogy of Fallot has not been well studied.

Risk Factors

Common risk factors in the development of pentalogy of fallot include:^[4]

Alcoholism in mother
Maternal Diabetes
Advanced maternal age i.e greater than 40 years
Malnutrition in pregnancy
Family history of tetralogy of fallot
Viral illness during pregnancy like Rubella.
Presence of Down syndrome or DiGeorge syndrome

Screening

There is insufficient evidence to recommend routine screening for the pentalogy of Fallot.

Natural History, Complications, and Prognosis

If left untreated, patients with pentalogy of fallot may progress to develop finger clubbing, stunted growth, cardiac arrhythmias, hypoplastic pulmonary artery, paradoxical emboli and polycythemia .^[3] Prognosis is generally excellent provided the VSD has been closed and the right ventricular outflow tract has been relieved.^[5]

Diagnosis

Diagnostic Study of Choice

There are no established criteria for the diagnosis of pentalogy Fallot.

History and Symptoms

The hallmark of pentalogy of fallot is cyanosis. A positive history of cyanosis and easy fatigability leading to squatting during exercise is suggestive of cyanotic congenital heart defect.^[5] . The most common symptoms of pentalogy of fallot include cyanosis, easy fatigabillity , and hypercyanotic spells with crying , feeding and defecating.^[5]

Physical Examination

Patients with pentalogy of Fallot appear cyanotic.^[3]^[6]

Physical examination of patients with Pentalogy of Fallot is usually remarkable for:
- Right ventricular heave
- Elevated jugular venous pressure
- Finger clubbing
- Displaced apex beat
- Normal S1 with single S2
- Peripheral edema
- Diastolic murmur at the left sternal border
- Systolic murmur increasing with inspiration at the left sternal border

Laboratory Findings

Some patients with pentalogy of fallot may have polycythemia which is usually suggestive of worsening hypoxia and compensatory production of erythropoetin.^[5]

Electrocardiogram

An ECG may be helpful in the diagnosis of pentalogy of Fallot, Findings on an ECG suggestive of pentalogy of fallot include right axis deviation and right ventricular hypertrophy.^[5]

Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874376/

X-ray

An x-ray may be helpful in the diagnosis of pentalogy of Fallot. Findings on an x-ray suggestive of pentalogy of fallot include boot shaped heart or coeur en sabot.^[5]

Echocardiography or Ultrasound

Echocardiography may be helpful in the diagnosis of pentalogy of fallot. Findings on an echocardiography diagnostic of pentalogy of fallot include.^[5]

Ventricular septal defect.
Atrial septal defect.
Right ventricular outflow tract obstruction.
overriding aorta
Department of Biochemistry, University of Allahabad, Allahabad-211002, India.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3299189/

CT scan

Thoracic CT angiography may be helpful in the diagnosis of pentalogy of fallot. Findings on CT scan diagnostic of pentalogy of fallot include. ^[7]

MRI

cardiac MRI may be helpful in the diagnosis of pentalogy of fallot. Findings on MRI diagnostic of pentalogy of fallot include RVOT stenosis, VSD, ASD,Overriding aorta, right ventricular hypertrophy and hypoplastic pulmonary arteries.^[7]

Other Imaging Findings

Other imaging findings for pentalogy of fallot include Right ventricular angiopraphy which demonstrates infundibular and pulmonary artery anatomy. left ventricular angiography, which demonstrates. ^[5]

Other Diagnostic Studies

There are no other diagnostic studies associated with pentalogy of Fallot

Treatment

Medical Therapy

The mainstay of treatment for pentalogy of fallot is Surgery.^[5]

Pharmacologic medical therapy is recommended among patients with severe RVOTO and hypercyanotic spells.^[5]

Pharmacologic medical therapies for pentalogy of fallot include.^[5]

prostaglandin E1 in neonates with ductal dependent pulmonary blood flow
Morphine and ketamine for sedation
vasopressors like phenylephrine
propanolol to decrease the need for palliative surgical intervention.
iron treatment to decrease frequency of spells.

Patients with hypercyanotic spells are treated with,

oxygen
volume expansion
morphine sedation.

Surgery

Surgery is the mainstay of treatment for the pentalogy of Fallot. interventional procedures are used to relieve pulmonary obstructions and embolize collaterals. different surgical procedures can be done to treat pentalogy of fallot and it includes.^[5]

Pulmonary valvotomy( for stenotic pulmonic valve)
Pulmonary valvectomy( for small and thickened pulmonic valve)
Closure of ASD/VSD
Shunt surgery for severe cyanosis or in patients with frequent spells in the first year of life
Blalock -Taussig Shunt- communication between the right or left pulmonary artery and the right or left subclavian artery.
Waterson-Cooley Shunt- communication between the ascending aorta with the right pulmonary artery
Potts shunt-communication between the descending aorta and left pulmonary artery
Central shunt- Communication between the main pulmonary artery and ascending aorta.

Primary Prevention

There are no established measures for the primary prevention of the pentalogy of Fallot.

Secondary Prevention

There are no established measures for the secondary prevention of the pentalogy of Fallot.

