Trilogy of Fallot

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Trilogy of Fallot
Other namesFallot's trilogy, Fallot's triad
Specialty Cardiology
Symptoms Cyanosis, increased fatigue, frequent upper respiratory infection, clubbing
Usual onsetFrom birth
DurationLifetime, unless fixed by surgery
Diagnostic method Echocardiography, Angiography
Differential diagnosis Tetralogy of Fallot
TreatmentSurgery
Frequency1.2% of congenital heart defects

The Trilogy of Fallot also called Fallot's trilogy is a rare congenital heart disease consisting of the following defects: pulmonary valve stenosis, right ventricular hypertrophy and atrial septal defect. [1] It occurs in 1.2% of all congenital heart defects. [2]

Contents

A 1960 case report of 22 patients who underwent surgery showed an excess of females with a ratio of 3:2, with the youngest person being 7 months old and the oldest being 50 years old. [2]

Symptoms and signs

History of 18 cyanotic patients from a 1960 case report [2]
No.
Cyanotic onset
First year8
1 to 10 year6
Over 10 years4
Increased fatigue11
Frequent U.R.I 9
Dyspnea 7
Squatting 4
Syncope 3
Poor growth2
Physical findings on 22 patients from a 1960 case report [2]
SymptomNo.%
Murmur at left base 22100%
Diminished or absent pulmonary second sound 1986%
Cyanosis 1882%
Thrill at left base1359%
Clubbing 1254%
Prominent A waves 1150%
Right ventricular lift 940%
Chest deformity418%

Mechanism

Trilogy of Fallot is a combination of three congenital heart defects: pulmonary stenosis, right ventricular hypertrophy, and an atrial septal defect. [1]

The first two of these are also found in the more common tetralogy of Fallot. However, the tetralogy has a ventricular septal defect instead of an atrial one, and it also involves an overriding aorta [3]

Pulmonary valve stenosis Pulmonary valve stenosis.svg
Pulmonary valve stenosis
Right ventricular hypertrophy Right Ventricular hypertrophy.svg
Right ventricular hypertrophy


The Three Malformations

ConditionDescription
Pulmonary stenosisA malformation near or on the pulmonary valve (the valve between the right ventricle and the pulmonary artery) that causes the opening of the valve to be narrowed, affecting blood flow. This narrowing can occur when one or more of the cusps is too thick or is otherwise defective, preventing the valve from opening fully and properly. [4]
Right ventricular hypertrophyThe right ventricle is more muscular than normal, causing a characteristic boot-shaped appearance as seen by chest X-ray. This enlargement is generally a secondary condition, resulting from increased pressure. Pulmonary valve defects resulting in tricuspid regurgitation, a common effect of pulmonary stenosis, can cause this increase in muscle mass. [5]
Atrial septal defectAn atrial septal defect is a hole in the septum that divides the right and left atria (the upper two chambers) of the heart. In the heart of a developing fetus, there are several holes between the atria, however these are expected to close before birth. This congenital condition arises if one of these holes remains. [6] Depending on the severity of the defect, it may need to be repaired surgically, as a significant defect can cause further damage to the heart and lungs. [7]

Diagnosis

Diagnosis is done via echocardiography or angiography.[ citation needed ]

Treatment

It is treated using surgery to repair the atrial septal defect and pulmonary stenosis, once the pulmonary stenosis has been fixed the right ventricular hypertrophy will usually go away on its own. [8] [4]

Balloon valvuloplasty is the most common treatment for pulmonary stenosis, a balloon is placed where the artery or valve is narrowed and is inflated, widening the artery or valve in the process, the balloon is then removed. It may cause valve regurgitation. If balloon valvuplasty is not an option open heart surgery must be performed where the valve is either repaired or replaced with an artificial one. [9]

History

It is named in honor of its discoverer: Etienne Fallot. [10]

Related Research Articles

Tetralogy of Fallot Type of congenital heart defect

Tetralogy of Fallot (TOF), formerly known as Steno-Fallot tetralogy, is a congenital heart defect characterized by four specific cardiac defects. Classically, the four defects are:

Congenital heart defect Defect in the structure of the heart that is present at birth

A congenital heart defect (CHD), also known as a congenital heart anomaly and congenital heart disease, is a defect in the structure of the heart or great vessels that is present at birth. A congenital heart defect is classed as a cardiovascular disease. Signs and symptoms depend on the specific type of defect. Symptoms can vary from none to life-threatening. When present, symptoms may include rapid breathing, bluish skin (cyanosis), poor weight gain, and feeling tired. CHD does not cause chest pain. Most congenital heart defects are not associated with other diseases. A complication of CHD is heart failure.

