Phallus tetraphy
The tetralogy of Fallot refers to the most common heart defects of the blue type. It accounts for 12-14% of all congenital heart defects and 50-75% of blue malformations. The first description belongs to Stensen( 1673) and Fallot( 1888).
In the classical version of the tetralogy of Fallot, there are 4 signs: stenosis( narrowing) of the outlet of the right ventricle at different levels, an interventricular septal defect, right ventricular myocardial hypertrophy( enlargement), and aortic dextrase.
During systole, blood flows from both ventricles into the aorta( as a result of its dextrase) and in a smaller amount to the pulmonary artery( depending on the degree of its narrowing).Location of the aorta "on horseback" on the interventricular septum( dekstrasipozitsiya) leads to unhindered ejection of blood from the right ventricle into it. The degree of oxygen starvation and severity of children's condition correlate with the magnitude of pulmonary artery stenosis. As a result of a large defect in the septum, an equal pressure is established in both ventricles.
Children of the first days of life are diagnosed with the most severe forms of the tetralogy of Fallot. The diagnosis is usually established for the first time for 6 months. Cyanosis( bluish cyanosis of the skin) is one of the main signs of the tetralogy of Fallot. The time of its appearance and severity is determined by the degree of stenosis( narrowing) of the pulmonary artery. Since birth, cyanosis is observed in about 40% of cases, more often becomes apparent to 8-12 months of life as the child's activity increases. Almost half of the children with this defect in the first year of life are cyanotic or mild, which is partly due to concomitant anemia. Severe cyanosis is noted in 13% of cases. Deformation of nails by the type of "watch glass" and fingers like "drumsticks" appears depending on the degree of oxygen starvation in the 1-2-year life of the child. Children with tetralogy Fallo often squat or lie in bed with their legs brought to the stomach, thereby facilitating their condition because of the decrease in the influx of "spent" blood to the heart.
The main manifestation of the tetralogy of Fallot, causing the severity of the condition and the development of brain complications, are dyspnea-cyanotic attacks. They are not present in children of the first three months of life, but they arise, leaking most heavily, at the age of 6 to 24 months, in the presence of anemia. Suddenly, the child becomes restless, dyspnea and blueness of the skin increase, then loss of consciousness, convulsions and even the development of incomplete paralysis of one half of the body( hemiparesis).
The lag in the mass( hypotrophy of II-III degree) in the tetralogy of Fallot occurs quite often. The tetralogy of Fallot is characterized by shortness of breath with deep, arrhythmic breathing, the respiratory rate varies little. The heart hump is missing, since the heart is not greatly enlarged in size. When auscultation, the doctor listens to the characteristic noise. Heart failure is not characteristic of the tetralogy of Fallot. Increased palpitations and shortness of breath are associated with oxygen deficiency. In addition, with this defect there is an increase in the size of the liver and spleen.
In blood tests in children with tetralogy of Fallot, anemia is detected.
Additional methods of examining children are ECG, PCG( graphic recording of cardiac murmurs), radiography of chest organs, ultrasound of the heart. If necessary, conduct a catheterization of the heart cavities and aortography.
In the tetralogy of Fallot, complications may arise from the central nervous system( hemiparesis against the background of dyspnea-cyanotic seizures, brain abscess).Also, bacterial endocarditis( bacterial lesion of the inner shell of the heart) and pulmonary tuberculosis are sometimes attached. Treatment of tetralogy of Fallot consists in carrying out of operation on correction of available anatomic defects.
It is known that dyspnea-cyanotic attacks are a temporary episode in the tetralogy of Fallot and pass after three years of a child's life, when manifestations of iron deficiency anemia disappear. The pediatrician must take into account all the moments provoking seizures in this child, in order to avoid possible operations. For this, active treatment of concomitant diseases( anemia, rickets, etc.), consultation of a neuropathologist, as well as medical treatment are necessary.