References

↑ ^1.0 ^1.1 Diaz-Frias J, Guillaume M. PMID 30020660. Missing or empty |title= (help)
↑ ^2.0 ^2.1 Apitz, Christian; Webb, Gary D; Redington, Andrew N (2009). "Tetralogy of Fallot". The Lancet. 374 (9699): 1462–1471. doi:10.1016/S0140-6736(09)60657-7. ISSN 0140-6736.
↑ ^3.0 ^3.1 ^3.2 OM, Akinlade; JA, Ogunmodede; OA, Adeyemi; WO, Yusuf; RO, Awodun; YA, Ayoola; IA, Yusuf; PM, Kolo (2020). "Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report". Asploro Journal of Biomedical and Clinical Case Reports. 3 (1): 62–66. doi:10.36502/2020/ASJBCCR.6187. ISSN 2582-0370.
↑ Silva, Joana A.; Neves, Ana L.; Flor-de-Lima, Filipa; Soares, Paulo; Guimarães, Hercília (2019). "Risk Factors and Outcomes of Tetralogy of Fallot: From Fetal to Neonatal Life". Pediatric Cardiology. 41 (1): 155–164. doi:10.1007/s00246-019-02239-4. ISSN 0172-0643.
↑ ^5.00 ^5.01 ^5.02 ^5.03 ^5.04 ^5.05 ^5.06 ^5.07 ^5.08 ^5.09 ^5.10 ^5.11 Braun-Falco, Markus; Mankin, Henry J.; Wenger, Sharon L.; Braun-Falco, Markus; Kendall, Stephan DiSean; Blobe, Gerard C.; Weber, Christoph K.; Lorenz, Richard; Adler, Guido; Whitcomb, David C.; Yadav, Dhiraj; Bode, Johannes; Wabitsch, Martin; Debatin, Klaus-Michael; Posovzsky, Pamela Fischer; Hassan, Akmal; Megahed, Mosaad; Lundgren, Tord M.; Pfister, Markus; Zenner, Hans-Peter; Berardi, Rossana; Pierantoni, Chiara; Scartozzi, Mario; Cascinu, Stefano; Hendy, Geoffrey N.; Schwarz, Johannes; Storch, Alexander; Schnog, John-John B.; Gerdes, Victor E. A.; Schneider, Susanne A.; Bhatia, Kailash P.; Gittenberger-de Groot, Adriana C.; Bökenkamp, Regina; DeRuiter, Marco C.; Leung, Alexander K. C.; Wong, Andrew L.; Lang, Undine E.; Leung, Alexander K. C.; Leung, Alexander K. C.; Seyhan, Muammer; Hofmann, Silke; Bruckner-Tuderman, Leena; Hofmann, Silke; Bruckner-Tuderman, Leena; Hofmann, Silke; Bruckner-Tuderman, Leena; Kopp, Peter; Forrest, Douglas; Misirlioğlu, Emine Dibek; Alpan, Nursel; Oette, Mark; Imazio, Massimo; Chinnaiyan, Kavitha M.; Mehta, Laxmi S.; Bhat, Mushtaq A.; Bhat, Javeed I.; Stöber, Gerald; Reis, André; Rémi, Jan; Noachtar, Soheyl; Jurkat-Rott, Karin; Lehmann-Horn, Frank; Holzhausen, Marinella; Vergnolle, Nathalie; Schillinger, Martin; Gdynia, Hans-Jürgen; Ludolph, Albert C.; Namdar, Thomas; Eisenberger, Claus Ferdinand; Knoefel, Wolfram Trudo; Ginés, Pere; Guevara, Mónica; Cuesta-Muñoz, Antonio L.; Eijer, Henk; Böhm, Markus; Luger, Thomas A.; Güttler, Flemming; Guldberg, Per; Koch, Richard; Moseley, Kathryn; Eisenhofer, Graeme; Pacak, Karel; Leonard, James V.; Jaeken, Jaak; Becker, Michael A.; Stephani, Ulrich; Frazier, Kendall S.; Böhm, Markus; Luger, Thomas A.; Leung, Alexander K. C.; Sauve, Reginald S.; Matejas, Verena; Zenker, Martin; Leung, Alexander K. C.; Leung, Alexander K. C.; Robson, William Lane M.; Beissert, Stefan; Leung, Alexander K. C.; Robson, William Lane M.; Woo, Tom Y.; Leung, Alexander K. C.; Cate, Hugo Ten; Light, Richard W.; Bozza, Patricia T.; Salluh, Jorge I.; Jantz, Michael A.; Vargas, Sergio L.; Tomic, Rade; Roman, Jesse; Mobeireek, Abdullah F.; Khalid, Mohammad; Torres, Harrys A.; Chemaly, Roy F.; Tomic, Rade; Roman, Jesse; Light, Richard W.; Dispenzieri, Angela; Krause, Sabine; Lochmüller, Hanns; Weihrauch, Julia; Krieg, Thomas; Kühn, Wolfgang; Walz, Gerd; Merker, Georg H.; Kubitz, Ralf; Häussinger, Dieter; Schnog, John-John B.; Gerdes, Victor E. A.; Musco, Giovanna; Stoll, Guido; Toyka, Klaus V.; Leung, Alexander K. C.; Leung, Alexander K. C.; Robson, William Lane M.; Böhm, Markus; Luger, Thomas A.; Pischik, Elena; Kauppinen, Raili; Frank, Jorge; Schwarz, Thomas; Thapar, Manish; Bonkovsky, Herbert. L.; Wagner, Jeffrey C.; Smith, A. Gordon; Mela, Maria; Thalheimer, Ulrich; Samonakis, Dimitrios; Burroughs, Andrew K.; Mela, Maria; Thalheimer, Ulrich; Samonakis, Dimitrios; Burroughs, Andrew K.; Shastri, Yogesh M.; Stein, Jürgen M.; Segman, Ronnen H.; Shalev, Arieh Y.; Jacob, Giris; Robertson, David; Leung, Alexander K. C.; Robson, William Lane M.; Leung, Alexander K. C.; Lampinen, Katja; Kublickiene, Karolina; Kaaja, Risto; Lenarczyk, Radosław; Kowalski, Oskar; Kalarus, Zbigniew; Wichterle, Dan; Leung, Alexander K. C.; Maguire, Jamie; Mody, Istvan; Janssens, Katrien; Vanhoenacker, Filip; Van Hul, Wim; Gdynia, Hans-Jürgen; Ludolph, Albert C.; Leonard, James V.; Cate, Hugo Ten; Geboes, Karel; Van Assche, Gert; Cate, Hugo Ten; Berden, Jo H. M.; Van Kuppevelt, Toin H.; Rops, Angelique L.; Cate, Hugo Ten; Cate, Hugo Ten; Frank, Jorge; Schwarz, Thomas; Ambros-Rudolph, Christina M.; Lamounier-Zepter, Valéria; Thomas, Christie P.; Thomas, Christie P.; Thomas, Christie P.; Koch, Christian A.; Weinstein, Lee S.; Silve, Caroline; Leung, Alexander K. C.; Uitto, Jouni; Jiang, Qiujie; Leung, Alexander K. C.; Robson, William Lane M.; Leung, Alexander K. C.; Yildiz, Orhan; Kayabas, Uner; Hegele, Richard G.; Tournier, Jean-Nicolas; Halefoğlu, Ahmet Mesrur; Hutson, Mary Redmond; Kirby, Margaret L.; Okada, Fumito; Ando, Yumiko; Ono, Asami; Mori, Hiromu; Moore, Timothy M.; Townsley, Mary I.; Krauth, Maria-T.; Pabinger, Ingrid; Ballmann, Manfred; Hegele, Richard G.; Trow, Terence K.; McLaughlin, Vallerie V.; Hegele, Richard G.; Fetouh Yassin, Atteyet-Alla; Uebing, Anselm; Gatzoulis, Michael A.; Gardiner, Helena M.; Ma, Lucia K.; Ma, Patrick T. S.; Leung, Alexander K. C.; Prieto, Lourdes; Latson, Larry; Keller, Nancy R.; Robertson, David; Fairbanks, Lynette D.; Simmonds, H. Anne; Brunner, Martina; Zouboulis, Christos C.; Everts, Vincent; Helfrich, Miep; Leung, Alexander K. C.; Wong, Andrew L.; Von Den Driesch, Peter; Bitsch, Roland; Bitsch, Roland; Bitsch, Roland; García-Cazorla, Angels; Saudubray, Jean Marie (2009). "Pentalogy of Fallot": 1602–1605. doi:10.1007/978-3-540-29676-8_1393.
↑ Parwani, Purvi; Phillips, Sabrina (2016). "IMPORTANCE OF PHYSICAL EXAMINATION IN ADULT PATIENTS WITH TETRALOGY OF FALLOT". Journal of the American College of Cardiology. 67 (13): 1101. doi:10.1016/S0735-1097(16)31102-0. ISSN 0735-1097.
↑ ^7.0 ^7.1 Lapierre, C.; Dubois, J.; Rypens, F.; Raboisson, M.-J.; Déry, J. (2016). "Tetralogy of Fallot: Preoperative assessment with MR and CT imaging". Diagnostic and Interventional Imaging. 97 (5): 531–541. doi:10.1016/j.diii.2016.01.009. ISSN 2211-5684.