The Rastelli procedure is an open heart surgical procedure developed by Italian physician and cardiac surgery researcher, Giancarlo Rastelli, in 1967 at the Mayo Clinic, Ajmer and involves using a pulmonary or aortic homograft conduit to relieve pulmonary obstruction in double outlet right ventricle with pulmonary stenosis.

Transposition of the great vessels Group of congenital heart defects involving an abnormal spatial arrangement of any of the great vessels: superior and/or inferior venae cavae, pulmonary artery, pulmonary veins, and aorta

Transposition of the great vessels (TGV) is a group of congenital heart defects involving an abnormal spatial arrangement of any of the great vessels: superior and/or inferior venae cavae, pulmonary artery, pulmonary veins, and aorta. Congenital heart diseases involving only the primary arteries belong to a sub-group called transposition of the great arteries (TGA), which is considered the most common congenital heart lesion that presents in neonates.

Pulmonary atresia Medical condition

Pulmonary atresia is a congenital malformation of the pulmonary valve in which the valve orifice fails to develop. The valve is completely closed thereby obstructing the outflow of blood from the heart to the lungs. The pulmonary valve is located on the right side of the heart between the right ventricle and pulmonary artery. In a normal functioning heart, the opening to the pulmonary valve has three flaps that open and close

Persistent truncus arteriosus Medical condition

Persistent truncus arteriosus (PTA), often referred to simply as Truncus Arteriosus, is a rare form of congenital heart disease that presents at birth. In this condition, the embryological structure known as the truncus arteriosus fails to properly divide into the pulmonary trunk and aorta. This results in one arterial trunk arising from the heart and providing mixed blood to the coronary arteries, pulmonary arteries, and systemic circulation. For the International Classification of Diseases (ICD-11), the International Paediatric and Congenital Cardiac Code (IPCCC) was developed to standardize the nomenclature of congenital heart disease. Under this system, English is now the official language, and persistent truncus arteriosus should properly be termed Common arterial trunk.

Tricuspid atresia Medical condition

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. This defect is contracted during prenatal development, when the heart does not finish developing. It causes the systemic circulation to be filled with relatively deoxygenated blood. Because of this, hypoxia occurs, so other defects must occur to maintain blood flow. Because of the lack of an atrioventricular connection, an atrial septal defect (ASD) must be present to fill the left atrium and the left ventricle with blood. Since there is a lack of a right ventricle, there must be a way to pump blood into the pulmonary arteries, and this is accomplished by a ventricular septal defect (VSD). The causes of tricuspid atresia are unknown.

Valvular heart disease Disease in the valves of the heart

Valvular heart disease is any cardiovascular disease process involving one or more of the four valves of the heart. These conditions occur largely as a consequence of aging, but may also be the result of congenital (inborn) abnormalities or specific disease or physiologic processes including rheumatic heart disease and pregnancy.

Atrioventricular septal defect Medical condition

Atrioventricular septal defect (AVSD) or atrioventricular canal defect (AVCD), also known as "common atrioventricular canal" (CAVC) or "endocardial cushion defect" (ECD), is characterized by a deficiency of the atrioventricular septum of the heart. It is caused by an abnormal or inadequate fusion of the superior and inferior endocardial cushions with the mid portion of the atrial septum and the muscular portion of the ventricular septum.

Pulmonary valve stenosis Medical condition

Pulmonary valve stenosis (PVS) is a heart valve disorder. Blood going from the heart to the lungs goes through the pulmonary valve, whose purpose is to prevent blood from flowing back to the heart. In pulmonary valve stenosis this opening is too narrow, leading to a reduction of flow of blood to the lungs.

Double outlet right ventricle (DORV) is a form of congenital heart disease where both of the great arteries connect to the right ventricle (RV). In some cases it is found that this occurs on the left side of the heart rather than the right side.

Pulmonic stenosis, is a dynamic or fixed obstruction of flow from the right ventricle of the heart to the pulmonary artery. It is usually first diagnosed in childhood.

A right-to-left shunt is a cardiac shunt which allows blood to flow from the right heart to the left heart. This terminology is used both for the abnormal state in humans and for normal physiological shunts in reptiles.

