Adult Tetrology of Fallot: A Doppler Echocardiographic Finding

Abstract

In TOF the morphological abnormalities are – overriding of aorta, pulmonary obstruction, right ventricular hypertrophy and ventricular septal defect. Normally it is nonrestrictive means free communications between the ventricles but sometimes very rarely it can become restrictive when the tricuspid valve restrict the flow across the ventricular septal defect. Among children with CHD 10% of them report TOF. Chest radiographs usually show a normal-size heart silhouette, with an upturned apex and a concave main pulmonary artery segment, commonly known as “boot-shaped” heart. On the electrocardiogram, it is common to see signs of right atrial enlargement and right ventricular hypertrophy showing right axis deviation, prominent R waves anteriorly and S waves posteriorly, upright T wave in V1 (abnormal after 7 days of life up to 10 years of age) and a qR pattern in the right precordial leads. If the ration between pulmonary artery orifice diameter to aortic orifice diameter is <.3 primary repair is unsuccessful and in that case we must go for shunt surgeries which are palliative procedures till permanent repair can be done. This should add proper assessment of coronary artery origin. This is a case of adult tetralogy of fallot (TOF) coming to outpatient department of cardiology with complaints of chest discomfort and sometimes cyanotic spells. Age of the patient is 42 years male. Doppler Echocardiography was done. In the image overriding of aorta was found around 20% over interventricular septum. Left sided aortic arch was detected along with ventricular septal defect (VSD) with size 14 mm. Size of pulmonary orifice 10 mm and that of aortic orifice was 22 mm. Hence pulmonary artery orifice was found to get stenosed.