Symptoms, diagnosis, surgery for the diagnosis of Tetrad of Fallot
Of all the congenital anomalies of heart development, one of the most frequently diagnosed is the tetrad of Fallot - it is determined in 7-10% of clinical cases of heart defects. In addition, it accounts for half of all anomalies of the heart development of the so-called cyanotic (blue) type.
Definition
Tetra of Fallot is a congenital heart disease (CHD) in which:
- stenosis (narrowing) of the outflow tract (pathway) of the right ventricle;
- defect (presence of a pathological opening) of the gastric septum;
- dextraposition of the aorta – in this case, an atypical high departure of the aorta from the left ventricle or the aorta generally departs from the right ventricle;
- hypertrophy (growth, thickening) of the cardiac muscle of the right ventricle.
In addition to the tetrad of Fallot, there are also its "simplified" and "supplemented" versions - triad and pentad of Fallot. The difference between the triad, tetrad, and pentad of Fallot according to anatomical features:
- with a triad, there are all the signs of a tetrad, except for an incorrect departure of the aorta;
- with a pentad there are all the signs of a tetrad and, in addition to them, an atrial septal defect.
Also, tetrad of Fallot can be diagnosed in combination with other cardiovascular defects - it can be:
- location of the aortic arch on the right;
- anomalies in the development of coronary vessels (vessels that supply blood to the heart);
- narrowing of the smaller branches of the pulmonary artery;
- additional superior vena cava.
Causes and essence of the disease
The disease develops due to the fact that in the period of embryonic development (2-8 weeks) there is a failure in the development of the heart - most often due to diseases and disorders of various nature in the future mother. It is easier to avoid them than to carry out a radical correction of the tetrad of Fallot in a born child. Such violations in a pregnant woman include:
- measles;
- scarlet fever;
- rubella;
- uncontrolled intake of a number of medicinal products;
- take of narcotic substances and alcoholic beverages;
- effect of harmful production factors.
Hereditary predisposition also plays a role.
Due to an anatomical violation on the part of the heart, blood circulation suffers - the nature of the flow of blood from the ventricles to the aorta and pulmonary artery changes.
Clinical picture
The tetrad of Fallot is characterized by symptoms:
- early cyanosis (blueness);
- delay in physical (especially motor) and mental development;
- dizziness;
- frequent fainting spells;
- dyspnea (dyspnea-cyanotic attack in tetrad of Fallot is characteristic).
Depending on when cyanosis appeared, five forms of tetrad of Fallot are distinguished:
- early cyanotic - from the first months of life;
- classical - from 2-3 years old;
- severe – shortness of breath and cyanotic attacks are observed;
- late cyanotic - cyanosis appears before 6-10 years of life;
- cyanotic - without cyanosis.
In addition, children with this disease are often diagnosed with colds, chronic tonsillitis, sinusitis and frequent recurrent pneumonia. Adults with tetrad of Fallot may develop pulmonary tuberculosis.
Diagnostics
Signs of tetrad of Fallot on fetal ultrasound are important for prenatal diagnosis.
The diagnosis is made on the basis of complaints and the results of additional diagnostic methods.
Physical examination data:
- on examination - the skin and mucous membranes are pale, with a bluish tint, the phalanges of the fingers are thickened, in the form of "drumsticks", the nails look like hourglasses. Cardiac hump (deformation of the chest) is less often found;
- with percussion (tapping) – the expansion of the borders of the heart is determined;
- on auscultation (listening with a stethoscope) – a clear, coarse systolic murmur can be heard, as well as a weakening of the heart tone above the pulmonary artery.
Treatment of the tetrad of Fallot in newborn children and adults is carried out after clarifying the diagnosis with the help of instrumental studies. These are the following methods:
- electrocardiography;
- ultrasound examination of the heart;
- X-ray examination of chest organs;
- phonocardiography;
- probing of the heart cavities (atria and ventricles);
- aortography;
- selective coronary angiography;
- magnetic resonance imaging of the heart.
Treatment. Radical correction of the tetrad of Fallot
This disease can be eliminated only by surgery. The volume of surgery for the diagnosis of Tetrad of Fallot depends on the severity, variant of the defect and the age of the patient. Conservative therapy is also involved - it is indicated in the presence of shortness of breath and cyanotic attacks. The basis of appointments:
- inhalation (inhalation) of oxygen;
- intravenous injections of rheopoliglukin, glucose, euphilin.
So-called palliative operations are often performed - they do not eliminate the defect, but alleviate the patient's condition. In particular, the formation of anastomoses - connections between the large vessels of the heart - is carried out.
As a radical correction of the tetrad of Fallot, plastic surgery of the defect of the interventricular septum and elimination of the stenosis of the outlet of the right ventricle is performed. Radical correction is carried out at the age of 0.5 to 3 years.
On the website of our clinic, Dobrobut.com, you can learn more - prognosis of surgery for tetralogy of Fallot, possible complications, etc.
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