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{{Short description|Congential heart defect}}
{{Infobox medical condition (new)
{{Infobox medical condition (new)
| name = Trilogy of Fallot
| image =
| name = Trilogy of Fallot
| caption =
| image =
| caption = |
|
| pronounce =
| pronounce =
| field =
| field = [[Cardiology]]
| synonyms =
| synonyms = Fallot's trilogy, Fallot's triad
| symptoms = [[Cyanosis]], increased fatigue, frequent upper respiratory infection, clubbing
| symptoms =
| complications =
| complications =
| onset =
| onset = From birth
| duration =
| duration = Lifetime, unless fixed by surgery
| types =
| types =
| causes =
| causes =
| risks =
| risks =
| diagnosis =
| diagnosis = [[Echocardiography]], [[Angiography]]
| differential =
| differential = [[Tetralogy of Fallot]]
| prevention =
| prevention =
| treatment =
| treatment = Surgery
| medication =
| medication =
| prognosis =
| prognosis =
| frequency =
| frequency = 1.2% of congenital heart defects
| deaths =
| deaths =
}}
}}
The T'''rilogy of Fallot''' is a rare congenital heart disease consisting of the following defects: [[pulmonary valve stenosis]], [[right ventricular hypertrophy]] and [[atrial septal defect]]. This disease is 1.6-1.8% of all congenital heart defects.{{citation needed|date=December 2017}}


The '''Trilogy of Fallot''' also called '''Fallot's trilogy''' is a rare [[Congenital heart defect|congenital heart disease]] consisting of the following defects: [[pulmonary valve stenosis]], [[right ventricular hypertrophy]] and [[atrial septal defect]].<ref name=":0">{{Cite web|title=Fallot trilogy (Concept Id: C0041022) - MedGen - NCBI|url=https://www.ncbi.nlm.nih.gov/medgen/52848?report=FullReport|access-date=2021-08-07|website=www.ncbi.nlm.nih.gov}}</ref> It occurs in 1.2% of all congenital heart defects.<ref name=":1">{{Cite journal|last=Swan|first=H.|last2=Marchioro|first2=T.|last3=Kinard|first3=S.|last4=Blount|first4=S. G.|date=August 1960|title=Trilogy of Fallot. Experience with twenty-two surgical cases|url=https://pubmed.ncbi.nlm.nih.gov/13836013/|journal=Archives of Surgery|volume=81|pages=291–298|doi=10.1001/archsurg.1960.01300020119018|issn=0004-0010|pmid=13836013}}</ref>
==Mechanism==
Trilogy of Fallot is a combination of three congenital heart defects: pulmonary stenosis, right ventricular hypertrophy, and an atrial septal defect.


A 1960 case report of 22 patients who underwent surgery showed an excess of females with a ratio of 3:2, with the youngest person being 7 months old and the oldest being 50 years old.<ref name=":1" />
The first two of these are also found in the more common [[tetralogy of Fallot]]. However, the tetralogy has a [[ventricular septal defect]] instead of an atrial one, and it also involves
[[File:Pulmonary valve stenosis.svg|link=https://en.wikipedia.org/wiki/File:Pulmonary%20valve%20stenosis.svg|thumb|250x250px|Pulmonary Valve Stenosis]]
[[File:Right Ventricular hypertrophy.svg|link=https://en.wikipedia.org/wiki/File:Right%20Ventricular%20hypertrophy.svg|thumb|247x247px|Right Ventricular Hypertrophy]]
Right Ventricular Hypertrophy


