The reasons for the development of Fallot's Tetrad in children, the alarming symptoms and treatment tactics
A tetralogy of Fallot in a fetus or child is a combination of several heart anomalies. Clinically, the vice shows itself immediately after birth in the form of cyanosis, fainting and other symptoms, which we will consider below.
The tetrad suggests a combination of four manifestations:
- persistent narrowing of the opening in the pulmonary artery;
- dextrose of the aorta;
- defect of septum between ventricles;
- hypertrophy of the muscular wall of the right ventricle.
The operation to correct the defect of the tetralogy of Fallot is carried out in two forms - palliative intervention or radical. The first option involves the imposition of intersystem anastomoses, and the radical remedies consist in the complete correction of defects by surgical means.
- Causes and symptoms
- Classification of the disease
- Nuances of hemodynamics
- Treatment of the tetralogy of Fallot
- Pentado Pento: Characterization and Treatment
Causes and symptoms
The main cause of the disease is now considered a violation of the process of cardiogenesis, which occurs during the period from the 2nd to the 8th week of embryo development. Congenital tetrad cause infections in the mother. These include measles, scarlet fever and even banal rubella. Because the tetrad of Fallot and the pregnancy itself are closely related.
The development of the disease can be caused by other causes:
- reception of hormones;
- treatment with sedatives;
- use of drugs or alcoholic beverages;
- The impact of adverse environmental factors or production.
In addition, the CHD can be based on chromosomal breakdowns (Down syndrome, Patau, Edwards, etc.).
One of the triggers is the incorrect rotation of the arterial cone. In this case, the aortic valve is displaced relative to the pulmonary trunk. The same leads to a narrowing and lengthening of the pulmonary trunk, after which it should be displaced. In addition, due to a violation of the outflow of blood, the right ventricle must expand.
Note! In the tetralogy of Fallot, stenosis of the pulmonary artery is observed, which can not be the case with the Eisenmenger complex (similar to a co-morbid malformation, but without narrowing the outlet of the right ventricle)..
The symptomatology of the disease differs depending on the shape and degree of the tetrad. The main symptoms include shortness of breath, weakness of the body, tachycardia, dizziness and fainting. In severe form, cyanosis of the skin and lips is noted, which is enhanced by physical and emotional stress, by crying or feeding.
After exercise, most patients squat. Children with tetralogy Fallo lag behind in physical development from their peers.
Classification of the disease
The degrees of a tetrad can be different. There are 4 in all, and all of them depend on the nature of the obstruction:
- Embryological. This is the tetralogy of Fallot in newborns, which appeared as a result of the shift of the cone-shaped septum. In this period, its low placement can also be observed. At the same time stenosis completely coincides with the level of the delimiting muscular ring. There are no changes in the design of the fibrous ring.
- Hypertrophic tetrad or the syndrome of Fallot. This is the second type of ailment. Obstruction develops due to the displacement of the septum in the same direction as for the first case, but some hypertrophic changes in the proximal area are observed. Stenosis is exactly the same as in the above situation.
- The tubular type. Here already the tetralogy of Fallot in young children is caused by other factors. Typically, this is a change in the pulmonary cone, which eventually turns out to be giplazirovannym, narrowed or shortened. All 3 signs can be observed simultaneously.
Important! Congenital heart disease of the tetralogy of Fallot of this category can cause hypoplasia of the fibrous ring, valvular stenosis..
- Multicomponent type. It is distinguished by a significant lengthening of the septum. In this case, a high departure of the trabeculae of the moderator strand is noted.
Nuances of hemodynamics
Features of hemodynamics can be different. In connection with these doctors distinguish three forms of vice:
- the first - there is atresia of the pulmonary artery mouth;
- the second is called cyanotic - the stenosis of the mouth is noted;
- the third is a cyanotonic.
The degree of obstruction directly affects the level of hemodynamic defects. The flow of blood into the aorta in large quantities and at the same time its release in a smaller proportion into the pulmonary trunk is determineddevelopment of significant pulmonary artery stenosis,septal defect of large-sized IVF.
It should be taken into account that the pressure in the two ventricles is the same because of the large defect of the septum between them. For the blemish of the extreme stage is characterized by the ingress of blood into the small circle of circulation through the aorta.
The development of the left-right flow of blood leads to moderate obstruction, which is characterized by a higher peripheral resistance than the stenotic outlet tract. As it develops, there is initially a cross-flow of blood, and then a veno-arterial discharge. Arterial hypoxemia develops.
Treatment of the tetralogy of Fallot
Now it's time to find out how the defect of the Fallot tetrad is treated. Conservative here is ineffective. Therefore, doctors resort exclusively to surgical intervention. We mentioned their types at the very beginning of the article. Now you should consider each option in more detail:
- Palliative correction. The essence of such an intervention is to restore a normal or slightly increased blood flow in a small circle This is done in two ways: by correcting the stenosis of the LA or by communicating two circles of circulation blood. There are several varieties of such correction. All of them boil down to creating special anastomoses through which blood will be shunted between the aorta and the LA.
- During a radical operation, sub-valvular and drip stenosis is eliminated, and the defects of the septum between the ventricles are plasticized. The most favorable period for such medical intervention is the age from 3 to 4 years. At the same time, modern medicine can boast of a positive experience of surgery and more young patients.
The artificial connection of the aorta and the LA is a preparatory stage, allowing the child to live up to a radical operation and prepare for it..
Important! It is necessary to understand that palliative therapy gives a positive result only for the first years after its holding. Further, the results will no longer be favorable, and radical methods will be required..
Treatment of the tetralogy of Fallot is performed on the open heart with the use of the apparatus of artificial circulation. Without surgery, the prognosis is unfavorable, patients die from affiliated infections (tuberculosis, pneumonia), thrombosis, and brain abscesses. A quarter of all children die without intervention in the first year of life.
Pentado Pento: Characterization and Treatment
This disease is a combination of five symptoms at once:
- aircraft stenosis;
- dextrose of the aorta;
- Defective MZHP;
- defect of MPP;
- hypertrophy of the right ventricle.
In other words, the pentad of Fallot is the same tetralogy of Fallot, but with the addition of one more sign - violation of the integrity of the interatrial septum. Significant defects in this area are extremely rare. Most often, doctors note incomplete infection of the hole. It develops due to the incomplete formation of the valve. The ailment is characterized by the release of blood in a small amount through a loose fitting oval hole.
From the differences in the vectors of blood ejection in humans, pronounced hypoxemia is noted. But it also happens that the splash goes in the direction from left to right. This means that the right ventricle has an extra load, which somewhat compensates for the symptom.
Clinical studies are carried out exactly as in tetrad. The doctor makes a conclusion only after carrying out a heart probing and a procedure called angiocardiography.
Drug treatment is ineffective, because doctors conduct operations. That the pentada that the tetralogy of Fallot is treated the same, but there is one nuance - doctors need to restore the integrity of MPP. The prognosis for people suffering from ailment is not very favorable. However, it is more positive than with tetrad. This is due to compensation for arterial hypoxemia. The earlier the radical intervention is performed, the greater the complications can be avoided, but the life span of patients with such defects rarely exceeds 40 years... .