Tetralogy of Fallot with pulmonary stenosis: fetal echocardiogram

Case contributed by Dr Cathy Cluver

Presentation

Tertiary review for fetal echocardiography

Patient Data

Age: Second trimester
Ultrasound

Four chamber view (4CV)

Four chamber view demonstrates a perimembranous VSD.  Right ventricular hypertrophy may or may not be seen on the antenatal 4CV.

Ultrasound

Left ventricular outflow tract (LVOT) or 5 chamber view

The left ventricular outflow tract is seen to be overiding the ventricular septum. This in association with the ventricular septal defect is referred to as a malaligned VSD.  The colour images demonstrate filling of the LVOT from both the left and right ventricles with more than 50% of flow coming from the left ventricle.  The LVOT is dilated. 

Also, note the left axis deviation.

Ultrasound

Right ventricular outflow tract (3 vessel view)

In the scenario of TOF with pulmonary stenosis, the three vessel view shows the narrow right ventricular outflow tract and dilated aorta.

This is in contrast to a TOF with pulmonary atresia, where the RVOT is absent in this view, and to a TOF with dysplastic pulmonary valve syndrome, where there is a dilated RVOT with tubulent flow.

Ultrasound

Three vessel - trachea (3VT) view

In the scenario of TOF with pulmonary stenosis, the 3VT view demonstrates a narrow duct with forward flow.  

This is in contrast to a TOF with pulmonary atresia, where there is reverse flow in the duct, and to a TOF with dysplastic pulmonary valve syndrome, where the duct is typically absent.

Case Discussion

There are a number of different subtypes of tetralogy of Fallot: Tetralogy of Fallot with pulmonary stenosis (75%), Tetralogy of Fallot with pulmonary atresia (20%) and Dysplastic (absent/ring) pumonary valve syndrome (5%).

This case demonstrates the typical findings on the standard fetal echo views in a case of tetralogy of Fallot with pulmonary stenosis.

 

Images courtsey of Dr Simon Meagher

PlayAdd to Share

Case information

rID: 26941
Case created: 15th Jan 2014
Last edited: 23rd Sep 2017
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.