== Symptoms and signs==
an [[overriding aorta]].
{| class="wikitable"
[[File:Atrial-septal-defect-asd-1.jpg|link=https://en.wikipedia.org/wiki/File:Atrial-septal-defect-asd-1.jpg|thumb|Atrial Septal Defect]]
|+History of 18 [[Cyanosis|cyanotic]] patients from a 1960 case report<ref name=":1" />
|
|'''No.'''
|-
|'''Cyanotic onset'''
|
|-
|First year
|8
|-
|1 to 10 year
|6
|-
|Over 10 years
|4
|-
|
|
|-
|Increased fatigue
|11
|-
|Frequent [[Upper respiratory tract infection|U.R.I]]
|9
|-
|[[Shortness of breath|Dyspnea]]
|7
|-
|[[Squatting position|Squatting]]
|4
|-
|[[Syncope (medicine)|Syncope]]
|3
|-
|Poor growth
|2
|}
{| class="wikitable"
|+Physical findings on 22 patients from a 1960 case report<ref name=":1" />
!Symptom
!No.
!%
|-
|[[Heart murmur|Murmur at left base]]
|22
|100%
|-
|[[Heart sounds|Diminished or absent pulmonary second sound]]
|19
|86%
|-
|[[Cyanosis]]
|18
|82%
|-
|Thrill at left base
|13
|59%
|-
|[[Nail clubbing|Clubbing]]
|12
|54%
|-
|[[Jugular venous pressure|Prominent A waves]]
|11
|50%
|-
|[[Parasternal heave|Right ventricular lift]]
|9
|40%
|-
|Chest deformity
|4
|18%
|}

==Mechanism==
Trilogy of Fallot is a combination of three congenital heart defects: [[Pulmonic stenosis|pulmonary stenosis]], [[right ventricular hypertrophy]], and an [[atrial septal defect]].<ref name=":0" />

The first two of these are also found in the more common [[tetralogy of Fallot]]. However, the tetralogy has a [[ventricular septal defect]] instead of an atrial one, and it also involves an [[overriding aorta]]<ref>{{Cite web|last=CDC|date=2019-11-19|title=Congenital Heart Defects - Facts about Tetralogy of Fallot {{!}} CDC|url=https://www.cdc.gov/ncbddd/heartdefects/tetralogyoffallot.html|access-date=2021-08-07|website=Centers for Disease Control and Prevention|language=en-us}}</ref>
[[File:Pulmonary valve stenosis.svg|thumb|250x250px|Pulmonary valve stenosis]]
[[File:Right Ventricular hypertrophy.svg|thumb|247x247px|Right ventricular hypertrophy]]


