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Adult Tetrology of Fallot: A Doppler Echocardiographic Finding

Received: 5 March 2021     Accepted: 18 March 2021     Published: 9 July 2021
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Abstract

In TOF the morphological abnormalities are – overriding of aorta, pulmonary obstruction, right ventricular hypertrophy and ventricular septal defect. Normally it is nonrestrictive means free communications between the ventricles but sometimes very rarely it can become restrictive when the tricuspid valve restrict the flow across the ventricular septal defect. Among children with CHD 10% of them report TOF. Chest radiographs usually show a normal-size heart silhouette, with an upturned apex and a concave main pulmonary artery segment, commonly known as “boot-shaped” heart. On the electrocardiogram, it is common to see signs of right atrial enlargement and right ventricular hypertrophy showing right axis deviation, prominent R waves anteriorly and S waves posteriorly, upright T wave in V1 (abnormal after 7 days of life up to 10 years of age) and a qR pattern in the right precordial leads. If the ration between pulmonary artery orifice diameter to aortic orifice diameter is <.3 primary repair is unsuccessful and in that case we must go for shunt surgeries which are palliative procedures till permanent repair can be done. This should add proper assessment of coronary artery origin. This is a case of adult tetralogy of fallot (TOF) coming to outpatient department of cardiology with complaints of chest discomfort and sometimes cyanotic spells. Age of the patient is 42 years male. Doppler Echocardiography was done. In the image overriding of aorta was found around 20% over interventricular septum. Left sided aortic arch was detected along with ventricular septal defect (VSD) with size 14 mm. Size of pulmonary orifice 10 mm and that of aortic orifice was 22 mm. Hence pulmonary artery orifice was found to get stenosed.

Published in Pathology and Laboratory Medicine (Volume 5, Issue 2)
DOI 10.11648/j.plm.20210502.12
Page(s) 26-28
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Tetralogy, Aorta, Artery, Orifice, Ventricle, Chest

References
[1] Frederique Bailliard, Robert H Anderson. Tetrology of Fallot. Orphanet journal of rare diseases. 2009. vol-4 (2). pg-1-10.
[2] Mark D. Twite and Richard J. Ing. Tetralogy of Fallot: Perioperative Anesthetic Management of Children and Adults. Seminars in Cardiothoracic and Vascular Anesthesia 16 (2): pg-97-105.
[3] Ruan Peng, Ju Zheng, Hong-Ning Xie, Miao He and Mei-Fang Lin. Genetic anomalies in fetuses with tetralogy of Fallot by using high-definition chromosomal microarray analysis. Cardiovascular Ultrasound (2019) 17 (8): pg-1-8.
[4] Roger E. Breitbart and Donald C. Fyler. Tetralogy of fallot. chapter 32. pg-559.
[5] Catherine A. Neill, Edward B. Clark. Tetralogy of Fallot The First 300 Years. Texas Heart Institute Journal 1994; 21: pg-272-9.
[6] Yeltay Rakhmanov, Paolo Enrico Maltese, Carla Marinelli, Tommaso Beccari, Munis Dundar and Matteo Bertelli. Genetic testing for tetralogy of Fallot. The Euro Biotech Journal. VOL 2 (1). 2018.
[7] https://www.ncbi.nlm.nih.gov/books/NBK513288/
[8] Edward J. Lammer, Jacqueline S. Chak, David M. Iovannisci, Kathleen Schultz, Kazutoyo Osoegawa, Wei Yang, Suzan L. Carmichael, and Gary M. Shaw. Chromosomal abnormalities among children born with conotruncal cardiac defects. Birth Defects Res A Clin Mol Teratol. 2009 January; 85 (1): 30–35.
[9] https://radiopaedia.org/articles/tetralogy-of-fallot.
[10] Balbir Singh and Jagdish C. Mohan. Doppler echocardiographic determination of aortic and pulmonary valve orifice areas in normal adult subjects. International journal of cardiology. vol-37 (1) 1992. pg-73-78.
[11] Neeraj Awasthy, S. Radhakrishnan. Stepwise evaluation of left to right shunts by echocardiography. Indian heart journal. vol-65 (2013): pg-201-218.
[12] Cristina Maria Stanescu and Kyriaki Branidou. A case of 75-year-old survivor of unrepaired tetralogy of Fallot and quadricuspid aortic valve. European Journal of Echocardiography (2008) 9, 167–170.
[13] Steffan Craatz, Eberhrd Kunzul, Katharina Spanel Borowski. Right sided aortic arch and tetralogy of fallot in human – a morphological study of 10 cases. Cardiovascular pathology. 12 (4): pg-226-32.
[14] Vivek Jaswal a, *, Shyam Kumar Singh Thingnam a, Rana Sandip Singh a, Manoj Kumar Rohit b, Uma Nahar Saikia. Histopathological changes of right ventricle outflow tract myocardium in relation to age in tetralogy of Fallot and its relation to clinical outcome. Journal of the Egyptian Society of Cardio-Thoracic Surgery 26 (2018) pg-287-296.
[15] Jahangir Rashid Bei, Wasim Ahmed, Imran Hafeez, Amit Gupt, Nisar Ahmed Tramboo, Hilal Ahmed Rather. Pentalogy of Fallot with a Single Coronary Artery: A Rare Case Report. J Teh Univ Heart Ctr 9 (3) July 03, 2014.
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  • APA Style

