Necropsies in some congenital diseases of the heart, mainly Fallot's tetralogy

The aortic arch in tetralogy of Fallot: types of branching and clinical implications

INTRODUCTION

Tetralogy of Fallot is the most common form of cyanotic CHD, with an incidence of 421 cases per million live births, constituting around 10% of CHD. Variations in aortic arch anatomy associated with tetralogy of Fallot, other than the incidence of right aortic arch (13-34%), are not frequently reported. A comprehensive analysis of a large number of tetralogy of Fallot cases is required to arrive at a compendious description of aortic arch anatomy.

MATERIALS AND METHODS

All patients with a diagnosis of tetralogy of Fallot who had CT or MRI either pre or post procedures between 1 January 2010 and 31 December 2019 at our hospital were included in the study. Using radiology consultants' reports and analysis of individual images, we identified the various morphological patterns of aortic arches prevalent in these patients.

RESULT

Out of 2684 patients who met the inclusion criteria, 1983 patients had left aortic arch (73.9%), 688 patients had right aortic arch (25.7%), four patients had cervical aortic arch (0.15%), eight patients had double aortic arch (0.3%), one patient had an aorto-pulmonary window (0.04%), and none of the patients had interrupted aortic arch. Sub-classification and clinical implications of the arch variations are described.

CONCLUSION

Up to 10% of tetralogy of Fallot patients may have significant anatomical variations of aortic arch that would necessitate changes or additional steps in their surgical or interventional procedures.

Systemic hypertension complicating tetralogy of Fallot: effects of antihypertensive therapy

A 20 year old woman with tetralogy of Fallot and an associated atrial septal defect presented with severe hypertension and congestive heart failure. She had been acyanotic for several years. An acute trial of antihypertensive therapy during cardiac catheterization resulted in severe systemic oxygen desaturation and loss of consciousness. Since surgical correction, antihypertensive therapy has been well tolerated. This case demonstrates the hemodynamic importance of systemic vascular resistance in tetralogy of Fallot and the need for extreme caution if aggressive antihypertensive therapy is attempted before surgical correction.

Radiologic diagnosis of different types of pulmonary stenoses

Right ventricular outflow obstructive lesions are among the most prevalent congenital cardiac anomalies with a frequency ranging from 6--10% when considered as isolated anomalies. As part of a more complicated developmental complex, their frequency is undoubtedly higher. The diagnosis can be suspected by the traditional clinical and hemodynamic findings, but a firm diagnosis can only be made by angiography. An exact diagnosis is most important since most of these lesions can be surgically corrected.

Right-sided aorta. I. Occurrence of right aortic arch in various types of congenital heart disease. II. Right aortic arch, right descending aorta, and associated anomalies

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Dextrocardia and isolated laevocardia. II. Situs inversus and isolated dextrocardia

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The Preoperative and Postoperative Vectorcardiogrom in Tetralogy of Fallot

The analysis and description of the preoperative and postoperative vectorcardiograms in tetralogy of Fallot are presented. The spatial orientation of the maximum QRS vectors to the right, anteriorly, and inferiorly in group I is indicative of right ventricular hypertrophy. In group II patients, the vectorcardiogram showed evidence of increased electrical activity of the left ventricle.

Vectorcardiographic patterns of complete right bundle-branch block were noted in nine patients in group III.

ATRIAL SEPTAL DEFECT IN INFANCY

The case histories of seven infants with atrial septal defect are presented to draw attention to certain features and possible dangers of this defect in infancy. Four infants were asymptomatic but one failed to thrive and two died suddenly. Five had ejection murmurs and two, with pulmonary hypertension, had loud pan-systolic murmurs with a thrill. In two infants murmurs were noted at birth, but in five they were first heard between the ages of 1 and 6 months. The second pulmonary sound was initially narrowly split in all, but became widely split between the ages of 12 and 20 months. Electrocardiograms and chest roentgenograms were of little help at the outset but later showed findings characteristic of the defect after one year. All infants were catheterized; a left-to-right atrial shunt was detected in each instance. Pulmonary hypertension was present in two infants, one of whom died.

The Electrocardiogram, Vectorcardiogram, and Ventricular Gradient in the Tetralogy of Fallot

The electrocardiogram, ventricular gradient, and spatial vectorcardiogram were studied in 140 patients with proved tetralogy of Fallot. The patients were separated into three groups according to hemodynamic data.

The salient features of the electrocardiogram in patients of group I consisted of diminutive R waves in leads I and V 6 , a deep Q wave and high R wave in lead III, a prominent R wave in lead V 1 , which was not wide, and the absence of Q waves in leads I, V 1 , and V 6 .

The electrocardiogram in patients of group II was similar to that of the patients of group I except for the appearance of more signs of left ventricular electric activity and less clock-wise rotation of the heart.

The electrocardiogram of the patients of group III was similar to that previously described for ventricular septal defect.

 QRS ,  T , Ĝ, and sVCG reflected the same general trend as the electrocardiograms.

The electrophysiologic data presented support clinical observations indicating that the tetralogy of Fallot includes patients with a wide range of hemodynamic differences.

Tetralogy of Fallot with Anomalous Tricuspid Valve Simulating Pulmonary Stenosis with Intact Septum

An anatomicopathologic entity of the tetralogy of Fallot with an additional finding of an accessory flap of tricuspid valvular tissue is described. In the 3 cases reported in this paper, the outstanding hemodynamic finding was a right ventricular systolic pressure that was significantly greater than the systemic systolic pressure.

The hemodynamic findings were explained by the fact that the accessory tricuspid flap partially closed the large ventricular septal defect.

The clinical picture was similar to that of either severe pulmonary stenosis with an intact ventricular septum or severe pulmonary stenosis with a small ventricular septal defect and a right-to-left shunt at the ventricular level.

THE NATURAL HISTORY OF VENTRICULAR SEPTAL DEFECT

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The prognosis of atrial septal defect

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The aorta and pulmonary arteries in Fallot's tetralogy

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Experiences with 180 cases of tetralogy of Fallot in infants and children

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The left-sided superior vena cava

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Rapid biplane angiocardiography in the tetralogy of Fallot

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