=== The Three Malformations ===
=== The Three Malformations ===
Line 41: Line 119:
!Description
!Description
|-
|-
|Pulmonary Stenosis
|Pulmonary stenosis
|A malformation near or on the pulmonary valve (the valve between the right ventricle and the pulmonary artery) that causes the opening of the valve to be narrowed, affecting blood flow. This narrowing can occur when one or more of the cusps is too thick or is otherwise defective, preventing the valve from opening fully and properly. <ref>{{Cite web|url=https://www.mayoclinic.org/diseases-conditions/pulmonary-valve-stenosis/symptoms-causes/syc-20377034|title=Pulmonary valve stenosis - Symptoms and causes|website=Mayo Clinic|language=en|access-date=2020-04-14}}</ref>
|A malformation near or on the pulmonary valve (the valve between the right ventricle and the pulmonary artery) that causes the opening of the valve to be narrowed, affecting blood flow. This narrowing can occur when one or more of the cusps is too thick or is otherwise defective, preventing the valve from opening fully and properly.<ref name=":2">{{Cite web|url=https://www.mayoclinic.org/diseases-conditions/pulmonary-valve-stenosis/symptoms-causes/syc-20377034|title=Pulmonary valve stenosis - Symptoms and causes|website=Mayo Clinic|language=en|access-date=2020-04-14}}</ref>
|-
|-
|Right Ventricular Hypertrophy
|Right ventricular hypertrophy
|The right ventricle is more muscular than normal, causing a characteristic boot-shaped appearance as seen by chest X-ray. This enlargement is generally a secondary condition, resulting from increased pressure. Pulmonary valve defects resulting in tricuspid regurgitation, a common effect of pulmonary stenosis, can cause this increase in muscle mass.<ref>{{Citation|last=Bhattacharya|first=Priyanka T.|title=Right Ventricular Hypertrophy|date=2020|url=http://www.ncbi.nlm.nih.gov/books/NBK499876/|work=StatPearls|publisher=StatPearls Publishing|pmid=29763051|access-date=2020-04-14|last2=Sharma|first2=Sandeep}}</ref>
|The right ventricle is more muscular than normal, causing a characteristic boot-shaped appearance as seen by chest X-ray. This enlargement is generally a secondary condition, resulting from increased pressure. Pulmonary valve defects resulting in tricuspid regurgitation, a common effect of pulmonary stenosis, can cause this increase in muscle mass.<ref>{{Citation|last=Bhattacharya|first=Priyanka T.|title=Right Ventricular Hypertrophy|date=2020|url=http://www.ncbi.nlm.nih.gov/books/NBK499876/|work=StatPearls|publisher=StatPearls Publishing|pmid=29763051|access-date=2020-04-14|last2=Sharma|first2=Sandeep}}</ref>
|-
|-
|Atrial Septal Defect
|Atrial septal defect
|An atrial septal defect is a hole in the septum that divides the right and left atria (the upper two chambers) of the heart. In the heart of a developing fetus, there are several holes between the atria, however these are expected to close before birth. This congenital condition arises if one of these holes remains. <ref>{{Cite web|url=https://www.cdc.gov/ncbddd/heartdefects/atrialseptaldefect.html|title=Congenital Heart Defects - Facts about Atrial Septal Defects {{!}} CDC|last=CDC|date=2019-11-19|website=Centers for Disease Control and Prevention|language=en-us|access-date=2020-04-14}}</ref> Depending on the severity of the defect, it may need to be repaired surgically, as a significant defect can cause further damage to the heart and lungs.<ref>{{Cite web|url=https://www.mayoclinic.org/diseases-conditions/atrial-septal-defect/symptoms-causes/syc-20369715|title=Atrial septal defect (ASD) - Symptoms and causes|website=Mayo Clinic|language=en|access-date=2020-04-14}}</ref>
|An [[atrial septal defect]] is a hole in the [[Interatrial septum|septum]] that divides the right and left atria (the upper two chambers) of the heart. In the heart of a developing fetus, there are several holes between the atria, however these are expected to close before birth. This congenital condition arises if one of these holes remains.<ref>{{Cite web|url=https://www.cdc.gov/ncbddd/heartdefects/atrialseptaldefect.html|title=Congenital Heart Defects - Facts about Atrial Septal Defects {{!}} CDC|last=CDC|date=2019-11-19|website=Centers for Disease Control and Prevention|language=en-us|access-date=2020-04-14}}</ref> Depending on the severity of the defect, it may need to be repaired surgically, as a significant defect can cause further damage to the heart and lungs.<ref>{{Cite web|url=https://www.mayoclinic.org/diseases-conditions/atrial-septal-defect/symptoms-causes/syc-20369715|title=Atrial septal defect (ASD) - Symptoms and causes|website=Mayo Clinic|language=en|access-date=2020-04-14}}</ref>
|}
|}


==Diagnosis==
==Diagnosis==

{{Empty section|date=September 2017}}
Diagnosis is done via [[echocardiography]] or [[angiography]].{{Citation needed|date=August 2021}}
Clinically trilogy of Fallot can have cardiomegaly, less symptomatic when compared to ToF, JVP increased, a wave is more elevated, delayed P2, apex beat will be of LV type. S4+, ejection click+,
On doing Cath, RV angiogram, when RV is flicked, to create a RV ectopic, there is post ectopic potentiation of the murmur, unlike ToF


==Treatment==
==Treatment==
[[Thoracotomy]] is used to surgically correct this pathology.<ref name="pmid10397435">{{Cite journal|title=Open-heart surgery in 48 patients via a small right anterolateral thoracotomy |journal=Tex Heart Inst J |volume=26 |issue=2 |pages=124–8 |year=1999 |pmid=10397435 |pmc=325616 |doi= |url= |display-authors=3 |author1=Wang YQ |author2=Chen RK |author3=Ye WW |name-list-format=vanc |last4=Zhong |first4=BT |last5=He |first5=QC |last6=Chen |first6=ZL |last7=Li |first7=ZJ}}</ref>
It is treated using surgery to repair the atrial septal defect and pulmonary stenosis, once the [[Pulmonic stenosis|pulmonary stenosis]] has been fixed the [[right ventricular hypertrophy]] will usually go away on its own.<ref name="pmid10397435">{{Cite journal|title=Open-heart surgery in 48 patients via a small right anterolateral thoracotomy |journal=Tex Heart Inst J |volume=26 |issue=2 |pages=124–8 |year=1999 |pmid=10397435 |pmc=325616 |display-authors=3 |author1=Wang YQ |author2=Chen RK |author3=Ye WW |name-list-style=vanc |last4=Zhong |first4=BT |last5=He |first5=QC |last6=Chen |first6=ZL |last7=Li |first7=ZJ}}</ref><ref name=":2" />

