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Ganigara M, Sagiv E, Buddhe S, Bhat A, Chikkabyrappa SM. Tetralogy of Fallot With Pulmonary Atresia: Anatomy, Physiology, Imaging, and Perioperative Management. Semin Cardiothorac Vasc Anesth 2020; 25:208-217. [DOI: 10.1177/1089253220920480] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Tetralogy of Fallot (ToF) with pulmonary atresia (ToF-PA) is a complex congenital heart defect at the extreme end of the spectrum of ToF, with no antegrade flow into the pulmonary arteries. Patients differ with regard to the sources of pulmonary blood flow. In the milder spectrum of disease, there are confluent branch pulmonary arteries fed by ductus arteriosus. In more severe cases, however, the ductus arteriosus is absent, and the sole source of pulmonary blood flow is via major aortopulmonary collateral arteries (MAPCAs). The variability in the origin, size, number, and clinical course of these MAPCAs adds to the complexity of these patients. Currently, the goal of management is to establish pulmonary blood flow from the right ventricle (RV) with RV pressures that are ideally less than half of the systemic pressure to allow for closure of the ventricular septal defect. In the long term, patients with ToF-PA are at higher risk for reinterventions to address pulmonary arterial or RV-pulmonary artery conduit stenosis, progressive aortic root dilation and aortic insufficiency, and late mortality than those with less severe forms of ToF.
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Affiliation(s)
- Madhusudan Ganigara
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Eyal Sagiv
- Seattle Children’s Hospital, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
| | - Sujatha Buddhe
- Seattle Children’s Hospital, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
| | - Aarti Bhat
- Seattle Children’s Hospital, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
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Talwar S, Sandeep JA, Choudhary SK, Gulati GS, Airan B. Tetralogy of Fallot with Anomalous Systemic and Pulmonary Venous Drainage, Anomalous Coronary Artery Pattern, and Abnormal Development of Diaphragm. CONGENIT HEART DIS 2009; 4:21-4. [DOI: 10.1111/j.1747-0803.2008.00242.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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