    Debajani Deka. (2021). Adult Tetrology of Fallot: A Doppler Echocardiographic Finding. Pathology and Laboratory Medicine, 5(2), 26-28. https://doi.org/10.11648/j.plm.20210502.12

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    ACS Style

    Debajani Deka. Adult Tetrology of Fallot: A Doppler Echocardiographic Finding. Pathol. Lab. Med. 2021, 5(2), 26-28. doi: 10.11648/j.plm.20210502.12

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    AMA Style

    Debajani Deka. Adult Tetrology of Fallot: A Doppler Echocardiographic Finding. Pathol Lab Med. 2021;5(2):26-28. doi: 10.11648/j.plm.20210502.12

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  • @article{10.11648/j.plm.20210502.12,
      author = {Debajani Deka},
      title = {Adult Tetrology of Fallot: A Doppler Echocardiographic Finding},
      journal = {Pathology and Laboratory Medicine},
      volume = {5},
      number = {2},
      pages = {26-28},
      doi = {10.11648/j.plm.20210502.12},
      url = {https://doi.org/10.11648/j.plm.20210502.12},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.plm.20210502.12},
      abstract = {In TOF the morphological abnormalities are – overriding of aorta, pulmonary obstruction, right ventricular hypertrophy and ventricular septal defect. Normally it is nonrestrictive means free communications between the ventricles but sometimes very rarely it can become restrictive when the tricuspid valve restrict the flow across the ventricular septal defect. Among children with CHD 10% of them report TOF. Chest radiographs usually show a normal-size heart silhouette, with an upturned apex and a concave main pulmonary artery segment, commonly known as “boot-shaped” heart. On the electrocardiogram, it is common to see signs of right atrial enlargement and right ventricular hypertrophy showing right axis deviation, prominent R waves anteriorly and S waves posteriorly, upright T wave in V1 (abnormal after 7 days of life up to 10 years of age) and a qR pattern in the right precordial leads. If the ration between pulmonary artery orifice diameter to aortic orifice diameter is <.3 primary repair is unsuccessful and in that case we must go for shunt surgeries which are palliative procedures till permanent repair can be done. This should add proper assessment of coronary artery origin. This is a case of adult tetralogy of fallot (TOF) coming to outpatient department of cardiology with complaints of chest discomfort and sometimes cyanotic spells. Age of the patient is 42 years male. Doppler Echocardiography was done. In the image overriding of aorta was found around 20% over interventricular septum. Left sided aortic arch was detected along with ventricular septal defect (VSD) with size 14 mm. Size of pulmonary orifice 10 mm and that of aortic orifice was 22 mm. Hence pulmonary artery orifice was found to get stenosed.},
     year = {2021}
    }
    

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    AU  - Debajani Deka
    Y1  - 2021/07/09
    PY  - 2021
    N1  - https://doi.org/10.11648/j.plm.20210502.12
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    AB  - In TOF the morphological abnormalities are – overriding of aorta, pulmonary obstruction, right ventricular hypertrophy and ventricular septal defect. Normally it is nonrestrictive means free communications between the ventricles but sometimes very rarely it can become restrictive when the tricuspid valve restrict the flow across the ventricular septal defect. Among children with CHD 10% of them report TOF. Chest radiographs usually show a normal-size heart silhouette, with an upturned apex and a concave main pulmonary artery segment, commonly known as “boot-shaped” heart. On the electrocardiogram, it is common to see signs of right atrial enlargement and right ventricular hypertrophy showing right axis deviation, prominent R waves anteriorly and S waves posteriorly, upright T wave in V1 (abnormal after 7 days of life up to 10 years of age) and a qR pattern in the right precordial leads. If the ration between pulmonary artery orifice diameter to aortic orifice diameter is <.3 primary repair is unsuccessful and in that case we must go for shunt surgeries which are palliative procedures till permanent repair can be done. This should add proper assessment of coronary artery origin. This is a case of adult tetralogy of fallot (TOF) coming to outpatient department of cardiology with complaints of chest discomfort and sometimes cyanotic spells. Age of the patient is 42 years male. Doppler Echocardiography was done. In the image overriding of aorta was found around 20% over interventricular septum. Left sided aortic arch was detected along with ventricular septal defect (VSD) with size 14 mm. Size of pulmonary orifice 10 mm and that of aortic orifice was 22 mm. Hence pulmonary artery orifice was found to get stenosed.
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Author Information
  • Gauhati Medical College & Hospital, Gauhati, Assam, India

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