[[Heart valve repair|Balloon valvuloplasty]] is the most common treatment for pulmonary stenosis, a balloon is placed where the artery or valve is narrowed and is inflated, widening the artery or valve in the process, the balloon is then removed. It may cause [[Pulmonary insufficiency|valve regurgitation]]. If balloon valvuplasty is not an option [[Cardiac surgery|open heart surgery]] must be performed where the valve is either [[Heart valve repair|repaired]] or replaced with an [[Artificial heart valve|artificial one]].<ref>{{Cite web|title=Pulmonary valve stenosis - Diagnosis and treatment - Mayo Clinic|url=https://www.mayoclinic.org/diseases-conditions/pulmonary-valve-stenosis/diagnosis-treatment/drc-20377039|access-date=2021-08-07|website=www.mayoclinic.org}}</ref>


==History==
==History==
It is named in honor of its discoverer: [[Etienne Fallot]].<ref>{{WhoNamedIt|synd|2283}}</ref>
It is named in honor of its discoverer: [[Etienne Fallot]].<ref>{{WhoNamedIt|synd|2283}}</ref>
{{clear}}


==References==
==References==
{{Reflist}}
{{Reflist}}


== External links ==
{{Medical resources
{{Medical resources
| DiseasesDB =
| DiseasesDB =
| ICD10 = Q21.3 ICD9 = {{ICD9|746.09}}, {{ICD9|746.8}} ([[CDC/BPA]] 746.84)
| ICD10 = Q21.3 ICD9 = {{ICD9|746.09}}, {{ICD9|746.8}} ([[CDC/BPA]] 746.84)
| ICDO =
| ICDO =
| OMIM =
| OMIM =
| MedlinePlus =
| MedlinePlus =
| eMedicineSubj =
| eMedicineSubj =
| eMedicineTopic =
| eMedicineTopic =
| MeshID = D014286
| MeshID = D014286
}}
}}
{{Congenital heart defects}}
{{Congenital heart defects}}


[[Category:Congenital heart defects]]
[[Category:Congenital heart defects]]


{{congenital-malformation-stub}}
{{circulatory-disease-stub}}

Latest revision as of 03:06, 30 October 2023

Trilogy of Fallot
Other namesFallot's trilogy, Fallot's triad
SpecialtyCardiology
SymptomsCyanosis, increased fatigue, frequent upper respiratory infection, clubbing
Usual onsetFrom birth
DurationLifetime, unless fixed by surgery
Diagnostic methodEchocardiography, Angiography
Differential diagnosisTetralogy of Fallot
TreatmentSurgery
Frequency1.2% of congenital heart defects

The Trilogy of Fallot also called Fallot's trilogy is a rare congenital heart disease consisting of the following defects: pulmonary valve stenosis, right ventricular hypertrophy and atrial septal defect.[1] It occurs in 1.2% of all congenital heart defects.[2]

A 1960 case report of 22 patients who underwent surgery showed an excess of females with a ratio of 3:2, with the youngest person being 7 months old and the oldest being 50 years old.[2]

Symptoms and signs

[edit]
History of 18 cyanotic patients from a 1960 case report[2]
No.
Cyanotic onset
First year 8
1 to 10 year 6
Over 10 years 4
Increased fatigue 11
Frequent U.R.I 9
Dyspnea 7
Squatting 4
Syncope 3
Poor growth 2
Physical findings on 22 patients from a 1960 case report[2]
Symptom No. %
Murmur at left base 22 100%
Diminished or absent pulmonary second sound 19 86%
Cyanosis 18 82%
Thrill at left base 13 59%
Clubbing 12 54%
Prominent A waves 11 50%
Right ventricular lift 9 40%
Chest deformity 4 18%

