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

Four chamber view (4CV)

Modality: Ultrasound

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

Left ventricular outflow tract (LVOT) or 5 chamber view

Modality: Ultrasound

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.

Right ventricular outflow tract (3 vessel view)

Modality: Ultrasound

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.

Three vessel - trachea (3VT) view

Modality: Ultrasound

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

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Case Information

rID: 26941
Case created: 15th Jan 2014
Last edited: 11th Nov 2015
Inclusion in quiz mode: Included

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