Tetralogy of Fallot: Difference between revisions
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Revision as of 15:01, 13 July 2011
Template:DiseaseDisorder infobox
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Tetralogy of fallot Microchapters |
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Diagnosis |
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Treatment |
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Tetralogy of Fallot On the Web |
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American Roentgen Ray Society Images of Tetralogy of Fallot |
For patient information click here
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Associate Editors-In-Chief: Keri Shafer, M.D. [2]; Atif Mohammad, M.D., Priyamvada Singh, MBBS
Tetralogy of fallot diagram
Tetralogy of fallot overview
Tetralogy of fallot anatomy
Tetralogy of fallot pathophysiology
Tetralogy of fallot epidemiology and demographics
Tetralogy of fallot natural history, complications and prognosis
Tetralogy of fallot causes
Tetralogy of fallot differential diagnosis
Tetralogy of fallot diagnosis
Tetralogy of fallot history and symptoms
Tetralogy of fallot physical examination
Tetralogy of fallot lab studies
Tetralogy of fallot electrocardiogram
Tetralogy of fallot chest xray
Tetralogy of fallot echocardiography
Tetralogy of fallot cardiac catheterization
Tetralogy of fallot other tests
Tetralogy of fallot treatment
ACC/AHA guidelines tetralogy of fallot
Tetralogy of fallot surgical techniques
Tetralogy of fallot prognosis
Tetralogy of fallot prevention
References
External Links for VSD
- Pediatric Heart Surgery
- The Congenital Heart Surgery Video Project
- VSD Repair, Perimembranous Ventricular Septal Defect
- VSD Repair Powerpoint™ Presentation
Acknowledgements and Initial Contributors to Page
Leida Perez, M.D. Redmond Burke M.D.
References
de:Herzfehler lv:Iedzimtās sirds slimības nn:Medfødd hjartefeil sr:Урођене срчане мане uk:Вроджені вади серця wa:Maladeye des bleus påpåds
- Arterial oxygen desaturation is evident, as is compensatory erythrocytosis, the magnitude of which is proportional to the severity of the desaturation.
Treatment
Tetralogy of Fallot is treated on two levels: with immediate emergency care for hypoxic or "tet" spells and with corrective surgery.
Emergency management of tet spells
Consequential acute hypoxia may be treated with beta-blockers such as propranolol, but acute episodes may require rapid intervention with morphine to reduce ventilatory drive and phenylephrine to increase blood pressure. Oxygen is ineffective in treating hypoxic spells because the underlying problem is lack of blood flow through the pulmonary circuit and not alveolar oxygenation. There are also simple procedures such as the knee-chest position which increases aortic wave reflection, increasing pressure on the left side of the heart, decreasing the right to left shunt thus decreasing the amount of deoxygenated blood entering the systemic circulation.[1]
Palliative surgery
The condition was initially thought untreatable until surgeon Alfred Blalock, cardiologist Helen B. Taussig, and lab assistant Vivien Thomas at Johns Hopkins University developed a surgical procedure, which involved forming an anastomosis between the subclavian artery and the pulmonary artery. It was actually Helen Taussig who convinced Alfred Blalock that the shunt was going to work. This redirected a large portion of the partially oxygenated blood leaving the heart for the body into the lungs, increasing flow through the pulmonary circuit, and greatly relieving symptoms in patients. The first Blalock-Thomas-Taussig shunt surgery was performed on 15-month old Eileen Saxon on November 29, 1944 with dramatic results.
The Pott shunt and the Waterson procedure are other shunt procedures which were developed for the same purpose.
Currently, Blalock-Thomas-Taussig shunts are not normally performed on infants with TOF except for severe variants such as TOF with pulmonary atresia.
Total surgical repair
The Blalock-Taussig procedure was the only surgical treatment until the first total repair was performed in 1954. Between 1944 and when total repair became available at major surgical centers in the early 1960s, many infants and children were treated with Blalock-Taussig procedures.
The total repair was performed by C. Walton Lillehei at the University of Minnesota in 1954 on a 10-month boy. Total repair initially carried a high mortality risk which has consistently improved over the years. Surgery is now often carried out in infants 1 year of age or younger with a <5% perioperative mortality. The surgery generally involves making incisions into the heart muscle, relieving the right ventricular outflow tract stenosis by careful resection of muscle, and repairing the VSD using a Gore-Tex or Dacron patch or a homograft. Additional reparative or reconstructive work may be done on patients as required by their particular anatomy.
Patients who have undergone "total" repair of tetralogy of Fallot often have good to excellent cardiac function after the operation with some to no exercise intolerance and have the potential to lead normal lives. Surgical success and long-term outcome greatly depends on the particular anatomy of the patient and the surgeon's skill and experience with this type of repair.
See also
- Trilogy of Fallot
- Pentalogy of Fallot
References
External links
- Tetralogy of Fallot information from Seattle Children's Hospital Heart Center
- Information by University of Michigan Health System
- Diagram of the condition
- Information for adults with ToF from the Adult Congenital Heart Association
- Michael Warman's Website on ToF
de:Fallot-Tetralogie it:Tetralogia di Fallot nl:Tetralogie van Fallot nn:Fallots tetrade uk:Тетрада Фалло