Examine this patient's heart.

This patient has Fallot's tetralogy with a Blalock-Taussig shunt and is mildly cyanosed, indicating a right

to left shunt (functional status).

Read: N Engl J Med 1993; 329: 655-6.

· VSD with a right-to-left shunt.

· Pulmonary stenosis (infundibular or valvular).

· Right ventricular hypertrophy.

· Dextroposition of the aorta with it overriding the ventricular septal defect.

· Cyanotic and syncopal spells.

· Cerebral abscess (in 10% of cases).

· Endocarditis (in 10% of cases).

Strokes - thrombotic secondary to polycythaemia.

· Paradoxical emboli.

It is the anastomosis of the left subclavian artery to the left pulmonary artery with the intention to increase

pulmonary blood flow.

With ready availability of cardiopulmonary bypass, such patients have total correction of their anomalies

at an early age.

It arises from the anterior displacement of the canal septum, which leads to unequal partitioning of the

conus at the expense of the right ventricular infundibulum and results in the obstruction of the right

ventricular outflow tract and failure to close the intraventricular foramen.

· Total correction under the age of 1 year when there is no need for an outflow transannular patch. A

second-stage total correction can be performed when the child is over the age of 2 years.

· Blalock-Taussig shunting is performed nowadays only if the anatomy is unfavourable for a total

correction.

· Modified Blalock-Taussig shunting is the interposition of a tubular graft between the subclavian and

pulmonary arteries.

· The Waterston shunt involves anastomosis of the back of the ascending aorta to the pulmonary

artery. A Waterston shunt is performed when surgery is required under the age of 3 months because

the subclavian artery is too small for a good Blalock-Taussig shunt.

· The Potts shunt involves anastomosis of the descending aorta to the back of the pulmonary artery

(JAMA1946; 132: 627).

· The Glenn operation involves anastomosis of the superior vena cava to the right pulmonary artery.

The bidirectional Glenn procedure involves anastomosis of the superior vena cava to both pulmonary

arteries.

· Pulmonary balloon valvuloplasty is sometimes used as an alternative to surgery.

· Anomalous coronary artery.

· Single pulmonary artery.

· Hypoplastic pulmonary arteries.

· Single pulmonary artery.

ASD, pulmonary stenosis and right ventricular hypertrophy.

Fallot's tetralogy with associated ASD is known as Fallot's pentalogy.

· Right-sided aortic arch (in 30% of cases).

· Double aortic arch.

· Left-sided superior vena cava (in 10% of cases).

· Hypoplasia of the pulmonary arteries.

· ASD.

VSD, ASD of the secundum type, patent ductus arteriosus and Fallot's tetralogy are the common

congenital heart diseases, in order of frequency.

· Boot-shaped heart.

· Enlarged right ventricle.

· Decreased pulmonary vasculature.

· Right-sided aortic arch (in 30% of cases).

In this condition the aorta arises from the right ventricle; the pulmonary trunk overrides both ventricles at

the site of an interventricular septal defect.

Etienne-Louis Arthur Fallot (1850-1911), Professor of Hygiene and Legal Medicine in Marseilles,

published his Contribution to the pathologic anatomy of morbus coeruleus cardiac cyanosis in 1888. The

tetralogy was first described by N. Stensen, Professor of Anatomy in Copenhagen, in 1672 (Fallot A.