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Tetralogia de Fallot

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Diagnóstico e Tratamento cirúrgico da Tetralogia de Fallot

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Tetralogia de Fallot

  1. 1. Tetralogia de FallotTetralogia de Fallot Tetralogia de Fallot é uma doençaTetralogia de Fallot é uma doença progressiva e a cianose pode não estarprogressiva e a cianose pode não estar presente nos primeiros meses de vidapresente nos primeiros meses de vida Presença de cianose que não respondePresença de cianose que não responde ao oxigênio. Sat < 80% pO2 < 60mmHgao oxigênio. Sat < 80% pO2 < 60mmHg Crises de hipóxiaCrises de hipóxia
  2. 2. Tetralogia de FallotTetralogia de Fallot Incidência: 4,6%; mais freqüenteIncidência: 4,6%; mais freqüente Cardiopatia CianóticaCardiopatia Cianótica Fallot Arthur. “Contribuition a l’anatomieFallot Arthur. “Contribuition a l’anatomie pathologique de la maladie bleue..pathologique de la maladie bleue.. (cyanose cardiaque) Marseille Med(cyanose cardiaque) Marseille Med 25:418 - 420 ;188825:418 - 420 ;1888
  3. 3. Tetralogia de FallotTetralogia de Fallot
  4. 4. T4F com boa anatomiaT4F com boa anatomia e arco aórtico para De arco aórtico para D
  5. 5. T4F e hipoplasia da artéria pulmonarT4F e hipoplasia da artéria pulmonar
  6. 6. T4F e Hipoplasia difusa daT4F e Hipoplasia difusa da Artéria PulmonarArtéria Pulmonar
  7. 7. T4F + PCA bilateralT4F + PCA bilateral
  8. 8. TetralogiaTetralogia de Fallotde Fallot CIVCIV Hipertrofia de VDHipertrofia de VD Estenose pulmonar (infundíbulo-valvar)Estenose pulmonar (infundíbulo-valvar) Dextroposição da aorta.Dextroposição da aorta.
  9. 9. Tetralogia de FallotTetralogia de Fallot Gravidade é dependente da ESTENOSE PULMONAR,Gravidade é dependente da ESTENOSE PULMONAR, TAMANHO DA CIV, GRAU DESTROPOSIÇÃO DATAMANHO DA CIV, GRAU DESTROPOSIÇÃO DA AORTAAORTATetralogia com boa, regular e má anatomiaTetralogia com boa, regular e má anatomia
  10. 10. Tetralogia de FallotTetralogia de Fallot ( ausculta)( ausculta) SS ejetivo no bordo esternalSS ejetivo no bordo esternal esquerdo propagado para outrosesquerdo propagado para outros focos.B2 única devidofocos.B2 única devido dextroposição e anteriorização dadextroposição e anteriorização da aortaaorta
  11. 11. Tetralogia de FallotTetralogia de Fallot ECG – QRS desviado para 2ºECG – QRS desviado para 2º quadrante;SVD, tipo sistólico “R” amploquadrante;SVD, tipo sistólico “R” amplo em V1;em V1; Radiologia – Coração em forma de bota –Radiologia – Coração em forma de bota – hipofluxo acentuadohipofluxo acentuado EcoEco  confirma o diagnósticoconfirma o diagnóstico CateterismoCateterismo  reservado para quando éreservado para quando é necessário arteriografia pulmonarnecessário arteriografia pulmonar
  12. 12. Dr. Alfred Blalock
  13. 13. Tetralogia de FallotTetralogia de Fallot Boa anatomia - Correção totalBoa anatomia - Correção total Má anatomia - Blalock –TaussigMá anatomia - Blalock –Taussig ClássicoClássico SubclaviaSubclavia  Ramo da APRamo da AP Riscos: Hipodesenvolvimento doRiscos: Hipodesenvolvimento do membro superior esquerdo oumembro superior esquerdo ou gangrena;gangrena;
  14. 14. Tetralogia de Fallot -B-T modificadoTetralogia de Fallot -B-T modificado Tubo entre AoTubo entre AoAP (shunt central)ouAP (shunt central)ou SubclaviaSubclavia  Ramo APRamo AP Preserva a artéria subclávia(essencial)Preserva a artéria subclávia(essencial) Resultado imediatoResultado imediato Permeabilidade: médio prazoPermeabilidade: médio prazo
  15. 15. Tetralogia de Fallot Blalock modificado (complicações)Blalock modificado (complicações) OBSTRUÇÃO PÓS-OP IMEDIATOOBSTRUÇÃO PÓS-OP IMEDIATO ESTENOSE INSERÇÃO PULMONARESTENOSE INSERÇÃO PULMONAR INSUFICIÊNCIA CARDÍACA (RARO)INSUFICIÊNCIA CARDÍACA (RARO) HIPERTENSÃO PULMONAR a Longo PrazoHIPERTENSÃO PULMONAR a Longo Prazo DEFORMAÇÃO ARTÉRIAS PULMONARESDEFORMAÇÃO ARTÉRIAS PULMONARES
  16. 16. Tetralogia de FallotTetralogia de Fallot CORREÇÃO TOTALCORREÇÃO TOTAL ANATOMIA FAVORÁVEL > 1 anoANATOMIA FAVORÁVEL > 1 ano CORREÇÃO NEONATAL (Boston)CORREÇÃO NEONATAL (Boston) ATUAL: CORREÇÃO > 6 MESESATUAL: CORREÇÃO > 6 MESES
  17. 17. Cirurgia T4F – Risco CirúrgicoCirurgia T4F – Risco Cirúrgico RelacionadosRelacionados Diâmetro dos ramos da artéria pulmonarDiâmetro dos ramos da artéria pulmonar Diâmetro do anel valvarDiâmetro do anel valvar Cirurgia Paliativa anterior (Presença deCirurgia Paliativa anterior (Presença de hipertensão Pulmonar e/ou distorçõeshipertensão Pulmonar e/ou distorções das ramos da artéria pulmonar.)das ramos da artéria pulmonar.) Necessidade de “ Patch” TransanularNecessidade de “ Patch” Transanular Grau de dextroposição da aorta.Grau de dextroposição da aorta.
  18. 18. Thank YouThank You

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