Fallot's Triad

Introduction to Fallot's Triad Fallot triad is a congenital pulmonary stenosis with a patent foramen ovale or secondary atrial septal defect, with a syndrome of right ventricular hypertrophy. In cyanotic congenital heart disease, the incidence rate is second only to the Faro quadruple syndrome, the incidence rate of females is higher than that of males, and the age distribution is below 20 years old. Due to pulmonary stenosis, the right ventricle and right atrial pressure are significantly increased, causing right-to-left shunt, clinical cyanosis, right atrial pressure is lower than left atrial pressure, and hemodynamic changes are left to right. Diversion, no clinical convulsions. Once the disease is diagnosed, surgical treatment should be actively used. The patient's symptoms are obvious or have a cyanosis, and the right ventricular pressure is significantly increased. The operation should be performed as soon as possible. Although right ventricular hypertrophy or pulmonary stenosis is mild, but there is a large shunt in the atrial septal defect, surgery should also be performed. basic knowledge The proportion of illness: 0.02% to 0.3% Susceptible people: more common in young children Mode of infection: non-infectious Complications: pulmonary hypertension

The cause of trilogy of Fallot

Fetal development environment (30%):

Intrauterine viral infection is the most important cause of congenital heart disease, of which the most common infection with rubella virus, followed by Coxsackie virus infection. Other causes such as amniotic membrane disease, fetal compression, early pregnancy threatened abortion, maternal malnutrition, diabetes, and the use of radiation and cytotoxic drugs in early pregnancy are the causes of congenital heart disease.

Genetic (15%):

In a family, brothers and sisters or parents and children with congenital heart disease, as well as many genetic abnormalities of chromosomal abnormalities and cases of cardiovascular vascular malformations, indicating that the disease has genetic factors.

Premature delivery (10%):

Premature birth is an important cause of congenital heart disease. Newborns born below 2,500 grams are more likely to have congenital heart disease.

Plateau environment (15%):

Low altitude oxygen pressure is one of the causes of congenital heart disease. The prevalence of congenital heart disease in the Qinghai-Tibet Plateau is much higher than that in the plain area.

Other (10%):

Older mothers (over 35 years of age) have a higher risk of developing tetralogy of Fallot and Down's syndrome.

Pathophysiology:

In the case of Fallot's collaterals, pulmonary stenosis occurs mostly in the valve part, which is rare in the funnel, but occasionally mixed stenosis, that is, the valve and the funnel are narrow. The traffic in the left and right heart rooms is mostly patent foramen ovale or secondary atrial septal defect. The severity of clinical occurrence of cyanosis or cyanosis depends on the degree of stenosis of the pulmonary artery. Different blood dynamic changes can be seen in Fallow's collaterals. In moderate or severe pulmonary stenosis, due to the significant increase in right atrial and right ventricular pressure, it can cause a "right to left" shunt in the heart, and clinical development occurs. When the mild pulmonary stenosis or atrial septal defect is large, because the right atrial pressure is lower than the left atrium, the heart is a "left to right" shunt, and there is no clinical development.

Fallot triple disease prevention

1 The focus of the prevention and treatment of Fallot's triad is prevention, especially the four major preventive measures of smoking cessation, weight loss, exercise and taboo. By changing the rules of life, regular inspections and drug coordination, 80% of myocardial infarctions can completely prevent or substantially alleviate the symptoms. Clinical experience has proven that the first measure to prevent trilogy of Fallot is to completely quit smoking; the second is to control weight, especially to reduce abdominal fat; the third is to strengthen exercise, such as walking at least 30 minutes every day, insisting on climbing stairs without taking the elevator, and Minimize driving and riding, etc. Fourth, pay attention to improving diet, not eating too much, not eating too much high-fat foods.

2 Fallot's triad is highly heritable and recurrent. Therefore, people with a family history of trilogy of Fallot and those who have had a triad of Fallot should be more preventive. However, 41% of French family members with family history of Fallot have not changed their unhealthy habits after the onset of relatives, and 40% of patients who have suffered from trilogy of Fallot remain. In addition, 45% of French people have never had the habit of physical exercise, which is also an important reason for the high incidence and mortality of French trilogy of Fallot.

Complications of Fallot's triad Complications pulmonary hypertension

May be complicated by heart disease, pulmonary hypertension, etc.

Symptoms of trilogy of Fallot common symptoms palpitations, pulmonary stenosis, murmur, sputum, short atrial septal defect

1. palpitations, shortness of breath, fatigue, poor development, light hair sputum can not be obvious, severe cases have more hair or convulsions, syncope.

2. The cyanosis is obvious. The second sound of the clubbing, toe, and pulmonary valve area is weakened or disappeared. The second rib of the left sternal border hears a rough systolic murmur, and there is systolic tremor.

Examination of Fallot's triad

Physical examination: right ventricular hypertrophy can occur in the chest area, and has a sense of lift, can be heard in the pulmonary valve area and systolic jet-like murmurs and convulsions and tremors, the second sound of the pulmonary artery is weakened or disappeared, but the pulmonary stenosis is light, When the septal defect is large, the second sound of the pulmonary artery is hyperactive and split.

(1) X-ray examination: X-ray findings of Luolianlian disease mainly include: right atrium, right ventricle enlargement, aortic shadow reduction or normal, pulmonary trunk showing stenosis and expansion, lung field clear, and lung texture reduced.

(2) Electrocardiogram: mainly for right heart changes, manifested as right ventricular hypertrophy, high-point P wave, incomplete right bundle branch block.

(3) Laboratory tests: the blood oxygen saturation of the patient with cyanosis is reduced, and the red blood cells and hemoglobin are increased.

(4) Echocardiography: The diagnosis can be confirmed, whether it is pulmonary stenosis or funnel stenosis and its degree of stenosis, and the size and location of patent foramen ovale or room defect.

(5) Right heart catheterization and selective right ventricular angiography.

1 right heart catheterization is of great value for diagnosis, 2 selective right ventriculography: can show stenosis and thickened valve, showing the expansion of the pulmonary artery after stenosis and its degree of expansion, showing the muscles of the funnel.

Fallow collaterals should be distinguished from the diagnosis of tetralogy of Fallot, simple pulmonary stenosis, atrial septal defect, ventricular septal defect and Eisenmenger syndrome.

Diagnosis and diagnosis of trilogy of Fallot

1 Diagnosis basis

1.1 After exertion, palpitations, shortness of breath, fatigue, chest pain, dizziness, etc., cyanosis appeared later, clubbing and polycythemia are not as significant as tetralogy of Fallot.

1.2 The pulmonary valve area has a loud systolic hairy jet murmur, often accompanied by fine tremor, and the second heart sound in the pulmonary valve area is weakened and split.

1.3 X-ray examination: the pulmonary vascular shadow is reduced, the right ventricle and the right atrium are enlarged, and the total trunk of the pulmonary artery is obviously protruding (expansion after stenosis of the valve).

1.4 ECG: There is right ventricular hypertrophy, strain and right atrial hypertrophy. The electric axis is right-biased.

1.5 Echocardiogram: showing right atrium, right ventricle enlargement, continuous interruption of atrial septum and pulmonary stenosis. Ultrasound contrast can directly show a right-to-left shunt at the atrial level.

1.6 Cardiac catheterization and selective right ventricle: The right heart catheter may enter the left atrium from the right atrium through an atrial septal defect. Continuous measurement of pulmonary artery and right ventricle is often based on valvular stenosis. Right ventricular angiography showed pulmonary stenosis, sometimes visible right ventricular funnel hypertrophy, and the contrast agent entered the left atrium when the right atrium contracted.

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