Tetralogy of Fallot: Diagnosis and Treatment
Tetralogy of Fallot is a congenital heart defect related to the "blue" type. This pathology covers about 15% of all congenital heart defects.
For tetralogy of Fallot the following symptoms are common:
- Pathology of the interventricular septum.
- The displacement of the aorta to the right, so that it is located on the mouth of ventricular septal defect.
- Pulmonary stenosis.
- The presence of wall hypertrophy of the right heart.
Pulmonary artery can be narrowed in the following variations:
- Subvalvular stenosis which is a narrowing of the output fibromuscle department right ventricular over from a few millimeters to 2-3 cm.
- Valve stenosis, when there is a fusion of the valves and the valve is formed properly.
- The combination of subvalvular and valvular stenosis.
- Artesia of the pulmonary artery mouth and hypoplasia or stenosis of the main trunk of the pulmonary artery or of its branches.
Diagnosis of tetralogy of Fallot
Newborn baby with tetralogy of Fallot is usually observed with a normal development, as the perinatal heart defects do not hinder circulation. But the first signs of disease may occur within a few days after birth. These symptoms include:
- Displaing of cyanosis during feeding or crying.
- Shortness of breath and cyanosis are becoming more pronounced with each month.
- At the age of 1-2 years the child has bluish skin, the veins are visible clearly.
- Cyanosis manifestated on the lips, ear shells, conjunctivitis, nail plates most evidently.
- The fingers take the form of drum sticks.
- In the development of the child lags behind its peers.
- It is often accompanied by malformation and other abnormalities, such as cleft lip and palate, funnel chest, flat feet, and others.
- A child is often forced to take a forced rest and squat. In some cases, patients are completely bedridden.
- During sudden attacks of shortness of breath, the patient may lose consciousness.
Without surgery, patients suffering from tetralogy of Fallot die before adulthood.
Diagnosis is carried out by means of vice phonocardiograms, ECG, Ultrasound and Color Doppler echocardiography, which help to identify the main morphological changes in the structure of the heart, which are inherent to this malfunction, as well as the pathological changes in the direction of blood flow.
The treatment of tetralogy of Fallot
Modern medicine offers two types of methods of the correction of tetralogy of Fallot:
- A radical method.
- Palliative methods.
The radical elimination of this malfunction is carried out with the help of cardioplegia and cardiopulmonary bypass. During the surgery, the surgeon performs the closing of interventricular defect and eliminates the stenosis. Depending on the type of stenosis, dissection is carried out in the way that pulmonary valve leaflets are fused at their commissures. Next fibromuscular roll of the right ventricle outflow tracts is excised, and the ongitudinal section of the outflow tract of the right ventricle and the pulmonary artery trunk are sewed with synthetic patches. Sewing patches to the edges of the defect eliminates pathology interventricular septum.
Palliative methods are the operations that consist of imposing bypasses between arteries. The most common type of such operations includes the compounding of the left and right branches of the pulmonary artery using a subclavian artery by applying direct anastomosis or by the means of a synthetic graft or prosthesis that is sewn between the vessels. Thus, blood flows through the arterial anastomosis in the lungs, and the pulmonary veins bring it further into the left atrium. This allows to increase the amount of oxygenated blood that flows into the left ventricle, thus there is a decrease in cyanosis. The purpose of this method is to provide the child with the opportunity to pass a difficult period, to carry out radical surgery in order to fully eliminate the defect later.