Template:WikiDoc Sources Template:WH Template:WS

[pmid30020660-1] 1.0 ^1.1 Diaz-Frias J, Guillaume M. PMID 30020660. Missing or empty |title= (help)

[ApitzWebb2009-2] 2.0 ^2.1 Apitz, Christian; Webb, Gary D; Redington, Andrew N (2009). "Tetralogy of Fallot". The Lancet. 374 (9699): 1462–1471. doi:10.1016/S0140-6736(09)60657-7. ISSN 0140-6736.

[OMJA2020-3] 3.0 ^3.1 ^3.2 OM, Akinlade; JA, Ogunmodede; OA, Adeyemi; WO, Yusuf; RO, Awodun; YA, Ayoola; IA, Yusuf; PM, Kolo (2020). "Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report". Asploro Journal of Biomedical and Clinical Case Reports. 3 (1): 62–66. doi:10.36502/2020/ASJBCCR.6187. ISSN 2582-0370.

[SilvaNeves2019-4] Silva, Joana A.; Neves, Ana L.; Flor-de-Lima, Filipa; Soares, Paulo; Guimarães, Hercília (2019). "Risk Factors and Outcomes of Tetralogy of Fallot: From Fetal to Neonatal Life". Pediatric Cardiology. 41 (1): 155–164. doi:10.1007/s00246-019-02239-4. ISSN 0172-0643.

