This document provides an overview of tetralogy of Fallot (TOF), one of the most common cyanotic congenital heart diseases. It discusses the history, epidemiology, pathophysiology, clinical presentation, investigations, management, and prognosis of TOF. Key points include: TOF is characterized by pulmonary stenosis, ventricular septal defect, overriding aorta, and right ventricular hypertrophy. Clinical features include cyanosis, clubbing, and systolic murmur. Investigations include CXR, ECG, echocardiogram and cardiac catheterization. Management involves medical treatment of spells, palliative shunt procedures, and complete repair surgery. Long-term prognosis depends on severity of pulmonary stenosis and associated anomalies,
Tricuspid atresia is a form of congenital heart disease whereby there is a complete absence of the tricuspid valve. Therefore, there is an absence of right atrioventricular connection. This leads to a hypoplastic (undersized) or absent right ventricle.
Tricuspid atresia is a form of congenital heart disease whereby there is a complete absence of the tricuspid valve. Therefore, there is an absence of right atrioventricular connection. This leads to a hypoplastic (undersized) or absent right ventricle.
commonly used for medical students, and helpful to use this ppt to study for them, and also a common man can understand very easily what is coarctation of aorta.
A cyanotic heart defect is a group-type of congenital heart defects (CHDs). The patient appears blue (cyanotic), due to deoxygenated blood bypassing the lungs and entering the systemic circulation. This can be caused by right-to-left or bidirectional shunting, or malposition of the great arteries.
Cyanotic heart defects, which account for approximately 25% of all CHDs, include:
Tetralogy of Fallot (ToF)
Total anomalous pulmonary venous connection
Hypoplastic left heart syndrome (HLHS)
Transposition of the great arteries (d-TGA)
Truncus arteriosus (Persistent)
Tricuspid atresia
Interrupted aortic arch
Pulmonary atresia (PA)
Pulmonary stenosis (critical)
Eisenmenger syndrome(Reversal of Shunt due to Pulmonary Hypertension) .
Patent ductus arteriosus may cause cyanosis in late stage.
Tetralogy of Fallot (TOF) is a congenital heart defect, which has four anatomical components:
Anterior malalignment ventricular septal defect (VSD)
Aortic override over the muscular septum
Variable degrees of subvalvar, valvar, and supravalvar pulmonary stenosis
Right ventricular (RV) infundibular narrowing and RV hypertrophy
Transposition of the great arteries is a serious but rare heart defect present at birth (congenital), in which the two main arteries leaving the heart are reversed (transposed). The condition is also called dextro-transposition of the great arteries.
Non infarction Q waves
Precise guide for Allied Health Science Students especially cardiac specialty students, DGNM, B.Sc Nursing & M.Sc Nursing Students regarding Non Infarction Q waves
Patent Ductus Arteroisus, PDA, Cardiology, Paediatrics, Pedicatrics, Critical Care, Emergency medicine, Medicine, Internal Medicine, MBBD, MD, India, CMC Vellore, Christian Medical College
most common congenital cyanotic heart disease.one of the conotruncal family of heart lesions.. It accounts for 7 to 10% of all congenital heart abnormalities.
commonly used for medical students, and helpful to use this ppt to study for them, and also a common man can understand very easily what is coarctation of aorta.
A cyanotic heart defect is a group-type of congenital heart defects (CHDs). The patient appears blue (cyanotic), due to deoxygenated blood bypassing the lungs and entering the systemic circulation. This can be caused by right-to-left or bidirectional shunting, or malposition of the great arteries.
Cyanotic heart defects, which account for approximately 25% of all CHDs, include:
Tetralogy of Fallot (ToF)
Total anomalous pulmonary venous connection
Hypoplastic left heart syndrome (HLHS)
Transposition of the great arteries (d-TGA)
Truncus arteriosus (Persistent)
Tricuspid atresia
Interrupted aortic arch
Pulmonary atresia (PA)
Pulmonary stenosis (critical)
Eisenmenger syndrome(Reversal of Shunt due to Pulmonary Hypertension) .
Patent ductus arteriosus may cause cyanosis in late stage.
