The designation of this heart error decreases/goes back on the French pathologist Etienne F. Fallot as Erstbeschreiber (1888). Also the abbreviation ToF common in German with the medical profession is derived from the English Tetralogy OF Fallot.

The false formations

The following false formations form the disease picture:

• The Pulmonalstenose as narrowing output profile width unit of the right Herzkammer to the lung. The individual portions of this Ausflusstraktes (heartnear portion, flap ring with sails and lungnear portion) can be differently strongly narrowed. The actual Pulmonalklappe is frequently measure-formed and points in over 60% of the cases of only two sails to (biscupide Pulmonalklappe). Therefore the severity level of the flap narrowing can vary very strongly. The actual according to the narrowings in the entire Ausflusstrakt - usually underdevelops.
• The ventricle septum defect is a hole in the septum between the Herzkammern, which is not with the Fallot Tetralogie a lack of substance of the Kammerscheidewand, but developed by the false formation of the heart. It lies usually directly below the Ausflusstraktes (Pulmonalklappe) and in the proximity of the Aortenklappe (discharge opening flap for the body cycle) and the Trikuspidalklappe (flap between right main chamber and right pre-chamber).
• By an unsatisfactory rotation of the in the heart development the Aortenwurzel remains positioned in its relationship with the right Herzkammer, so that "„a over riding of the Aorta results "“over the ventricle septum defect.
• The Rechtsherzhypertrophie, the heart activity obstructing increase of the muscle mass of the right heart due to the chronic overload, can be at the beginning of small, increase however in the course of the time.

Consequences for the cardiovascular system

Over right atrium the oxygen-poor (venous) blood arrived due to the narrowing of the pulmonalen Ausflusstraktes only partly into the lung, returning from the body, in order with oxygen to be loaded there. An accordingly larger portion evades over the large ventricle septum defect and flows under evasion of the lung cycle directly over the Aorta (body artery) again into the body. Such a crossing of blood of the right heart directly into the body cycle is right-left-shunted called. By the mixture of oxygen-poor blood over shunt with the oxygen-rich blood returning from the lung develops a cyanosis. That is visible at a blue color of skin and mucous membranes, mainly at mouth and hands/feet, by the oxygen deficiency in the body cycle. It can be more or less pronounced depending upon quantity of the crossing blood and becomes visible possibly only after load (with small children drinking or crying). If cyanosis is small, one speaks Pink Fallot also of one "„"“.

To the lack of oxygen in the blood the body reacts with a Vermehrung of the Erythrozyten (red blood corpuscles). Within certain limits thereby the oxygen deficit can become balanced. But the flow characteristic of the blood is changed likewise and it to be able to do small Gerinnsel form, which can release a Embolie. Also the growth of the small containers at fingers and toes increases. "„Trommelschlegelfinger can develop "“and "„watch glass nails "“. Because of the worsened flow characteristic of the blood should drink the children always sufficiently to be offered.

accumulations

A characteristic of the Fallot Tetralogie are accumulations. They arise only with a small part of the children, with children with other cyanotic heart errors are however hardly observed. With such an accumulation the children become jerky and fearful, cyanosis increase, the heart frequency rise to values between 140 to 160 impacts/minute. The children can appear grey pale blue and consciousness are clouded, up to the unconsciousness. The accumulations do not develop usually without recognizable outside causes and the cause are clearly recognizable always.

The Kinderkardiologe will refer parents to this complication and if a suspicion insists on a accumulation, the child belongs into the hospital. Its occurrence requires usually an imminent operation. Under domestic conditions fresh air and a calming are suitable as a first assistance. In the hospital an accumulation is treated with oxygen gifts and medicines.

Diagnostics

To the diagnostics today the Echokardiografie and also the early heart catheter investigation stand for order.

Therapy

In order to achieve a higher age for the correction, first an Blalock Taussig anastomosis is often put on. The therapy exists in a surgical correction. It is aimed at creating a normal anatomy. The Pulmonalstenose is extended and the ventricle septum defect by a Patch (patch) - usually from Perikard or Goretex - in such a way locked that the Aorta receives excluding oxygen-rich blood from the left ventricle (Herzkammer). An operation in a step is aimed at - today (2004) in the first Lebensjahr. It depends however on the individual factors with the patient whether this procedure is possible. At special constellations it can be still indicated also today, a Palliativoperation by plant one aorto pulmonalen Shunts of the main operation to place in front. Most frequently modified Blalock Taussig shunting put on in form of a Goretex prosthesis between Truncus brachiocephalicus and right Pulmonalarterie or more central shunt between Aorta and Pulmonalarterie. This operation is considered as the easier interference and without employment of the heart lung machine is usually accomplished. Thus the lung blood circulation is increased and thus the oxygen supply is improved. With the later final operation shunt again locked. In some cases "“the Pulmonalstenose with a balloon the operation can be postponed around some weeks or months with a baby in the context of a heart catheter intervention in form "„of breaking.

Treatment results and control investigations

Usually it to the operation to a complicationless process and the Herzkammern come can normally develop. Regular controls (all six to twelve months, lifelong) by the Kinderkardiologen should be absolutely accomplished around a small Pulmonalstenose or leakage of the flap possibly remained to observe. Also on arising heartbeat disturbances with these control investigations one respects. A Endokarditisprophylaxe must be lifelong considered.

It is to be expected the fact that the children operated today develop normally and at the adult age a normal physical maximum stress and achieves good quality of life. However the process, like in the case of all complex innate heart errors, can be different. Patients operated in former times, with whom the correction operation for technical reasons (missing early diagnostic and operation possibilities) was only made in the child or young person age, are not to be compared possibly with the children operated nowadays.

See also

Fallot Trilogie - Fallot Pentalogie

Related links

• Heart error description of the UNIVERSITY OF
• HerzKinderWiki - for parents of heart-ill children with innate heart error, with meeting, left, literature and association lists

Articles in category "Fallot Tetralogie"

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