[Braun-FalcoMankin2009-5] 5.00 ^5.01 ^5.02 ^5.03 ^5.04 ^5.05 ^5.06 ^5.07 ^5.08 ^5.09 ^5.10 ^5.11 Braun-Falco, Markus; Mankin, Henry J.; Wenger, Sharon L.; Braun-Falco, Markus; Kendall, Stephan DiSean; Blobe, Gerard C.; Weber, Christoph K.; Lorenz, Richard; Adler, Guido; Whitcomb, David C.; Yadav, Dhiraj; Bode, Johannes; Wabitsch, Martin; Debatin, Klaus-Michael; Posovzsky, Pamela Fischer; Hassan, Akmal; Megahed, Mosaad; Lundgren, Tord M.; Pfister, Markus; Zenner, Hans-Peter; Berardi, Rossana; Pierantoni, Chiara; Scartozzi, Mario; Cascinu, Stefano; Hendy, Geoffrey N.; Schwarz, Johannes; Storch, Alexander; Schnog, John-John B.; Gerdes, Victor E. A.; Schneider, Susanne A.; Bhatia, Kailash P.; Gittenberger-de Groot, Adriana C.; Bökenkamp, Regina; DeRuiter, Marco C.; Leung, Alexander K. C.; Wong, Andrew L.; Lang, Undine E.; Leung, Alexander K. C.; Leung, Alexander K. C.; Seyhan, Muammer; Hofmann, Silke; Bruckner-Tuderman, Leena; Hofmann, Silke; Bruckner-Tuderman, Leena; Hofmann, Silke; Bruckner-Tuderman, Leena; Kopp, Peter; Forrest, Douglas; Misirlioğlu, Emine Dibek; Alpan, Nursel; Oette, Mark; Imazio, Massimo; Chinnaiyan, Kavitha M.; Mehta, Laxmi S.; Bhat, Mushtaq A.; Bhat, Javeed I.; Stöber, Gerald; Reis, André; Rémi, Jan; Noachtar, Soheyl; Jurkat-Rott, Karin; Lehmann-Horn, Frank; Holzhausen, Marinella; Vergnolle, Nathalie; Schillinger, Martin; Gdynia, Hans-Jürgen; Ludolph, Albert C.; Namdar, Thomas; Eisenberger, Claus Ferdinand; Knoefel, Wolfram Trudo; Ginés, Pere; Guevara, Mónica; Cuesta-Muñoz, Antonio L.; Eijer, Henk; Böhm, Markus; Luger, Thomas A.; Güttler, Flemming; Guldberg, Per; Koch, Richard; Moseley, Kathryn; Eisenhofer, Graeme; Pacak, Karel; Leonard, James V.; Jaeken, Jaak; Becker, Michael A.; Stephani, Ulrich; Frazier, Kendall S.; Böhm, Markus; Luger, Thomas A.; Leung, Alexander K. C.; Sauve, Reginald S.; Matejas, Verena; Zenker, Martin; Leung, Alexander K. C.; Leung, Alexander K. C.; Robson, William Lane M.; Beissert, Stefan; Leung, Alexander K. C.; Robson, William Lane M.; Woo, Tom Y.; Leung, Alexander K. C.; Cate, Hugo Ten; Light, Richard W.; Bozza, Patricia T.; Salluh, Jorge I.; Jantz, Michael A.; Vargas, Sergio L.; Tomic, Rade; Roman, Jesse; Mobeireek, Abdullah F.; Khalid, Mohammad; Torres, Harrys A.; Chemaly, Roy F.; Tomic, Rade; Roman, Jesse; Light, Richard W.; Dispenzieri, Angela; Krause, Sabine; Lochmüller, Hanns; Weihrauch, Julia; Krieg, Thomas; Kühn, Wolfgang; Walz, Gerd; Merker, Georg H.; Kubitz, Ralf; Häussinger, Dieter; Schnog, John-John B.; Gerdes, Victor E. A.; Musco, Giovanna; Stoll, Guido; Toyka, Klaus V.; Leung, Alexander K. C.; Leung, Alexander K. C.; Robson, William Lane M.; Böhm, Markus; Luger, Thomas A.; Pischik, Elena; Kauppinen, Raili; Frank, Jorge; Schwarz, Thomas; Thapar, Manish; Bonkovsky, Herbert. L.; Wagner, Jeffrey C.; Smith, A. Gordon; Mela, Maria; Thalheimer, Ulrich; Samonakis, Dimitrios; Burroughs, Andrew K.; Mela, Maria; Thalheimer, Ulrich; Samonakis, Dimitrios; Burroughs, Andrew K.; Shastri, Yogesh M.; Stein, Jürgen M.; Segman, Ronnen H.; Shalev, Arieh Y.; Jacob, Giris; Robertson, David; Leung, Alexander K. C.; Robson, William Lane M.; Leung, Alexander K. C.; Lampinen, Katja; Kublickiene, Karolina; Kaaja, Risto; Lenarczyk, Radosław; Kowalski, Oskar; Kalarus, Zbigniew; Wichterle, Dan; Leung, Alexander K. C.; Maguire, Jamie; Mody, Istvan; Janssens, Katrien; Vanhoenacker, Filip; Van Hul, Wim; Gdynia, Hans-Jürgen; Ludolph, Albert C.; Leonard, James V.; Cate, Hugo Ten; Geboes, Karel; Van Assche, Gert; Cate, Hugo Ten; Berden, Jo H. M.; Van Kuppevelt, Toin H.; Rops, Angelique L.; Cate, Hugo Ten; Cate, Hugo Ten; Frank, Jorge; Schwarz, Thomas; Ambros-Rudolph, Christina M.; Lamounier-Zepter, Valéria; Thomas, Christie P.; Thomas, Christie P.; Thomas, Christie P.; Koch, Christian A.; Weinstein, Lee S.; Silve, Caroline; Leung, Alexander K. C.; Uitto, Jouni; Jiang, Qiujie; Leung, Alexander K. C.; Robson, William Lane M.; Leung, Alexander K. C.; Yildiz, Orhan; Kayabas, Uner; Hegele, Richard G.; Tournier, Jean-Nicolas; Halefoğlu, Ahmet Mesrur; Hutson, Mary Redmond; Kirby, Margaret L.; Okada, Fumito; Ando, Yumiko; Ono, Asami; Mori, Hiromu; Moore, Timothy M.; Townsley, Mary I.; Krauth, Maria-T.; Pabinger, Ingrid; Ballmann, Manfred; Hegele, Richard G.; Trow, Terence K.; McLaughlin, Vallerie V.; Hegele, Richard G.; Fetouh Yassin, Atteyet-Alla; Uebing, Anselm; Gatzoulis, Michael A.; Gardiner, Helena M.; Ma, Lucia K.; Ma, Patrick T. S.; Leung, Alexander K. C.; Prieto, Lourdes; Latson, Larry; Keller, Nancy R.; Robertson, David; Fairbanks, Lynette D.; Simmonds, H. Anne; Brunner, Martina; Zouboulis, Christos C.; Everts, Vincent; Helfrich, Miep; Leung, Alexander K. C.; Wong, Andrew L.; Von Den Driesch, Peter; Bitsch, Roland; Bitsch, Roland; Bitsch, Roland; García-Cazorla, Angels; Saudubray, Jean Marie (2009). "Pentalogy of Fallot": 1602–1605. doi:10.1007/978-3-540-29676-8_1393.