Tetralogy of Fallot (TOF) is a congenital heart defect, which has four anatomical components:
Anterior malalignment ventricular septal defect (VSD)
Aortic override over the muscular septum
Variable degrees of subvalvar, valvar, and supravalvar pulmonary stenosis
Right ventricular (RV) infundibular narrowing and RV hypertrophy
Transposition of the great arteries is a serious but rare heart defect present at birth (congenital), in which the two main arteries leaving the heart are reversed (transposed). The condition is also called dextro-transposition of the great arteries.
Non infarction Q waves
Precise guide for Allied Health Science Students especially cardiac specialty students, DGNM, B.Sc Nursing & M.Sc Nursing Students regarding Non Infarction Q waves
Patent Ductus Arteroisus, PDA, Cardiology, Paediatrics, Pedicatrics, Critical Care, Emergency medicine, Medicine, Internal Medicine, MBBD, MD, India, CMC Vellore, Christian Medical College
most common congenital cyanotic heart disease.one of the conotruncal family of heart lesions.. It accounts for 7 to 10% of all congenital heart abnormalities.
This presentation is an overview of congenital cyanotic heart diseases, with a special discussion on Tetralogy of Fallot. We discuss the pathophysiology, clinical manifestations as well as the most updated management options for treating this condition. The topic ends with a few important complications seen in TOF patients. Hope you find it useful.
You can follow us on: Facebook page 'Neonatohub' (online academic platform) OR visit our YouTube channel 'Neonatohub' for more paediatric and neonatology presentations.
This file was made while my course of studying pediatrics at college,intednded to make the cardiology lessons more organized and easier to study and memorize. And I do hope it will be useful to the other medical students who read it.
Seminar on critical Congenital heart disease Dr Habibur Rahim | Dr Faria YasminDr. Habibur Rahim
Seminar on critical Congenital heart disease Dr Habibur Rahim | Dr Faria Yasmin
Duct-dependent systemic circulations
Critical aortic stenosis
Coarctation of the aorta
Interruption of aortic arch
Hypoplastic left heart syndrome
Duct-dependent pulmonary circulations
Pulmonary atresia Critical pulmonary stenosis
Tricuspid atresia
Tetralogy of Fallot
Ebstein’s anomaly
Parallel non-mixing circulation
Transposition of great arteries
Other
Total anomalous pulmonary venous connection (TAPVC)
Double outlet right ventricle
Single ventricle
Truncus arteriosus
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
4. History
1671 Danish
anatomist Nils
Steno
The first description
1777 Sandifort described a .“blue boy.” with the
anatomic features of TOF
1784 William Hunter cyanotic spells and poor growth in a
boy with TOF
Louis-Etienne Fallot ( A French physician) in 1888 , first correlate
the clinical and pathological features of TOF
1924 Maude Abbott coined the term“tetralogy of
Fallot.”
1936 produced the first illustrations of the pathologic and circulatory
features, and described x-ray and electrocardiographic features of TOF
5. One of the conotruncal family of heart lesions
Primary defect is an anterior deviation of the
infundibular septum
- Obstruction of RVOT(PS)
- VSD
- Overriding of aorta
- RVH
Tetralogy of fallot
6.
7. Most common congenital cyanotic heart disease
Occurs in 3 of every 10,000 live births, and
Accounts for 7–10% of all congenital cardiac
malformations.
Epidemiology
8. Multifactorial
But associations include
untreated maternal diabetes, phenylketonuria, &
intake of retinoic acid.
Associated chromosomal anomalies include
trisomies 21, 18, and 13
The risk of recurrence in families is 3%.
Etiology
Recent experience points to the much more frequent association of
microdeletions of chromosome 22. 22q11.2 deletion syndrome
9. Developmental Fault
• Defective embryonic neural crest migration- abnormal
conotruncal development.
• Incomplete rotation and faulty partitioning of the
conotruncus during separation.
• Malrotation of truncal-bulbar ridges results in mis-
alignment of the outlet and trabecular septum and
consequent straddling of the aorta over the malaligned
VSD.
• Abnormally anterior septation of the conotruncus by the
bulbotruncal ridges- subpulmonic obstruction.
