Tetrology of fallot complex of 4 abnormalities : 1. ventricular septal defect. A VSD is a hole in the part of the septum that separates the ventricles
hole allows oxygen‑ rich blood to flow from the left ventricle into the right ventricle instead of flowing into the aorta, the main artery leading out to the body
Pulmonic stenosis 2.Pulmonic stenosis In pulmonary stenosis, the heart has to work harder than normal to pump blood, and not enough blood can get to the lungs.
3. The aorta "overrides" the ventricular septal defect. the aorta - between -the left and right ventricles, directly over the VSD. As a result, oxygen‑ poor blood from the right ventricle can flow directly into the aorta instead of into the pulmonary artery to the lungs.
4. Thickening (hypertrophy) of the right ventricle Thickening (hypertrophy) of the This is when the right ventricle right ventricle thickens because This is when the right the heart has to ventricle thickens pump harder because the heart has to pump harder than it than it should to should to move blood move blood through the narrowed through the pulmonary valve narrowed pulmonary valve
Harm Decrease blood flow to lungs Mixing of blood Together, these four defects mean that not enough blood is able to reach the lungs to get oxygen, and oxygen-poor blood flows out to the body.
Prognosis Despite its seeming complexity, it is quite common and often can be completely repaired.
THE SERIOUSNESS DEPENDS ON THE DEGREE OF PULMONARY STENOSIS AND VSD MORE THE STENOSIS – MORE BLOOD IS DIVERTED TO LEFT VENTRICLE THROUGH VSD UNOXYGENATED BLOOD TO BODY PARTS BLUISHNESS OF INDIVIDUALS- CYANOSIS IS A CARDINAL SIGN
SIGNS What are the warning signs and symptoms of Tetralogy of Fallot? Bluish coloring around the mouth, lips, tongue, and fingertips (called cyanosis) DYSPNOEA
Presence of a heart murmur Occasionally, early on, the degree of Pulmonary Stenosis will be very mild and the symptoms will be that of a Ventricular Septal Defect, including labored breathing, poor feeding, and poor weight gain. Polycyaethemia secondary to hypoxia
How is Tetralogy of Fallot detected? Heart murmur or Cyanosis. This leads to performing an Cardiac catheterization with angiography is needed prior to surgery to obtain more detailed anatomical information.
Relieving the stenosis Closing the ventricular septal defect by suturing or patch grafting during cardiopulmonary by – pass. Constraints:Size/condition- patientSeverity of malformationLack of cardiopulmonary by pass facilities
(large concentric hypertrophy of rt. Ventricle and only a narrow slit like lumen of PA- cannot be managed by a closed procedure ) Construction of a palliative shunt – rather than correcting the pulmonary stenosis by a closed technique
The open-heart repair is then deferred until the patient gets bigger. Less serious TF , have balanced or left to right shunt- and not cyanotic- correcting pulmonary stenosis without correcting VSD is contraindicated
Palliative shunts Cyanotic – congenital heart disease, polycythemia, history of excessive dyspnea or fainting Subclavean artery with PT (Blalock- Tausssig operation)
If above not possible- Potts-Smith operation-lt.PA with descending aorta rt.PA with ascending aorta(Waterson shunt) All these – increase blood flow to PA- so spontaneous shunts like PDA in TF – should not be corrected unless hemodyanamics are corrected
Lobectomy Commonly performed- GA and IPPV Partial/ complete Partial – penetrating wounds – cannot be sutured Complete- pulmonary neoplasms / abscess/cyst/severe lacerations
Site – depends--caudal / accessory lobe- 5th or 6th i.c.s.-cranial/middle- 4th /5th icsNo noticeable reduction in respiratory function
Isolate a lobe- hilus is reached- art., bronchus and vein are dividedLigatures with 3-0 silk- vessels
Lobectomy Area immediately around bronchus – carefully packed off – moist sponges Lobe should be handled as little as possible Cut the shortest possible stump of bronchus Donot apply crushing forecep- stump that is to remain
Lobectomy After cutting bronchus – a short distance- suture is placed across the edges- prevent escape of air Continue ctting and placing suture- remove the lobe
Lobectomy Alternatively, hold with rt. Angled foreceps- without crushing- apply 2nd clamp and divide Remove the lobe- close the stump with double row of continuous sutures
Drip saline during IPPV, - check for air leakage-close the leaks by simple interrupted or matress suture