Abstract
The characteristic features of tetralogy of Fallot including the large perimembranous malalignment VSD, overriding of the aorta and obstruction of the right ventricular outflow tract can be well displayed by 2D echocardiography. Colour Doppler provides important information regarding shunting across the VSD, allows detection of additional muscular VSDs and helps to clarify the sites of obstruction of the right ventricular outflow tract. Colour Doppler is also required for clarification of collateral lung perfusion and laterality of the aortic arch as well as for detection of subclavian artery anomalies. PW and CW Doppler provide the possibility to quantify the gradient across the right ventricular outflow tract. Following surgical repair, PW and CW Doppler are important tools for quantification of systolic right ventricular pressure, residual gradient across the right ventricular outflow tract and pulmonary regurgitation.
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11.1 Electronic Supplementary Material
Video 11.1
The parasternal long-axis view in this infant with tetralogy of Fallot shows the large perimembranous malalignment VSD and overriding of the aorta (AVI 20524 kb)
Video 11.2
The sweep in the parasternal long axis from the plane of the left ventricular outflow to the plane of the right ventricular outflow (same patient as in Video 11.1) shows anterior deviation of the outlet septum resulting in subvalvular obstruction of the right ventricular outflow tract (AVI 57825 kb)
Video 11.3
Colour Doppler in the sweep from the parasternal long-axis view of the left ventricular outflow to the plane of the right ventricular outflow tract (same patient as in Videos 11.1 and 11.2) shows acceleration of flow starting well below the level of the pulmonary valve (AVI 26706 kb)
Video 11.4
The parasternal short-axis view in this infant with tetralogy of Fallot (same patient as in Videos 11.1, 11.2 and 11.3) nicely shows the large perimembranous malalignment VSD, anterior deviation of the outlet septum and the resulting subvalvular right ventricular outflow tract obstruction (AVI 19576 kb)
Video 11.5
Colour Doppler in the apical four-chamber view shows an intact ventricular septum in the plane of the atrioventricular valves. Anterior sweep of the transducer reveals the large VSD and overriding of the aorta, which receives flow both from right and left ventricles (AVI 12841 kb)
Video 11.6
Parasternal short-axis sweep in an infant with tetralogy of Fallot. The sweep starts at the level of the papillary muscles. Cranial tilt of the transducer reveals the large perimembranous malalignment VSD, anterior deviation of the outlet septum and infundibular stenosis of the right ventricular outflow tract (AVI 54409 kb)
Video 11.7
The parasternal short-axis view at the level of the aortic valve shows nicely infundibular obstruction resulting from anterior deviation of the outlet septum (AVI 12138 kb)
Video 11.8
In this newborn the parasternal short-axis view at the level of the aortic valve shows severe infundibular obstruction resulting from anterior deviation of the outlet septum. In addition the pulmonary valve is severely stenotic (AVI 10926 kb)
Video 11.9
Colour Doppler in the parasternal short-axis view (same patient as in Video 11.8) reveals only minimal flow across the pulmonary valve (AVI 6003 kb)
Video 11.10
The parasternal short-axis view at the level of the aortic valve in a newborn with tetralogy of Fallot shows restriction of the large VSD by redundant accessory tricuspid valve tissue (AVI 31560 kb)
Video 11.11
The parasternal short-axis view of the pulmonary bifurcation in a newborn with tetralogy of Fallot shows relatively small central pulmonary arteries (AVI 6382 kb)
Video 11.12
Colour Doppler short-axis view from a high parasternal window in a newborn with tetralogy of Fallot. Cranial tilt of the transducer displays the innominate vein, coursing cranial to the aorta, connecting to the superior vena cava. Clockwise rotation of the transducer opens the right aortic arch of this patient (AVI 22931 kb)
Video 11.13
Colour Doppler in the high parasternal short-axis view in this patient with tetralogy of Fallot and right aortic arch (same patient as in Video 11.12) reveals that the first brachiocephalic vessel courses to the left representing a left innominate artery branching into left subclavian and left common carotid artery (AVI 7861 kb)
Video 11.14
Suprasternal long-axis view of the aortic arch in a newborn with tetralogy of Fallot shows origin of a long and tortuous ductus arteriosus from the undersurface of the aortic arch (AVI 20397 kb)
Video 11.15
Colour Doppler interrogation (same patient as in Video 11.14) confirms left to right shunting across the ductus with acceleration of flow at its pulmonary end (AVI 4089 kb)
Video 11.16
The subcostal short axis in this neonate with tetralogy of Fallot shows significant obstruction at infundibular level due to anterior deviation of the outlet septum (AVI 11105 kb)
Video 11.17
Colour Doppler (same patient as in Video 11.16) confirms obstruction by acceleration of flow and turbulence in the right ventricular outflow tract (AVI 6069 kb)
Video 11.18
The RAO view in this newborn with tetralogy of Fallot shows the large VSD and anterior deviation of the infundibular (outlet) septum. Despite its anterior deviation, the outlet septum does not cause subvalvular obstruction in this patient (AVI 6990 kb)
Video 11.19
The parasternal short-axis view at the level of the main pulmonary artery and bifurcation in a newborn with tetralogy of Fallot and absent pulmonary valve shows the dysplastic nodules instead of a normal pulmonary valve. Note the pathognomonic severe dilatation of the main and central pulmonary arteries (AVI 12263 kb)
Video 11.20
Colour Doppler in the parasternal short-axis view (same patient as in Video 11.19) reveals both accelerated and turbulent antegrade flow in systole and severe pulmonary regurgitation in diastole (AVI 3575 kb)
Video 11.21
Colour Doppler in the parasternal short-axis view of an infant with tetralogy of Fallot confirms significant acceleration of flow starting at infundibular level, where the anteriorly deviated outlet septum approaches the anterior wall of the right ventricle. Note laminar flow across the large perimembranous malalignment VSD (AVI 4659 kb)
Video 11.22
Colour Doppler in the parasternal short-axis view of a 2-month-old infant with tetralogy of Fallot shows somewhat small central pulmonary arteries without obstruction at the bifurcation. Continuous inflow close to the origin of the left pulmonary artery is due to a small ductus arteriosus (AVI 3392 kb)
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Hofbeck, M., Deeg, KH., Rupprecht, T. (2017). Tetralogy of Fallot. In: Doppler Echocardiography in Infancy and Childhood. Springer, Cham. https://doi.org/10.1007/978-3-319-42919-9_11
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DOI: https://doi.org/10.1007/978-3-319-42919-9_11
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