Right ventricular hypertrophy Medical condition

Right ventricular hypertrophy (RVH) is a condition defined by an abnormal enlargement of the cardiac muscle surrounding the right ventricle. The right ventricle is one of the four chambers of the heart. It is located towards the lower-end of the heart and it receives blood from the right atrium and pumps blood into the lungs.

Lutembachers syndrome Medical condition

Lutembacher's syndrome is a very rare form of congenital heart disease that affects one of the chambers of the heart as well as a valve. It is commonly known as both congenital atrial septal defect (ASD) and acquired mitral stenosis (MS). Congenital atrial septal defect refers to a hole being in the septum or wall that separates the two atria; this condition is usually seen in fetuses and infants. Mitral stenosis refers to mitral valve leaflets sticking to each other making the opening for blood to pass from the atrium to the ventricles very small. With the valve being so small, blood has difficulty passing from the left atrium into the left ventricle. Septal defects that may occur with Lutembacher's syndrome include: Ostium primum atrial septal defect or ostium secundum which is more prevalent.

The following outline is provided as an overview of and topical guide to cardiology, the branch of medicine dealing with disorders of the human heart. The field includes medical diagnosis and treatment of congenital heart defects, coronary artery disease, heart failure, valvular heart disease and electrophysiology. Physicians who specialize in cardiology are called cardiologists.

Right atrial enlargement Medical condition

Right atrial enlargement (RAE) is a form of cardiomegaly, or heart enlargement. It can broadly be classified as either right atrial hypertrophy (RAH), overgrowth, or dilation, like an expanding balloon. Common causes include pulmonary hypertension, which can be the primary defect leading to RAE, or pulmonary hypertension secondary to tricuspid stenosis; pulmonary stenosis or Tetralogy of Fallot i.e. congenital diseases; chronic lung disease, such as Cor Pulmonale. Other recognised causes are: right ventricular failure, tricuspid regurgitation, and atrial septal defect.

Ventricular outflow tract obstruction Medical condition

A ventricular outflow tract obstruction is one type of congenital heart defect in which either the right or left ventricular outflow tract is blocked or obstructed. These obstructions represent a spectrum of disorders.

Absent pulmonary valve syndrome is a congenital heart defect that occurs when the flaps of the pulmonary valve do not develop or are severely underdeveloped (hypoplasia) resulting in aneurysms (dilation) of the pulmonary arteries and softening of the trachea and bronchi (tracheobronchomalacia). Usually, APVS occurs together with other congenital heart defects, most commonly ventricular septal defect and right ventricular outflow tract obstruction. It is sometimes considered a variant of Tetralogy of Fallot.

References

  1. 1 2 "Fallot trilogy (Concept Id: C0041022) - MedGen - NCBI". www.ncbi.nlm.nih.gov. Retrieved 2021-08-07.
  2. 1 2 3 4 Swan, H.; Marchioro, T.; Kinard, S.; Blount, S. G. (August 1960). "Trilogy of Fallot. Experience with twenty-two surgical cases". Archives of Surgery. 81: 291–298. doi:10.1001/archsurg.1960.01300020119018. ISSN   0004-0010. PMID   13836013.
  3. CDC (2019-11-19). "Congenital Heart Defects - Facts about Tetralogy of Fallot | CDC". Centers for Disease Control and Prevention. Retrieved 2021-08-07.
  4. 1 2 "Pulmonary valve stenosis - Symptoms and causes". Mayo Clinic. Retrieved 2020-04-14.
  5. Bhattacharya, Priyanka T.; Sharma, Sandeep (2020), "Right Ventricular Hypertrophy", StatPearls, StatPearls Publishing, PMID   29763051 , retrieved 2020-04-14
  6. CDC (2019-11-19). "Congenital Heart Defects - Facts about Atrial Septal Defects | CDC". Centers for Disease Control and Prevention. Retrieved 2020-04-14.
  7. "Atrial septal defect (ASD) - Symptoms and causes". Mayo Clinic. Retrieved 2020-04-14.
  8. Wang YQ, Chen RK, Ye WW, et al. (1999). "Open-heart surgery in 48 patients via a small right anterolateral thoracotomy". Tex Heart Inst J. 26 (2): 124–8. PMC   325616 . PMID   10397435.
  9. "Pulmonary valve stenosis - Diagnosis and treatment - Mayo Clinic". www.mayoclinic.org. Retrieved 2021-08-07.
  10. synd/2283 at Who Named It?