[ParwaniPhillips2016-6] Parwani, Purvi; Phillips, Sabrina (2016). "IMPORTANCE OF PHYSICAL EXAMINATION IN ADULT PATIENTS WITH TETRALOGY OF FALLOT". Journal of the American College of Cardiology. 67 (13): 1101. doi:10.1016/S0735-1097(16)31102-0. ISSN 0735-1097.

[LapierreDubois2016-7] 7.0 ^7.1 Lapierre, C.; Dubois, J.; Rypens, F.; Raboisson, M.-J.; Déry, J. (2016). "Tetralogy of Fallot: Preoperative assessment with MR and CT imaging". Diagnostic and Interventional Imaging. 97 (5): 531–541. doi:10.1016/j.diii.2016.01.009. ISSN 2211-5684.

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@@ Line 1: / Line 1: @@
 __NOTOC__
 {{SI}}
-{{CMG}} {{AE}}[[User:Abdulkareem Opeoluwalukan|Abdulkareem Opeoluwalukan, M.D]].
+{{CMG}} {{AE}}[[User:Abdulkareem Opeoluwalukan|Abdul-Kareem Lukan, M.D]].
 ==Overview==
-Pentalogy of Fallot is defined as the occurrence of Tetralogy of Fallot plus an [[atrial septal defect]].
+Pentalogy of Fallot is defined as the occurrence of Tetralogy of Fallot plus an [[atrial septal defect]].[[File:Pentalogy_of_fallot_image_1.png |200p|thumb|center|  Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa. paolo.pazzi@up.ac.za.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3984729/]]
 ==Historical Perspective==
-tetrallogy of fallot  was first discovered by Niel Stenson, a Denish physician Anatomist, in 1671<ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref>.
+*[[Tetrallogy of fallot|Tetralogy of fallot]]  was first discovered by Niel Stenson, a Denish physician [[Anatomist]], in 1671. <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref>
+* The association between [[right ventricular outflow tract obstruction]] and a large [[ventricular septal defect]]  and [[Tetralogy of Fallot|tetralogy of fallot]] was made in 1888 by Etinne-Louise.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref>
-The association between Rigt ventriular outflow tract obstruction and a large ventricular septal defect  and tetrallogy of fallot. was made in 1888 by Etinne-Louise]<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref>.
+* In 1924, Canadian, Maude Abbott was the first to discover the association between [[ventricular septal defect]] , [[Pulmonary valve stenosis|pulmonary stenosis]], [[overriding aorta]] and [[right ventricular hypertrophy]] and the development of [[tetralogy of Fallot]].<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref
+In 1939, the first surgical treatment  was developed by  Dr Helen Taussig in Johns Hopkins&amp;amp;lt;nowiki&amp;amp;gt;&&amp;amp;lt;/nowiki&amp;amp;gt;lt;nowiki&amp;lt;nowiki&amp;gt;&&amp;lt;/nowiki&amp;gt;gt;&lt;nowiki&gt;&&lt;/nowiki&gt;lt;nowiki<nowiki>&</nowiki>gt;<nowiki>&lt;nowiki&gt;<ref name="pmid30020660">&lt;/nowiki&gt;</nowiki>&lt;/nowiki&gt;&lt;/nowiki&gt;{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref>
-In 1924, Canadian, Maude Abbott was the first to discover the association between ventricular septal defect , pulmonary stenosis, overriding aorta and right ventricular hypertrophy and the development of tetrallogy of Fallot.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref
-In 1939, the first surgical treatment  was developed by  Dr Helen Taussig in Johns Hopkins<nowiki><ref name="pmid30020660"></nowiki>{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref>
 ==Classification==
-There is no established system for the classification of [pentallogy of fallot ].
+* There is no established system for the [[classification]] of the pentalogy of Fallot.
-<br />
 ==Pathophysiology==
+It is thought that conotruncal  diseases like [[Tetralogy of Fallot|tetralogy of fallot]] and pentalogy of Fallot  occur as a result of:<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref>
+* [[Neural crest]] migration defect.
+* Underdevelopment of right ventricular infundibulum
-It is thought that [tetrallogy of fallot] is the result of anterocephalad deviation of the aortico pulmonary septum<ref name="pmid25870631">{{cite journal |vauthors=Beig JR, Ahmed W, Hafeez I, Gupta A, Tramboo NA, Rather HA |title=Pentalogy of fallot with a single coronary artery: a rare case report |journal=J Tehran Heart Cent |volume=9 |issue=3 |pages=132–4 |date=2014 |pmid=25870631 |pmc=4393836 |doi= |url=}}</ref> thus leading to
-* ventricular septal defect
-* right ventricular outflow tract obstruction
-*overriding aorta
-* right ventricular hypertrophy with an additional ASD( atrial septal defect) with ostium secundum type being the most common followed by ostium primum <ref name="pmid25870631">{{cite journal |vauthors=Beig JR, Ahmed W, Hafeez I, Gupta A, Tramboo NA, Rather HA |title=Pentalogy of fallot with a single coronary artery: a rare case report |journal=J Tehran Heart Cent |volume=9 |issue=3 |pages=132–4 |date=2014 |pmid=25870631 |pmc=4393836 |doi= |url=}}</ref>. thus making it a pentallogy of fallot. even though there are no reports on the molecular pathophysiology of pentallogy of fallot, conotruncal heart defects like tetrallogy of fallot are associated with neural crest migration defect. systemic pathophysiology of tetrallogy of fallot depends on the extent of right ventricular outflow tract obstruction, severe pulmonic stenosis leads to a significant decrease in pulmonary circulation and worsening right to left shunt leading to cyanosis.A collateral PDA makes Tetrallogy of fallot compatible with life as it preserves pulmonic circulation <ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. 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 ==Causes==
+*The [[cause]] of the pentalogy of Fallot has not been identified.
+*To review [[risk factors]] for the development of pentalogy of Fallot, click [[Pentalogy of Fallot#Risk factors|here]].
