Tetralogy of Fallot

Pathogenesis of ventricular and atrial septal defects. (A) The common atrial chamber is being separated into the right and left atria (RA and LA) by the septum primum. Because the septum primum has not yet joined the endocardial cushion material, there is an open ostium primum. The ventricular cavity is being divided by a muscular interventricular septum into right and left chambers (RV and LV). SVC, superior vena cava; IVC, inferior vena cava. (B) The septum primum has joined the endocardi...

Coronal view of the heart with a congenital ventricular septal defect. Oxygenated blood is allowed to travel from the left to right ventricle into the pulmonary trunk.

<bold>Figure 33-39</bold> Echocardiogram 4 chamber view with color Doppler analysis demonstrates an apical musular ventricular septal defect. (LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle; VSD, ventricular septal defect.)

<bold>Fig CA 13-5 Ventricular septal defect.</bold> The pulmonary trunk is very large and overshadows the normal-sized aorta, which seems small by comparison. The pulmonary artery branches in the hilum and in the periphery of the lung are enlarged, and the pulmonary vascular volume is increased. The heart is enlarged and somewhat triangular.¹

<bold>Fig CA 2-1 Tetralogy of Fallot.</bold> (A) Frontal view shows right ventricular enlargement as a lateral and upward displacement of the radiographic cardiac apex (arrow). (B) On the lateral view, the enlarged right ventricle fills most of the retrosternal space (arrows).

<bold>Fig CA 2-1 Tetralogy of Fallot.</bold> (A) Frontal view shows right ventricular enlargement as a lateral and upward displacement of the radiographic cardiac apex (arrow). (B) On the lateral view, the enlarged right ventricle fills most of the retrosternal space (arrows).

<bold>Fig CA 5-7 Single ventricle.</bold> (A) Frontal view from a right ventriculogram shows muscular tracts leading from the right ventricle to both great arteries, the valves of which (arrows) are at the same horizontal level. (B) A lateral view shows the anteriorly situated right ventricle (RV) communicating with the left ventricle (LV) via a ventricular septal defect (single arrows). (PA, pulmonary artery; Ao, aorta.)⁴

<bold>Fig CA 5-7 Single ventricle.</bold> (A) Frontal view from a right ventriculogram shows muscular tracts leading from the right ventricle to both great arteries, the valves of which (arrows) are at the same horizontal level. (B) A lateral view shows the anteriorly situated right ventricle (RV) communicating with the left ventricle (LV) via a ventricular septal defect (single arrows). (PA, pulmonary artery; Ao, aorta.)⁴

A case of complex congenital heart disease. Patient has situs inversus, dextrocardia, is status-post tetralogy of Fallot repair, and presents with symptoms of right-sided heart failure. A: Axial gradient echo images showing dextrocardia and right ventricular dilation. B: Sagittal gradient-echo images showing free pulmonary regurgitation (arrow) at the site of previous infundibular resection.

<bold><italic>Figure 13-21</bold> Ventricular septal defect.</bold> This defect is at the upper end of the interventricular septum.

<bold><italic>Figure 13-22</bold> Tetralogy of Fallot: a right-to-left cardiac shunt.</bold> The defects are: 1) misplacement (rightward shift) of the aortic valve so that the aortic orifice catches unoxygenated blood coming through the 2) ventricular septal defect in a right-to-left shunt because 3) pulmonary artery stenosis obstructs pulmonary blood flow, which increases right ventricular pressure, causing 4) right ventricular hypertrophy.

Auscultation, ventricular septal defect - A small ventricular septal defect causes a holosystolic murmur that often has a slight midsystolic accentuation. The second sound is not altered

Auscultation, ventricular septal defect - Moderate ventricular septal defect permits left-to-right shunting but maintains left-ventricular-to-right ventricular pressure gradient. The increased flow through the mitral valve causes an early diastolic "flow" (ventricular filling) murmur

Tetralogy of Fallot - Chest x-ray showing features of tetralogy of Fallot: diminished pulmonary vascularity, concave pulm. a., rt.aortic arch, and rt. descending aorta. Note oval-shaped heart w/ laterally displaced and elevated cardiac apex leading to "boot" shaped silhouette

Ventricular septal defect - Chest X-ray showing features of ventricular septal defect: increased pulmonary vascularity, moderate cardiomegaly, and left ventricular dilation producing "sagging" or "drooping" of the cardiac apex. Left atrial enlargement is also present

Ventricular septal defect - Removal of a portion of the r. ventricular wall revealing three types of septal defects: 1, membranous; 2, muscular; 3, subpulmonic