00:01 Let's move on to tetralogy of Fallot. 00:06 Tetralogy of Fallot is the most common cyanotic heart disease and it frequently shows up on multiple choice tests. 00:14 So I think it's important to go through tetralogy and really understand what it is. 00:19 It's important to memorize the four findings in the tetralogy and I'm going to go through them now for you. 00:25 There are four major findings and it can look pretty complicated. 00:31 But if I go through it one step at a time, I think you'll understand it. 00:36 Here we go. 00:39 On the left side, you can see a normal heart. 00:43 On the right side of your slide, you can see tetralogy of Fallot. 00:48 I'm going to walk through the tetralogy, the four findings in tetralogy, and I'm going to make it so you're convinced that it's not as complicated as it sounds. 00:56 Let's start with an overriding aorta. 00:59 In these patients, there is that connection between the two ventricles called the VSD. 01:07 The aorta rides over that VSD and allows the mixed blood to go into the aorta. 01:15 That's why these infants are cyanotic. 01:17 Some of that right-sided blood is shunting to the left through that VSD and up into that overriding aorta. 01:24 Two of the findings in tetralogy are overriding aorta and VSD. 01:29 When you hear "tetralogy," it's not really true. 01:33 Maybe you could call it triology of Fallot because you couldn't really have an overriding aorta without a VSD. 01:40 if you imagine how could the aorta ride over both ventricles unless there's a hole between them? Additionally, these patients have some pulmonary stenosis. 01:51 Basically, as that area shifts over and you're allowing for that overriding aorta, there's a squeezing of the pulmonary artery allowing for stenosis. 02:04 That narrowed pulmonary stenosis results in a right ventricular hypertrophy. 02:11 Really, it's the biology of Fallot in that you're both having the VSD and the overriding aorta, and the pulmonary stenosis resulting at right ventricular hypertrophy. 02:26 However, realistically, this is just one thing. 02:31 You could call it "The Fallot" if you want. 02:33 The abnormal rotation of the conotruncal septum at the top part of the heart is it's abnormally rotated as opposed to the intraventricular septum - the bottom part of the heart - and this whole shifting results in all of these findings. 02:52 It's really just a shifting of the upper part against the lower part of the heart that results in the full tetralogy. 02:59 That might make it a little bit more clearer. 03:03 It's important to understand that children who have a high-degree of pulmonary stenosis are going to be sicker than children who have less pulmonary stenosis. 03:13 The key thing about how blue a baby is at birth is how much pulmonary stenosis there is. 03:20 In a baby with a lot of pulmonary stenosis, more of that blood is going to get shunted over to the left side. 03:26 In a baby with less pulmonary stenosis, it's going to go right up into the lungs, and that's going to be the distinguishing feature between a baby who's what we call a "pink tet" - someone with less stenosis and less cyanosis - versus a "blue tet" - a baby who has a lot of pulmonary stenosis and a lot of blood shunting. 03:47 Additional points that are high-yield are the boot-shaped appearance of the heart on CXR. 03:52 And the role of squatting in increasing peripheral vascular resistance and thus decreasing the magnitude of the right-to-left shunt.
The lecture Tetralogy of Fallot (TOF) by Brian Alverson, MD is from the course Pediatric Cardiology.
What finding in tetralogy of Fallot most directly affects whether a child is a “pink tet” or a “blue tet”?
Which of the following is NOT a feature of tetralogy of Fallot (TOF)?
How does the heart silhouette typically appear on a posterior-anterior X-ray in a patient with tetralogy of Fallot (TOF)?
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I liked the explanation for the Tetraology of Fallot and that important points were added or emphasized.
I really love it.. I just wish it have the indications and timing of the repair.
Excellent lecture as usual. It makes a complicated topic much easier. Thanks!
thanks to this video i now have a much clearer understanding of TOF much thank you dr alverson
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