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TOF WITH MILD PULMONARY STENOSIS.
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TOF WITH MILD PULMONARY STENOSIS.

Dear Doctor,

I underwent FETAL ECHOCARDIOGRAPHY - COLOR DOPPLER scan which shows 28-29 WEEKS fetal maturity.

The following are the details observed on the report:

The CARDIAC SITUS is normal.
The ATRIO-VENTRICULAR & VENTRICULO-ARTERIAL  concordance noted.
There is evidence of over riding of the Aorta over the I.V.S with a mild pulmonary stenosis - FORWARD FLOW NOTED.
AORTIC ROOT DIAMETER - 8.3mm
R.V.O.T - Diameter - 4.0mm
INTER VENTRICULAR SEPTUM - 3.5mm perimembranous V.S.D noted.
The INTER ATRIAL SEPTUM shows a foramen ovale with normal flow across.
The CHAMBER SIZES are within normal limits.
Fetal Heart Rate - 152/Min                         1:1 Conduction noted.
The MITRAL& TRICUSPID VALVES  are normal.
The AORTA - ARCH & DESCENDING  -  are normal with normal flows.
The PULMONARY ARTERY BIFURCATION is normal with normal flows.
The I.V.C. is normal with normal connection to the RIGHT ATRIUM.
COLOR & PULSED WAVE DOPPLER STUDY - Revealed normal flow across the MITRAL,TRICUSPID, AORTIC VALVES.

IMPRESSION:
TETRALOGY OF FALLOTS' WITH MILD PULMONARY STENOSIS.

My question is, What is the severity of TOF for my baby, does it require any surgery? We are very much worried about this, your answer and suggestion is eagerly awaited, thanks a lot in advance.
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773637_tn?1327450515
Dear Padmashri,

Tetralogy of Fallot is a congenital heart defect that has four classic findings:  1) a ventricular septal defect (VSD), 2) aortic override of the ventricular septum, 3) pulmonary stenosis (obstruction of the pulmonary outflow tract), and 4) right ventricular hypertrophy (thickening of the right ventricle).  It does not spontaneously resolve, and definitely requires surgical intervention to improve the lifespan and quality of life of these children.  Unfortunately, I cannot tell you much more about the severity of the defect based on the limited amount of information that you have given me.  The fact that the pulmonary stenosis is mild is probably a good thing.  I cannot estimate how small the pulmonary artery is in relation to the rest of the size of the baby, however, which means that I cannot say more about the severity.  

Tetralogy is typically repaired between ages 2 and 6 months, with complete repair occurring at that time.  Occasionally, due to more complicated cardiac anatomy, a staged approach may need to be done.  This would include a shunt placed between the aorta and the pulmonary artery to increase pulmonary blood flow and allow more time for cardiac growth followed by a complete repair and shunt takedown at a later time.
2 Comments
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Dear doctor,

My sincere thanks to you for taking time to respond to my queries.

I had posted a question earlier on the same topic (http://www.medhelp.org/posts/Pediatric-Heart/Tetralogy-of-fallot/show/1161159) to which you had replied seeking more information to better diagnose the criticality of the tetralogy of fallot condition.

The doctor we have consulted here, has only speculated that it could be tetralogy of fallot with the Echo readings he has obtained. The reason I am posting here is to seek your opinion as to whether it indeed is a case of TOF. If so, based on the recent Fetal Echo readings obtained, what could you infer on the criticality?

Is surgical intervention really a necessity?
We are curious to know your findings based on the latest readings.

Recent Fetal Echo readings(28-29 WEEKS fetal maturity) :

The CARDIAC SITUS is normal.
The ATRIO-VENTRICULAR & VENTRICULO-ARTERIAL  concordance noted.
There is evidence of over riding of the Aorta over the I.V.S with a mild pulmonary stenosis - FORWARD FLOW NOTED.
AORTIC ROOT DIAMETER - 8.3mm
R.V.O.T - Diameter - 4.0mm
INTER VENTRICULAR SEPTUM - 3.5mm perimembranous V.S.D noted.
The INTER ATRIAL SEPTUM shows a foramen ovale with normal flow across.
The CHAMBER SIZES are within normal limits.
Fetal Heart Rate - 152/Min                         1:1 Conduction noted.
The MITRAL& TRICUSPID VALVES  are normal.
The AORTA - ARCH & DESCENDING  -  are normal with normal flows.
The PULMONARY ARTERY BIFURCATION is normal with normal flows.
The I.V.C. is normal with normal connection to the RIGHT ATRIUM.
COLOR & PULSED WAVE DOPPLER STUDY - Revealed normal flow across the MITRAL,TRICUSPID, AORTIC VALVES.

Thank you,
Padmashri
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