+==Differentiating pentalogy of Fallot from other Diseases==
+*Pentalogy of Fallot  must be differentiated from other [[diseases]] that cause:<ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref>
-The cause of pentalogy of fallot has not been identified. To review risk factors for the development of pentalogy of fallot, click [[tetralogy of fallot causes#Overview|here]].
+===Right to left shunt===
+*[[Transposition of the great vessels|Transposition of great arteries]] with [[Right ventricular outflow tract obstruction|Pulmonic stenosis]]
-==Differentiating pentalogy of fallot  from other Diseases==
+*[[Double outlet right ventricle]] including [[Taussig-Bing syndrome|Taussig-Bing anomaly]]
-pentallogy of Fallot  must be differentiated from other diseases that cause .
+*[[Tricuspid atresia]]
+* [[Ebstein Anomaly]]
-===right to left shunt===
+*[[Pulmonary atresia]] with intact [[Interventricular septum|ventricular septum]]
-* transposition of great arteries with pulmonic stenosis,
+*[[Respiratory]] diseases
-* double outlet right ventricle including Taussig-Bing anomaly,
+** [[Bronchiolitis]]
-*tricuspid atresia,
+** Viral and bacterial [[Pneumonia]]
-* Ebstein Anomaly,
+** [[Pneumothorax]] because when they are in [[Congestive heart failure|heart failure]] they present with signs of respiratory distress, [[cyanosis]] and [[failure to thrive]].
-* pulmonary atresia with intact ventricular septum ,
+=== Bidirectional shunt  diseases===
+* [[Total anomalous pulmonary venous return]]
-=== Respiratory diseases===
+*[[Hypoplastic left heart syndrome]]
-* Bronchiolitis,
+*[[Single ventricle]]
-*viral and bacterial pneumonia
+*[[Persistent truncus arteriosus|Truncus arteriosus]]
-* pneumothorax because when they are in heart failure they present with signs of respiratory distress, cyanosis and failure to thrive
-= Bidirectional shunt  diseases=
-*  total anomalous pulmonary venous return,
-* hypoplastic left heart syndrome,
-* single ventricle
-* truncus arteriosus <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref>
 ==Epidemiology and Demographics==
-The epidemiology of pentalogy of fallot has not been well studied.
+The epidemiology of the pentalogy of Fallot has not been well studied.
 ==Risk Factors==
+Common [[risk factors]] in the development of pentalogy of fallot include:<ref name="SilvaNeves2019">{{cite journal|last1=Silva|first1=Joana A.|last2=Neves|first2=Ana L.|last3=Flor-de-Lima|first3=Filipa|last4=Soares|first4=Paulo|last5=Guimarães|first5=Hercília|title=Risk Factors and Outcomes of Tetralogy of Fallot: From Fetal to Neonatal Life|journal=Pediatric Cardiology|volume=41|issue=1|year=2019|pages=155–164|issn=0172-0643|doi=10.1007/s00246-019-02239-4}}</ref>
+*[[Alcoholism]] in mother
+* Maternal [[Diabetes]]
-Common risk factors in the development of pentalogy of fallot includes<ref name="SilvaNeves2019">{{cite journal|last1=Silva|first1=Joana A.|last2=Neves|first2=Ana L.|last3=Flor-de-Lima|first3=Filipa|last4=Soares|first4=Paulo|last5=Guimarães|first5=Hercília|title=Risk Factors and Outcomes of Tetralogy of Fallot: From Fetal to Neonatal Life|journal=Pediatric Cardiology|volume=41|issue=1|year=2019|pages=155–164|issn=0172-0643|doi=10.1007/s00246-019-02239-4}}</ref>
-* Alcoholism in mother
-* Maternal Diabetes
 * Advanced maternal age i.e greater than 40 years
-* Malnutrition in pregnancy
+*[[Malnutrition]] in pregnancy
-* Family history of tetralogy of fallot
+* Family history of [[Tetralogy of Fallot|tetralogy of fallot]]
-* Viral illness during pregnancy like Rubella.
+* [[Viral]] illness during pregnancy like [[Rubella]].
-* presence of Down syndrome or DiGeorge syndrome
+* Presence of [[Down syndrome]] or [[22q11.2 deletion syndrome|DiGeorge syndrome]]
 ==Screening==
-There is insufficient evidence to recommend routine screening for pentalogy of fallot.
+There is insufficient evidence to recommend routine screening for the pentalogy of Fallot.
 ==Natural History, Complications, and Prognosis==
-If left untreated,  patients with pentalogy of fallot  may progress to develop finger clubbing, stunted growth,  cardiac arrhythmias, hypoplastic pulmonary artery and polycythemia with relative iron deficiency.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref>
+If left untreated,  patients with pentalogy of fallot  may progress to develop [[Clubbing|finger clubbing]], [[stunted growth]], [[Cardiac arrhythmia|cardiac arrhythmias]], hypoplastic pulmonary artery, [[Paradoxical embolism|paradoxical emboli]] and [[polycythemia]] .<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref>
-Prognosis is generally excellent provided the  VSD has been closed and the right ventricular outflow tract has been relieved,<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref>
+Prognosis is generally excellent provided the  [[Ventricular septal defect|VSD]] has been closed and the [[right ventricular outflow tract]] has been relieved.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref>
 ==Diagnosis==
 ===Diagnostic Study of Choice===
+There are no established criteria for the diagnosis of pentalogy Fallot.
-There are no established criteria for the diagnosis of pentalogy fallot.
 ===History and Symptoms===
+The hallmark of pentalogy of fallot  is [[cyanosis]]. A positive history of [[cyanosis]] and easy fatigability leading to squatting during exercise is suggestive of cyanotic [[congenital]] heart defect.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref>
-The hallmark of pentalogy of fallot  is cyanosis. A positive history of cyanosis and easy fatigability leading to squatting during exercise is suggestive of cyanotic congenital heart defct <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref>
