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Cyanotic congenital heart disease with decreased pulmonary blood flow in children.
Pediatr Clin North Am 1999; 46(2):385-404PC

Abstract

Of the "five T's" of cyanotic congenital heart disease--tetralogy of Fallot, TGA, TAPVC, truncus, and tricuspid valve abnormalities (tricuspid atresia, stenosis, and displacement)--the first and last are commonly associated with diminished PBF. The four features that comprise tetralogy of Fallot--right ventricular hypertrophy, VSD, overriding aorta, and subpulmonary stenosis--are all secondary to a single morphogenetic defect: failure of expansion of the subpulmonary conus. This also explains the variability in clinical presentation. When neonates need intervention, shunts are usually performed. Coronary arterial anatomy must be defined before repair, which is usually done after these infants are 3 months of age. Although children with repaired tetralogy of Fallot are not completely "normal," markedly increased longevity and improvement in quality of life can be achieved. When major associated defects are present, such as atrioventricular canal defect, diminutive pulmonary arteries or collateral vessels, or left heart lesions, the prognosis changes from excellent to merely good. Tetralogy of Fallot with absent pulmonary valve syndrome is physiologically different from other tetralogy of Fallot conditions and characterized primarily by airway obstruction from massive dilatation of the central and perihilar pulmonary arteries; repair with pulmonary artery reduction is necessary. Tricuspid valve abnormalities include atresia, hypoplasia (i.e., pulmonary atresia with intact ventricular septum), and displacement (i.e., Ebstein anomaly). The pathophysiology that dictates these children's clinical condition (and prognosis) relates to three factors: (1) status of the tricuspid valve, (2) presence and size of a VSD, and (3) TGA or normally related great arteries. Virtually all children with tricuspid valve abnormalities can be palliated; reparative options include repair using two-ventricle, one-ventricle, or 1-1/2 ventricle repair. Children with critical pulmonary stenosis generally have a normal tricuspid valve and right ventricle. Balloon dilation is usually the only therapy necessary.

Authors+Show Affiliations

University of New Mexico Health Sciences Center, Children's Hospital Heart Center, Albuquerque, USA.No affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

10218082

Citation

Waldman, J D., and J A. Wernly. "Cyanotic Congenital Heart Disease With Decreased Pulmonary Blood Flow in Children." Pediatric Clinics of North America, vol. 46, no. 2, 1999, pp. 385-404.
Waldman JD, Wernly JA. Cyanotic congenital heart disease with decreased pulmonary blood flow in children. Pediatr Clin North Am. 1999;46(2):385-404.
Waldman, J. D., & Wernly, J. A. (1999). Cyanotic congenital heart disease with decreased pulmonary blood flow in children. Pediatric Clinics of North America, 46(2), pp. 385-404.
Waldman JD, Wernly JA. Cyanotic Congenital Heart Disease With Decreased Pulmonary Blood Flow in Children. Pediatr Clin North Am. 1999;46(2):385-404. PubMed PMID: 10218082.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cyanotic congenital heart disease with decreased pulmonary blood flow in children. AU - Waldman,J D, AU - Wernly,J A, PY - 1999/4/28/pubmed PY - 1999/4/28/medline PY - 1999/4/28/entrez SP - 385 EP - 404 JF - Pediatric clinics of North America JO - Pediatr. Clin. North Am. VL - 46 IS - 2 N2 - Of the "five T's" of cyanotic congenital heart disease--tetralogy of Fallot, TGA, TAPVC, truncus, and tricuspid valve abnormalities (tricuspid atresia, stenosis, and displacement)--the first and last are commonly associated with diminished PBF. The four features that comprise tetralogy of Fallot--right ventricular hypertrophy, VSD, overriding aorta, and subpulmonary stenosis--are all secondary to a single morphogenetic defect: failure of expansion of the subpulmonary conus. This also explains the variability in clinical presentation. When neonates need intervention, shunts are usually performed. Coronary arterial anatomy must be defined before repair, which is usually done after these infants are 3 months of age. Although children with repaired tetralogy of Fallot are not completely "normal," markedly increased longevity and improvement in quality of life can be achieved. When major associated defects are present, such as atrioventricular canal defect, diminutive pulmonary arteries or collateral vessels, or left heart lesions, the prognosis changes from excellent to merely good. Tetralogy of Fallot with absent pulmonary valve syndrome is physiologically different from other tetralogy of Fallot conditions and characterized primarily by airway obstruction from massive dilatation of the central and perihilar pulmonary arteries; repair with pulmonary artery reduction is necessary. Tricuspid valve abnormalities include atresia, hypoplasia (i.e., pulmonary atresia with intact ventricular septum), and displacement (i.e., Ebstein anomaly). The pathophysiology that dictates these children's clinical condition (and prognosis) relates to three factors: (1) status of the tricuspid valve, (2) presence and size of a VSD, and (3) TGA or normally related great arteries. Virtually all children with tricuspid valve abnormalities can be palliated; reparative options include repair using two-ventricle, one-ventricle, or 1-1/2 ventricle repair. Children with critical pulmonary stenosis generally have a normal tricuspid valve and right ventricle. Balloon dilation is usually the only therapy necessary. SN - 0031-3955 UR - https://www.unboundmedicine.com/medline/citation/10218082/Cyanotic_congenital_heart_disease_with_decreased_pulmonary_blood_flow_in_children_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0031-3955(05)70125-5 DB - PRIME DP - Unbound Medicine ER -