tetralogy of fallot  

history

- history of TOF

history of TOF

- left-to-right shunt

- right-to-left shunt : tet spells or hypercyanotic spells

physical examination

- physical examination of TOF

physical examination of TOF

- single and accentuated S2

- murmur

pathogenesis

- pathogenesis of TOF

- pathogenesis of Tet spells

pathogenesis of TOF

- abnormal anatomy

- other abnormal anatomy

 

pathogenesis of Tet spells

- near occlusion of the right ventricular outflow tract with profound cyanosis

** mechanism of squatting

classification

- classification of TOF

- classification of TOF by duct dependent

classification of TOF

- classic TOF

++ TOF with pulmonary stenosis

- atypical TOF

 

classification of TOF by duct dependent

- duct independent

++ TOF mild to moderat form

- duct dependent

++ TOF severe form

++ TOF with pulmonary atresia

investigation

- CXR

- EKG

- echocardiography

- cardiac catheterization

 

CXR

- CXR finding of TOF

CXR finding of TOF

EKG

- EKG finding of TOF

EKG finding of TOF

cardiac catheterization

- indication cardiac catheterization

indication cardiac catheterization

- r/o the presence of MAPCAs

- confirm the coronary artery anomalies

treatment

- supportive Rx

- surgery

 

supportive Rx

- supportive Rx รักษาอะไรบ้าง

- Rx hypoxic spell

supportive Rx รักษาอะไรบ้าง

- well-hydrated state

- B-blocker : prevent cyanotic spell

- diuretics : minimal RVOTO with pulmonary overcirculation

- severe RVOT : iv PGE1

- ATB prophylaxis

 

Rx hypoxic spell

- place knee-chest position

- sedation

- oxygen

- systemic vasoconstriction

- volume repletion: iv fluid >> NSS 10-20 ml/kg/dose

- B-blocker

++ propanolol : reduce heart rate and reverse all spells

- morphine

- correct metabolic acidosis : NaHCO3

B-blocker

- dose B-blocker

- ถ้า B-blocker ไม่ได้ผล ให้ยาอะไรอื่นแทน

dose B-blocker

 

ถ้า B-blocker ไม่ได้ผล ให้ยาอะไรอื่นแทน

- phenylephrine 5-20 ug/kg/dose iv >> **ถ้ายานี้ให้แล้วไม่ได้ผลควร emergency surgery

morphine

- ทำไมต้องให้ morphine

- dose morphine

ทำไมต้องให้ morphine

- : suppress the respiratory center and relax the sub-pulmonary infundibulu

 

dose morphine

- 0.1 mg/kg/dose iv

surgery

- surgical options

 

surgical options

- surgical options มีอะไรบ้าง

-ตัวบ่งบอกในการเลือก surgical options

surgical options มีอะไรบ้าง

- palliative surgery : shunt surgery

- surgical repair

 

ตัวบ่งบอกในการเลือก surgical options

- McGoon ratio

++ < 1.6 : paliative sx

++ > 1.6 : total repair

paliative surgery (shunt surgery)

- indication shunt surgery

- type of shunt shunt surgery

indication shunt surgery

- medically refractory hypercyanotic spells

- severe RVOT obstruction with no suitable repair due to prematurity, hypoplastic pulmonary arteries or coronary artery anatomy

 

type of shunt surgery

- classic aortopulmonary shunt

++ Classic Blalock-Taussig shunt (rare)

++ Waterson shunt

++ Potts shunt

- modified aortopulmonary shunt

++ modified Blalock-Taussig shunt

surgical repair

- ระยะเวลาที่เหมาะสมในการผ่าตัด

- ทำไมต้องรอเวลาผ่าตัด

- contraindicaiton surgical repair

- surgical technique เป็นอย่างไรบ้าง

ระยะเวลาที่เหมาะสมในการผ่าตัด

- 6 mo-1 yr

- 3-4 mo

 

ทำไมต้องรอเวลาผ่าตัด

- PVR down

- infant to grow to a larger size

 

contraindication surgical repair

 

surgical technique เป็นอย่างไรบ้าง

- surgical approach

++ transventricular approach : risk for late ventricular arrhythmia

++ transatrial approach

- surgical treatment in RVOT obstruciton

++ pulmonary valve preservation : annulus size > 70-80% of normal

++ pulmonary valve replacement : annulus size < 70-80% of normal

- surgical options in TOF/PA

** large pulmonary artery confluent : Rastelli procedure

** small or no PA and major MAPCAs : unilocalization + Rastelli procedure

 

 

Rastelli procedure เป็นการผ่าตัดอะไร

- total correction by hemograft between RV and pulmonary artery

postopoerative care

- indication reoparation

indication reoperation

complication

- complication of TOF

- complication of surgery

complication of TOF

- cyanosis

- hypercyanotic spell

- possible residual lesion

 

complication of surgery

- heart failure

- ventricular arrhythmia and sudden death

- atrial tachycardia adn atrial flutter

heart failure

- สาเหตุของ heart failure

สาเหตุของ heart failure