+. The most common symptoms of pentalogy of fallot include [[cyanosis]], easy fatigabillity , and hypercyanotic spells with crying , feeding and defecating.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref>
-. The most common symptoms of pentalogy of fallot include cyanosis, easy fatigabillity , and hypercyanotic spells with crying , feeding and defecating<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref>
+==Physical Examination==
+[[Patients]] with pentalogy of Fallot appear [[cyanotic]].<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><ref name="ParwaniPhillips2016">{{cite journal|last1=Parwani|first1=Purvi|last2=Phillips|first2=Sabrina|title=IMPORTANCE OF PHYSICAL EXAMINATION IN ADULT PATIENTS WITH TETRALOGY OF FALLOT|journal=Journal of the American College of Cardiology|volume=67|issue=13|year=2016|pages=1101|issn=07351097|doi=10.1016/S0735-1097(16)31102-0}}</ref>
-===Physical Examination===
+* Physical examination of patients with Pentalogy of Fallot is usually remarkable for:
-== Appearance==
+** Right ventricular heave
-* patients with pentalogy of fallot usually appear small due to failure to thrive.
+** Elevated jugular venous pressure
-* patients may be found in squatting position( compensatory mechanism)
+** [[Clubbing|Finger clubbing]]
+** Displaced apex beat
-== Vital Signs==
+** Normal S1 with single S2
-* Tachycardia with regular pulse
+** [[Pedal edema|Peripheral edema]]
-* Tachypnea
+** [[Heart murmur|Diastolic murmur]] at the left sternal border
-* low grade fever in patients with concomitant infective endocarditis
+** [[Systolic murmur]] increasing with [[inspiration]] at the [[left sternal border]]
-== Skin==
-* cyanosis may be present
-== HEENT==
-* Retinal vessel engorgement may be present
-==pulmonary==
-*Pulmonary examination of patients with tetralogy of Fallot is usually normal.
-== Heart==
-A thrill may be present at left sternal border.
-*A right ventricular impulse may be prominent.
-*First heart sound (S1) is normal
-*Second heart sound (S2) is single as P2 is absent.
-*A harsh systolic ejection murmur best heard at the left sternal border is usually present.
-*The loudness and length of systolic murmur is inversely proportional to the severity of right ventricular outflow tract obstruction (RVOTO). In other words as the RVOTO *worsens, the murmur softens. The more cyanotic the patient, the softer the murmur.
-* As the RVOTO progresses towards occlusion the right ventricular blood is diverted to left ventricle through ventricular septal defect. This causes the pulmonic murmur to become shorter and softer.
-*P2 is faint and delayed in mild cyanosis and inaudible in severe cyanosis.
-*A diastolic murmur may be heard due to aortic regurgitation.
-== Abdomen==
-*Abdominal examination of patients with tetralogy of Fallot is usually normal.
-== Extremities==
-*Clubbing
-*Cyanosis is most prominent at lips and nail beds
 ===Laboratory Findings===
+Some patients with pentalogy of fallot may have [[polycythemia]]
+which is usually suggestive of worsening [[hypoxia]] and compensatory production of erythropoetin.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref>
-Some patients with pentalogy of fallot may have polycythemia <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref>
-which is usually suggestive of worsening hypoxia and compensatory production of erythropoetin.
-.
 ===Electrocardiogram===
+An ECG may be helpful in the diagnosis of pentalogy of Fallot,
+Findings on an ECG suggestive of pentalogy of fallot include [[right axis deviation]] and  [[right ventricular hypertrophy]].<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref>
-An ECG may be helpful in the diagnosis of pentalogy of fallot <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref>
+ [[File: Right_ventrriular_hypertophy.png|200p|thumb|right|Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874376/]]
-Findings on an ECG suggestive of pentalogy of fallot include right axis deviation and  right ventricular hypertrophy.
 ===X-ray===
+An x-ray may be helpful in the diagnosis of pentalogy of Fallot. Findings on an x-ray suggestive of pentalogy of fallot include boot shaped heart or coeur en sabot.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref> [[File:Boot_shaped_heart.png|200p|thumb|left| Typical preoperative chest X‐ray of a 16‐month‐old boy with tetralogy of Fallot.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5412831/]]
-An x-ray may be helpful in the diagnosis of pentalogy of Fallot. Findings on an x-ray suggestive of pentalogy of fallot include boot shaped heart or coeur en sabot.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref>
-.
 ===Echocardiography or Ultrasound===
+Echocardiography  may be helpful in the diagnosis of pentalogy of fallot. Findings on an echocardiography diagnostic of pentalogy of fallot include.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref>
+*[[Ventricular septal defect]].
+* Atrial septal defect.
+*[[Right ventricular outflow tract obstruction]].
-Echocardiography  may be helpful in the diagnosis of pentalogy of fallot. Findings on an echocardiography diagnostic of pentallogy of fallot include Ventricular septal defect, Atrial septal defect , Right ventricular outflow tract obstruction and overriding aorta<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref>
+*[[overriding aorta]] [[File:Pentalogy_of_fallot_image_2.png|200p|thumb|left | Department of Biochemistry, University of Allahabad, Allahabad-211002, India.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3299189/]]
 ===CT scan===
+Thoracic [[CT angiography]]  may be helpful in the diagnosis of pentalogy of fallot. Findings on CT scan diagnostic of pentalogy of fallot include. <ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref>
