Tetralogy of Fallot - a complex heart defect. This combination of stenosis (narrowing) the mouth of the pulmonary trunk, ventricular septal defect, shift to the right and anterior to the aorta and the developing secondary right ventricular hypertrophy. All these defects can be expressed in varying degrees. Tetralogy of Fallot is one of the most common blue (cyanosis accompanied), congenital heart defects. Its rate of 10-15% of all congenital heart defects. Perhaps the defect is hereditary in nature.
Tetralogy of Fallot is characterized by the same pressure in the right and left parts of the heart, as both the department communicated with each other. The manifestations of vice are largely dependent on the degree of narrowing of the pulmonary artery. In severe stenosis most of the blood from the right heart enters the left. In the arterial blood that is spread through the body a lot of venous blood is not oxygenated. Because venous blood is darker, this explains the cyanosis of the patient's skin. If a minor degree of narrowing, the admixture of venous blood is small. Cyanosis and the patient may not be. For some time vice can be compensated by hypertrophy of the heart muscle, increasing the number of red blood cells, which may eventually lead to an increased risk of blood clots.
In severe pulmonary artery stenosis 25% of children die within the first year of life, while 50% did not live to five years. Only 5% of patients may survive up to 40 years without surgery. The cause of death in older age is usually heart failure.
A newborn signs of tetralogy of Fallot is not noticeable, because before birth defect that does not interfere with the heart. After a few days or weeks after birth may appear blue color of the skin or cyanosis during breastfeeding, the baby cry. The child appears short of breath. With age, the baby's skin takes a bluish tint. This is especially pronounced on the lips, ears, nail phalanges. . Sometimes, cyanosis occurs only after the child begins to walk. Because of circulatory disorders of the fingers with the age of the patient take the form of drumsticks - thicker at the end, the nails become rounded in the form of "time windows". Children can not move much. After several moves they have to sit down and relax. Most patients do not get up from bed. For some types of skin blemish cyanosis may not be.
Diagnosis of tetralogy of Fallot is based on the appearance of the patient, listening to the "dry", rough systolic murmur on the left of the sternum. An electrocardiogram reveals signs of right heart hypertrophy. Visible on the radiograph typical changes - the heart as a "wooden shoe." Helps diagnose echocardiography, but the basic method - is angiography. The study of the heart with the help of contrast agents. It helps to clarify the indications for surgery and to plan how much the operation will be carried out.
Tetralogy of Fallot - is an absolute indication for surgical treatment. If a severe defect for heart surgery is carried out immediately. The operation is performed in a heart-lung machine. Previously, surgery was conducted in two phases, now do everything at once. In some patients, radical surgery is not possible at one time and their surgical treatment is carried out in two stages.
Mortality in surgical treatment in infants less than 5%. As a result of surgery disappears cyanosis, dyspnea, normalize blood. The operated children should be supervised. Long-term results of surgical treatment are good.