Posterior and leftward displacement of the infundibular septum is the basic abnormality in tetralogy of Fallot.
The bundle of His runs along the posteroinferior border of the VSD.
Additional VSDs are present in approximately 25% of patients.
The pulmonary valve is usually the narrowest part of the right ventricular outflow tract.
Although the infundibulum is hypoplastic, the pulmonary annulus is usually normal in size.
Question 2: Which of the following statements is true regarding the pathophysiology of TOF?
Spells are triggered by any event that increases pulmonary vascular resistance.
RVH in the neonatal period represents significant overload of the right ventricle.
Branch pulmonary artery stenoses can be identifed with echocardiography.
Cyanosis at birth indicates a fixed obstruction to pulmonary flow.
All patients should have pulmonary artery pressures and PVR measured during catheterization.
Question 3: Which of the following statements is true regarding management of TOF?
Operative repair should be delayed until oxygen saturation falls below 65%.
Operative repair is not indicated if hypoxemic spells can be controlled with propranolol.
Shunting is indicated with anomalous origin of the left anterior descending coronary artery.
Leaving the VSD open provides a "safety valve" for the hypoplastic pulmonary system.
A patent foramen ovale should be closed in the neonatal patient to prevent right ventricular failure.
Question 4: Which of the following statements is true for operative technique during repair of TOF?
VSD closure should be approached through the ventriculotomy.
Diffuse hypoplasia of the RVOTO is best approached from the right atrium.
A post-repair RV/LV pressure over 0.7 is an indication for a transannular patch.
Patients with nonconfluent branch pulmonary arteries should be palliated with a systemic-to-pulmonary artery shunt.
RV pressures higher than LV pressures following repair will gradually resolve in the setting of hypoplastic pulmonary arteries.
Question 5: Which of the following statements is true for operative technique for repair of TOF?
An anomalous LAD should be mobilized to allow placement of a transanular patch.
Patients with absent pulmonary valve should optimally have complete intracardiac repair with a valved conduit.
Older age at repair is not a risk factor for late death.
Small residual VSDs are fairly well tolerated and can be conservatively managed.
Complete heart block remains the most common cause of late sudden death.
Question 1 Question 2 Question 3 Question 4 Question 5 Question 1 Question 2 Question 3 Question 4 Question 5