+*[[ventricular septal defect]].
-Thoracic CT angiography  may be helpful in the diagnosis of pentallogy of fallot. Findings on CT scan diagnostic of pentalogy of fallot include ventricular septal defect, right ventricular hypertrophy, pulmonary atresia and major aortopulmonary collateral arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref>
+*[[right ventricular hypertrophy]],
+*[[pulmonary atresia]]
+*[[Aortopulmonary Window|aortopulmonary]] collateral arteries.
 ===MRI===
+[[Cardiovascular magnetic resonance imaging (CMR)|cardiac MRI]] may be helpful in the diagnosis of pentalogy of fallot. Findings on MRI diagnostic of pentalogy of fallot include RVOT stenosis, [[VSD,]]  [[ASD,]][[Overriding aorta]], [[right ventricular hypertrophy]] and hypoplastic pulmonary arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref>
-cardiac MRI may be helpful in the diagnosis of pentalogy of fallot. Findings on MRI diagnostic of pentalogy of fallot include RVOT stenosis, VSD,  ASD,Overriding aorta, right ventricular hypertrophy and hypoplastic pulmonary arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref>
 ===Other Imaging Findings===
-Other imaging findings for pentalogy of fallot include Right ventricular angiopraphy, which demonstrates infundibular and pulmonary artery anatomy,  and left ventricular angiography, which demonstrates VSD, ASD, and Overiding aorta <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref>
+Other imaging findings for pentalogy of fallot include [[Right ventricular angiopraphy]] which demonstrates infundibular and [[pulmonary artery]] anatomy.  left ventricular angiography, which demonstrates. <ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref>
+*[[Ventricular septal defect|VSD]]
+*[[Atrial septal defect|ASD]],
+*[[Overiding aorta]]
 ===Other Diagnostic Studies===
 There are no other diagnostic studies associated with pentalogy of Fallot
 ==Treatment==
 ===Medical Therapy===
-The mainstay of treatment for pentalogy of fallot  is Surgery.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref>
+The mainstay of treatment for pentalogy of fallot  is Surgery.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref>
-Pharmacologic medical therapy is recommended among patients with severe RVOTO and hypercyanotic spells<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref>
+Pharmacologic medical therapy is recommended among patients with severe [[Right ventricular outflow tract obstruction|RVOTO]] and hypercyanotic spells.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref>
-Pharmacologic medical therapies for pentalogy of fallot include <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref>
+Pharmacologic medical therapies for pentalogy of fallot include.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref>
-* prostaglandin E1 in neonates with ductal dependent pulmonary blood flow
+*[[prostaglandin E1]] in neonates with ductal dependent pulmonary blood flow
-* Morphine and ketamine  for sedation
+*[[Morphine]] and [[ketamine]]  for sedation
-*vasopressors like phenylephrine
+*vasopressors like [[phenylephrine]]
-*propanolol to decrease the need for palliative surgical intervention.
+*[[Propranolol|propanolol]] to decrease the need for palliative surgical intervention.
 * iron treatment to decrease frequency of spells.
-Patients with hypercyanotic spells are treated with oxygen,volume expansion and morphine sedation.
+Patients with hypercyanotic spells are treated with,
+* oxygen
+*volume expansion
+* morphine sedation.
 ===Surgery===
-Surgical intervention is not recommended for the management of [disease name].
+Surgery is the mainstay of treatment for the pentalogy of Fallot. interventional procedures are used to relieve pulmonary obstructions and embolize collaterals.
+different surgical procedures can be done to treat pentalogy of fallot and it includes.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref>
-OR
+* Pulmonary valvotomy( for stenotic pulmonic valve)
+* Pulmonary valvectomy( for small and thickened pulmonic valve)
-Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]
+* Closure of [[Atrial septal defect|ASD]]/[[Ventricular septal defect|VSD]]
+* Shunt surgery for severe [[cyanosis]] or in patients with frequent spells in the first year of life
-OR
+* Blalock -Taussig Shunt- communication between the right or left [[pulmonary artery]] and the right or left [[subclavian artery]].
+* Waterson-Cooley Shunt- communication between the [[ascending aorta]] with the right [[pulmonary artery]]
-The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].
+* Potts shunt-communication between the [[descending aorta]] and left [[pulmonary artery]]
+* Central shunt- Communication between the main [[Pulmonary artery|pulmonary arter]]<nowiki/>y and [[ascending aorta.]]
-OR
-The feasibility of surgery depends on the stage of [malignancy] at diagnosis.
-OR
-Surgery is the mainstay of treatment for [disease or malignancy].
 ===Primary Prevention===
-There are no established measures for the primary prevention of [disease name].
+There are no established measures for the primary prevention of the pentalogy of Fallot.
-OR
-There are no available vaccines against [disease name].
-OR
-Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
-OR
-[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].
 ===Secondary Prevention===
-There are no established measures for the secondary prevention of [disease name].
+There are no established measures for the secondary prevention of the pentalogy of Fallot.
-OR
-Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].
 ==References==
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