HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Anderson, R. H. Articles by Zuberbuhler, J. R. Search for Related Content PubMed PubMed Citation Articles by Anderson, R. H. Articles by Zuberbuhler, J. R.

The Journal of Thoracic and Cardiovascular Surgery, Vol 81, 887-896, Copyright © 1981 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association

ARTICLES

Surgical anatomy of tetralogy of Fallot

RH Anderson, SP Allwork, SY Ho, CC Lenox and JR Zuberbuhler

On the basis of previous experience, we have analyzed the anatomy of a series of 53 hearts catalogued as having tetralogy of Fallot in the museum of the Children's Hospital of Pittsburgh. All hearts had a ventricular septal defect, aortic overriding, infundibular pulmonary obstruction, and right ventricular hypertrophy. None of the hearts had been operated upon during life. We paid particular attention to features of surgical importance. Thus the ventricular septal defect was found to be of variable form. It was perimembranous in 42 hearts. In 11 hearts it had entirely muscular rims and in the remaining heart it was roofed by the conjoined aortic and pulmonary valve rings (subarterial). From our previous histologic experience, it was evident that this varying morphology significantly affected the surgical anatomy of the atrioventricular conduction tissues. We endeavored to display this disposition as might be viewed by the surgeon. The degree of aortic override was variable, the aortic valve being connected by 15% to 95% to the right ventricle. In 17 hearts more than half the aortic valve was attached to right ventricular musculature. The nature of the infundibular obstruction also varied markedly. In all cases (except the one with absent infundibular septum) the infundibular septum was deviated in cephalad and anterior direction so as to produce obstruction. In the majority of hearts further anatomic structures also contributed to the obstruction. In some hearts there was hypertrophy of the infundibular septum, particularly at its junction with the trabecular septum. In others there was hypertrophy of the trabecula septomarginalis, and in many hearts there was hypertrophy of additional anterior infundibular trabeculations. The pulmonary valve was the narrowest point of the outflow tract in only six hearts, but in many of the others, it was abnormal. The results emphasize that while hearts may exhibit the classical features of tetralogy of Fallot, there is usually considerable individual variation in each of these features which is of major surgical significance.

This article has been cited by other articles:

				E. A Shinebourne, S. V Babu-Narayan, and J. S Carvalho Tetralogy of Fallot: from fetus to adult. Heart, September 1, 2006; 92(9): 1353 - 1359. [Full Text] [PDF]

				G. R. Veldtman, H. M. Connolly, M. Grogan, N. M. Ammash, and C. A. Warnes Outcomes of pregnancy in women with tetralogy of fallot J. Am. Coll. Cardiol., July 7, 2004; 44(1): 174 - 180. [Abstract] [Full Text] [PDF]

				M. Ando, Y. Takahashi, T. Kikuchi, and K. Tatsuno Tetralogy of fallot with subarterial ventricular septal defect Ann. Thorac. Surg., October 1, 2003; 76(4): 1059 - 1065. [Abstract] [Full Text] [PDF]

				P. K. Goel, M. Shahi, T.S. Mahant, P.K. Mittal, S. Radhakrishnan, and P. K. Goel Absent Conal Septum in Tetralogy of Fallot: An Angiographic Study Angiology, July 1, 1997; 48(7): 643 - 647. [Abstract] [PDF]

				T. Geva, N. A. Ayres, F. A. Pac, and R. Pignatelli Quantitative Morphometric Analysis of Progressive Infundibular Obstruction in Tetralogy of Fallot : A Prospective Longitudinal Echocardiographic Study Circulation, August 15, 1995; 92(4): 886 - 892. [Abstract] [Full Text]

				Y. Okita, S. Miki, Y. Ueda, T. Tahata, T. Sakai, K. Matsuyama, M. Matsumura, and T. Tamura Early and late results of repair of tetralogy of Fallot with subarterial ventricular septal defect: A comparative evaluation of tetralogy with perimembranous ventricular septal defect J. Thorac. Cardiovasc. Surg., July 1, 1995; 110(1): 180 - 185. [Abstract] [Full Text]

				H. Uemura, T. Yagihara, Y. Kawashima, F. Yamamoto, K. Nishigaki, O. Matsuki, T. Kamiya, S. Y. Ho, and R. H. Anderson A Bicuspid Pulmonary Valve Is Not a Contraindication for the Arterial Switch Operation Ann. Thorac. Surg., February 1, 1995; 59(2): 473 - 476. [Abstract] [Full Text]