Salient features which may be assessed during a standard sequence of transthoracic echocardiographic views include 16

EchocardiographyД®chocardiography allows direct visualization of the abnormal anatomy and remains the primary modality for the diagnosis of tetralogy of Fallot.В It has limitations on assessing associated extracardiac anomalies (e.g.В peripheral pulmonary stenosis and atresia). A right-sided aortic arch is seen in 25%. Pulmonary oligemia occurs due to decreased pulmonary arterial flow. Most infants with tetralogy of Fallot, however, may not show this finding 2. Radiographic features Plain radiographД¬hest radiographs may classically show a 'boot-shaped' heart with an upturned cardiac apex due to right ventricular hypertrophy and concave pulmonary arterial segment. In ~15% of cases, it is associated with a deletion on chromosome 22q11 13. The right ventricular hypertrophy is a result of the ventricular septal defect and right ventricular outlet obstruction, both contributing to elevated resistance to right heart emptying 6.

right ventricular hypertrophy: only develops after birth.

hypoplastic pulmonary valve annulus, or.

right ventricular outflow tract obstruction (RVOTO) due to.

Tetralogy of Fallot is classically characterized by four features which are: In cases where outflow obstruction is minimal, cyanosis may be inapparent ( pink tetralogy) resulting in delayed presentation, even into adulthood, although this is rare. Typically this is significant, resulting in cyanosis evident in the neonatal period, as a consequence of the right to left shunt across the ventricular septal defect. The presentation relies on the degree of right ventricular outflow tract obstruction (RVOTO).

extracardiovascular associations:В may be present in ~15% of cases 10.

persistent left-sided superior vena cava.

coronary artery anomalies: seen in 3% of cases 6.

atrial septal defect (ASD)В or patent ductus arteriosus (PDA)В (termed pentalogy of Fallot).

pulmonary hypoplasiaВ +/- atresia: particularly important in determining treatment 8, when there is pulmonary atresiaВ it is sometimes termed pseudotruncus arteriosus 9.

right-sided aortic arch: seen in ~25% of cases.

Tetralogy of Fallot accounts for 5 to 10% of all congenital heart disease and has an estimated prevalence of 1 in 2000 births 10.

Patofisiologi tetralogi fallot pdf