10. Lesion Frequency in TOF
Structural
Pulmonary atresia
Atrial septal defect
Additional VSD
Atrioventricular septal defect
PDA
Dextrocardia
12%
20%
5%
1-3%
4-6%
2%
Vascular
Right aortic arch
Congenital absence of Pul valve
Coronary artery anomaly
Aberrant subclavian artery
MAPCAS
15-25%
3%
3-8%
2%
Additional structural and vascular lesions in TOF
12. Tetralogy Of Fallot
• Obstruction of RVOT(PS)
• Ventricular septal defect
• Overriding of aorta
• Right ventricular hypertrophy
13. Pathophysiology
Owing to right ventricular obstruction
during ventricular systole
deoxygenated blood of right ventricle
shunts through VSD to the left ventricle,
mix with oxygenated blood and this
mixed blood passes through the aorta
to different parts of the body.
14. • The flow occurs across the pulmonic stenosis
producing an ejection systolic murmur --
more severe the pulmonic stenosis, the less the
flow into the pulmonary artery and the bigger
the right to left shunt
• more severe the pulmonic stenosis, the shorter
the ejection systolic murmur and the more the
cyanosis
• the severity of cyanosis is directly proportional
to the severity of pulmonic stenosis, but the
intensity of the systolic murmur is inversely
related to the severity of pulmonic stenosis
15. • the right ventricular
outflow obstruction
results in the delay in the
P2 -- since the
pulmonary artery
pressure is reduced, the
P2 is also reduced in
intensity -- the late and
soft P2 is generally
inaudible in TOF -- the
S2 is , therefore, single and
the audible sound is A2 --
since the aorta is
somewhat anteriorly
displaced, the audible
single A2 is quite loud.
16. The VSD of TOF is always large enough to allow free exit to
the right to left shunt --- since the right ventricle is
effectively decompressed by the VSD --- congestive failure
almost never occurs in TOF.
As the systolic pressures between two ventricle are
identical there is little or no shunt and the VSD is silent
17. The degree of RVOT obstruction determines
The timing of the onset of symptoms
Severity of cyanosis
Degree of RVH
RVOT obstruction
Mild- moderate
Balanced shunt across the VSD
No visibly cyanosed-Pink TOF
Severe
Cyanosis will be present
from birth
19. Cyanosis , clubbing
Conjunctival congestion
Pulse: Normal
Blood pressure : Normal
Normal sized heart with parasternal impulse, a
systolic thrill in less than 30 % patients.
Physical examination
20. Normal first sound, Single second sound
An ejection systolic murmur : Loud & harsh, most
intensity at the left sternal border
Occasionally continuous murmur ( if prominent
collaterals are present)
Physical examination
21. Paroxysmal hypercyanotic attack
Hypoxic, blue or tet spell
Particular problem during the 1st 2 years of life
Hyperpneic, restless, cyanosis increases,
gasping respiration & syncope
Frequently occur in the morning on awakening or
after episodes of vigorous crying
Last for few min to hrs
Onset is spontaneous & unpredictable
22.
23. Paroxysmal hypercyanotic attack
Short episodes are followed by generalized
weakness & sleep
Severe spell progress to unconsciousness,
occasionally to convulsion/ hemiparesis
Temporary disappearance /↓ in intensity of the
systolic murmur
Occurs due to already compromised pulmonary blood flow as a result
of severe hypoxia & metabolic acidosis
25. 1. Boot shaped heart(“coeur en
sabot”) : apex is lifted up, narrow
base & there is a concavity in the
region of pulmonary artery
2. Normal heart size
3. Oligaemic lung fields
4. Hilar vessels are few, lung
vessels also few
X ray chest
27. The extent of aortic
override of the septum
Location & degree of the
RVOT obstruction
The size of pulmonary
valve annulus
The side of aortic arch
Echocardiography
28. Cardiac catheterization
Presence of multiple VSDs
Degree &levels of stenosis in
right ventricular outflow
tract, pulmonary arteries,
coronary artery anomaly.
30. Treatment
General measure
Management of hyper cyanotic spell
Surgery
Treatment of complication
Prophylaxis
31. Treatment depends upon the RVOT
obstruction
Severe tetralogy require urgent
medical treatment & surgical
intervention in neonatal period
Less severe obstruction,
stable & waiting for surgery
1. Oxygenation
2. Prevention of hypothermia
3. I/V PG E1 (.01-.02
micro/kg/min)
4. Monitoring of blood
glucose
1. Oral propanolol (0.5-1
mg/kg every 6hr)
2. Prevention/prompt
treatment of
dehydration
3. Iron supplementation
32. Management of cyanotic spell
1.Knee chest position:
1) Constriction of Femoral artery PVR left
ventricular presser Rt- Lt shunt improves
pulmonary blood flow better oxygenation &
improves cyanosis
2) Constriction of femoral vein venous return
Rt- Lt shunt
33. • It is difficult to achieve to
knee-chest position. It is
favorable to hold the child
in parents shoulder with
knees bent and oxygen is
administered by another
person from behind.