Mechanism

[edit]

Trilogy of Fallot is a combination of three congenital heart defects: pulmonary stenosis, right ventricular hypertrophy, and an atrial septal defect.[1]

The first two of these are also found in the more common tetralogy of Fallot. However, the tetralogy has a ventricular septal defect instead of an atrial one, and it also involves an overriding aorta[3]

Pulmonary valve stenosis
Right ventricular hypertrophy


The Three Malformations

[edit]
Condition Description
Pulmonary stenosis A malformation near or on the pulmonary valve (the valve between the right ventricle and the pulmonary artery) that causes the opening of the valve to be narrowed, affecting blood flow. This narrowing can occur when one or more of the cusps is too thick or is otherwise defective, preventing the valve from opening fully and properly.[4]
Right ventricular hypertrophy The right ventricle is more muscular than normal, causing a characteristic boot-shaped appearance as seen by chest X-ray. This enlargement is generally a secondary condition, resulting from increased pressure. Pulmonary valve defects resulting in tricuspid regurgitation, a common effect of pulmonary stenosis, can cause this increase in muscle mass.[5]
Atrial septal defect An atrial septal defect is a hole in the septum that divides the right and left atria (the upper two chambers) of the heart. In the heart of a developing fetus, there are several holes between the atria, however these are expected to close before birth. This congenital condition arises if one of these holes remains.[6] Depending on the severity of the defect, it may need to be repaired surgically, as a significant defect can cause further damage to the heart and lungs.[7]

Diagnosis

[edit]

Diagnosis is done via echocardiography or angiography.[citation needed]

Treatment

[edit]

It is treated using surgery to repair the atrial septal defect and pulmonary stenosis, once the pulmonary stenosis has been fixed the right ventricular hypertrophy will usually go away on its own.[8][4]

Balloon valvuloplasty is the most common treatment for pulmonary stenosis, a balloon is placed where the artery or valve is narrowed and is inflated, widening the artery or valve in the process, the balloon is then removed. It may cause valve regurgitation. If balloon valvuplasty is not an option open heart surgery must be performed where the valve is either repaired or replaced with an artificial one.[9]

History

[edit]

It is named in honor of its discoverer: Etienne Fallot.[10]

References

[edit]
  1. ^ a b "Fallot trilogy (Concept Id: C0041022) - MedGen - NCBI". www.ncbi.nlm.nih.gov. Retrieved 2021-08-07.
  2. ^ a b c d Swan, H.; Marchioro, T.; Kinard, S.; Blount, S. G. (August 1960). "Trilogy of Fallot. Experience with twenty-two surgical cases". Archives of Surgery. 81: 291–298. doi:10.1001/archsurg.1960.01300020119018. ISSN 0004-0010. PMID 13836013.
  3. ^ CDC (2019-11-19). "Congenital Heart Defects - Facts about Tetralogy of Fallot | CDC". Centers for Disease Control and Prevention. Retrieved 2021-08-07.
  4. ^ a b "Pulmonary valve stenosis - Symptoms and causes". Mayo Clinic. Retrieved 2020-04-14.
  5. ^ Bhattacharya, Priyanka T.; Sharma, Sandeep (2020), "Right Ventricular Hypertrophy", StatPearls, StatPearls Publishing, PMID 29763051, retrieved 2020-04-14
  6. ^ CDC (2019-11-19). "Congenital Heart Defects - Facts about Atrial Septal Defects | CDC". Centers for Disease Control and Prevention. Retrieved 2020-04-14.
  7. ^ "Atrial septal defect (ASD) - Symptoms and causes". Mayo Clinic. Retrieved 2020-04-14.
  8. ^ Wang YQ, Chen RK, Ye WW, et al. (1999). "Open-heart surgery in 48 patients via a small right anterolateral thoracotomy". Tex Heart Inst J. 26 (2): 124–8. PMC 325616. PMID 10397435.
  9. ^ "Pulmonary valve stenosis - Diagnosis and treatment - Mayo Clinic". www.mayoclinic.org. Retrieved 2021-08-07.
  10. ^ synd/2283 at Who Named It?
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