Fallots Tetralogy

Question 1

Anatomical structures

Answer 1

Ventricular septum, pulmonary valve, aorta and right ventricle

Question 2

Structural abnormalities

Answer 2

Ventricular septal defect
Pulmonary stenosis
Overriding aorta - position is over the right as well as left ventricle
Right ventricular hypertrophy

Question 3

Physiological abnormalities

Answer 3

Low oxygenation of blood due to mixing of oxygenated and deoxygenated blood in LV
Preferential flow of the mixed blood from ventricles through the aorta due to pulmonary valve obstruction} right to left shunt

Question 4

Prior events

Answer 4

Born with it

Question 5

Symptoms

Answer 5

cyanosis, 
difficulty feeding, 
failure to gain weight, 
retarded growth and physical development, 
dyspnoea on exertion

Question 6

Signs

Answer 6

Heart murmur,
clubbing,
polycythemia- large amount of red blood cells
Tet spells - may result in hypoxic brain injury
Older children squat during Tet spells- increases systemic vascular resistance and allows for a temporary reversal of the shunt

Question 7

Abnormal test results

Answer 7

Echocardiogram- abnormal anatomy, shunt passing form left to right initially and later from right to left ( Eisenmenger complex)
The abnormal “coeur-en-sabot” (boot like) appearance of the heart is visible with x-ray

Question 8

Medical/surgical intervention

Answer 8

O2- treat Tet spells, it is a potent pulmonary vasodilator and systemic vasocontrictor
Surgery forming an anastomosis between the subclavian artery and pulmonary artery to allow more blood to get to the lungs

Question 9

Primary and secondary intervention

Answer 9

Curative heart surgery- relieves RV outflow tract stenosis by removal of muscle and repair of VSD
Despite surgery still at risk of sudden cardiac death and heart failure.