34. 2. Oxygen: Oxygen to improve oxygenation. It is better given
in nebulized form .
3. Morphine: Depresses respiratory center→abolishes
hyperpnea→ decreases Systemic Venous Return. 0.2mg/kg
SC.
4. IV fluids: to correct dehydration
5. Inj NaHCO3: (1-2 meq/kg intravenously slowly). To
correct metabolic acidosis
35. 6. Propanolol: 0.1-0.2 mg/kg I/V over 5 min.
Reduces dynamic RVOT obstruction and slow the HR
thereby decreasing R→L shunting.
Increase SVR by antagonizing the vasodilating effects
of β2 adrenergic stimulation.
36. 7. Phenylephrine Hydrochloride: 0.01 mg/kg IV (slowly) or
0.1 mg/kg SC or IM (Improve RV outflow, ↓R→L shunt
8. Ketamine: 0.25- 1.0 mg/kg. IV or IM→ has dual benefit
causes sedation and ↑ SVR
9. Premature attempts to obtain blood samples should be
avoided.
37. Long Term medical Management
1. Educate the parents to recognize the spell and know what
to do.
2. Oral propanolol therapy ,0.5-1.5 mg/kg every 6 hr
3. Maintenance of good dental hygiene and practice of
antibiotic prophylaxis against SBE are important.
38. Long Term medical Management (cont’)
4. A relative iron deficiency state should be
detected and treated.
5. Hct values are usually normal so RBC indices and PBF
should be monitored.
40. Surgical
Palliative Shunt Procedures :
-To increase pulmonary blood flow
Indications:
1. Neonates with TOF and pulmonary atresia.
2. Infants with hypoplastic pulmonary annulus.
3. Infants younger than 3-4 months with medically
unmanageable hypoxic spells.
41. Classic Blalock-Taussing shunt-(SA-PA)
Modified B-T shunt- A Gore-Tax interposition is placed
between the Subclavian Artery and the ipsilateral
Pulmonary Artery
Potts operation- between the descending aorta and left PA.
Waterson Shunt-a between ascending aorta and right PA.
42.
43. Corrective /Complete Repair Surgery:
Indications
1. Oxygen saturation <75 to 80%.
2. Occurrence of hypoxic spell
3. Mildly cyanotic infants who have had
previous shunt surgery
4. Asymptomatic children with coronary artery
anomalies.
44. Timing
Symptomatic infants may have primary repair at 4-
6months.Most centers prefer primary elective repair by 1 to
2years of age .
The procedure include
- Patch closure of VSD
- Relief of RVOT obstruction by resecting
obstructive muscle bundle
- And Pulmonary valvotomy
Surgical mortality rate is <5%
46. NATURAL HISTORY
1. Infants with acyanotic TOF gradually become cyanotic.
Patients who are already cyanotic become more cyanotic
as a result of the worsening condition of the infundibular
stenosis and polycythemia.
2. Polycythemia develops secondary to cyanosis.
3. Development of relative iron-deficiency state (i.e.,
hypochromia)
47. NATURAL HISTORY(contd.)
4. Hypoxic spells may develop in infants
5. Growth retardation may be present if cyanosis is
severe
6. Brain abscess and cerebrovascular accident rarely
occur
7. SBE is occasionally a complication.
8. Some patients, particularly those with severe
TOF, develop AR.
9. Coagulopathy is a late complication of a long-
standing cyanosis.
48. • The survival for untreated Tetralogy of Fallot is
approximately 75% after the first year of life, 60%
by four years, 30% by ten years, and 5% by forty
years.
49. TOF with RVOT
obstruction
Clinical course Survival
Mild
Obstruction
Cyanosis appear in
childhood
3rd-4th decade
Moderate Cyanosis since early
infancy
2nd-3rd decade
Severe Cyanosed since birth Seldom survive
beyond 2nd decade
50. Without surgery around 50% of children with TOF will
die within the first few years of life and survival beyond
30 years is uncommon.
With corrective surgery in childhood, survival is 95-
99%, and almost all children can be expected to survive to
adulthood.