The İncidence And Significance Of Right Superior Ors Axis İn Tetralogy Of Fallot

Abstract

Sixty seven patients with classical tetralogy of Fallot who were clinically, radiologicaliy, hemodynamicaliy and angiocardiographically similar, were examined. In these cases electrocardiograms were nalso uniformiy similar. While the percentage of right axis deviation was 92,6 the right superior axis Was 7,4 percent. No relationship has been found between right superior axis and cyanosis, pulmonary vascularity, the degree of pulmonary infundibular stenosis and associated lesions. In two cases that had right superior axis, atriovenitricular canal type ventricular septal defect waş seen in surgery. The reasons for right superior axis deviation were discussed. Although the number of cases is not enough, it could be concluded that right superior axis might indicate atriovenitricular canal type ventricular septal defect or extreme right ventricular hypertrophy which is an important aspect.

Keywords

• radiologicaliy
• hemodynamicaliy and angiocardiographically similar
• classical tetralogy

Fallot Tetralojisinde Sağ Süperior ORS Aksının İnsidansı ve Önemi

Abstract

Klinik, radyolojik, hemodinamik ve anjiokardiografik olarak aynı spektrumu gösteren 67 klasik FT'nin incelenmesinde elektrokardiografi bulgularının da birbirine benzediği görüldü. Sağ aks sapması 96 92,6 iken, sağ süperior aks sapması 6 7,4 oranında bulundu. Sağ süperior aks sapması ile siyanoz, pulmoner vaskülarite, infundibuler darlığın şiddeti ve ilave lezyonlar arasında bir ilişki tesbit edilmedi. Sağ süperior aks sapması gösteren iki olguda cerrahi olarak atrioveniriküler kanal tipi VSD saptandı. Sağ süperior aksın oluş mekanizması tartışılmaya çalışıldı. Olgu sayısının az olmasına rağmen sağ süperior aks sapmasının, atrioventriküler kanal tipi VSD'e işaret edebileceği veya aşırı sağ ventrikül hipertrofisini gösterebileceği için önemli bir bulgu olduğu düşünüldü.

Keywords

• siyanoz
• ventrikül hipertrofisini
• hemodinamik

References

1. 1, Adams FH, Emmanouilides GC : Heart disease in infanst, children and adolesconts. 3. ed. The Williams and Wilkins corapany. Baltimore 217-221, 1983.
2. 2. Anderson RH, Macartney FJ, Shinebourne EA, Tynan M : Paediatric Cardiology. 2. ed. Churcill Livingstone. New York 252-255, 1987.
3. 3. Bender SR, Dreifus LS, Downing D : Anatomic and electrocardiographic correlation of Fallot's tetralogy. Am J Cardiol 7 : 475-480, 1961.
4. 4, Burch GE, DePasguale NP ; Electrocardiography in the diagnosis of congenital heart disease. Lea and Febiger, Philadelphia 367-369, 1967.
5. 5.Coelho E, DePavia E, DePadua FP, Nunes A, Amran S, Esa B, Luis S : Tetralogy of Fallot. Angiographic, electrocardiographic, vectorcardiographic and hemodynamicstudies of the Fallot type complex, Am J Cardiol 7 : 538-564, 1981. gradient in the tetralogy of Fallot. Circulation 24 : 94-109, 1961.
6. 7.Dickinson DF, Wilkinson AS, Hamilton DI, Anderson RH ; Variations in the morphology of the veniricular septal defect and disposition of the atrioveniri-. cular conduction tissues in tetralogy of Fallot. Thorac. Cardiovasc. Surgeon 30 ; 243-249, 1982.
7. 8.Feldt RH, DuShane JW, Titus JL : The atrioventricular conduction system in persistent common atrioventricular canal defect. Correlatiöns with electrocardiogram. Circulation 42 ; 437-445, 1970.
8. 9.Feldt RH, DuShane JW, Titus JL : The anatomy of the atrioventricular conducton system in veniricular septal defect and Tetralogy of Fallot : Correlations with the electrocardiogram and vectorcardiogram. Circulation 34 : 774-782, 1966.

9. 10.Hoffman JIE, Rudolph AM, Nadas AS, Paul MH : Physiologic differantiation of pulmonic stenosis with and without an intact ventricular septum. Circulation 22 : 385-404, 1960.
10. 11.Keith JD, Rowe RD, Vlad P : Heart disease in infancy and childhood. 3. ed. MaçMillan Publishing company, New York 470-483, 1978.
11. 12.Khoury GH, DuShane JW, Ongley PA : The preoperative and postoperative vectorcardiogram in tetralogy of Fallot. Circulation 31 : 85-94, 1985.
12. 13.Perloff JK : The clinical recognition of congenital heart disease, W.B. Saunders Company, Philadelphia, 424-427, 1987.
13. 14.Pileggi F, Bocanegra J, Tranchesi J, Macruz R, Borges S, Portugal O, Villarinho MG, Barbato E, Decourt LV : The electrocardiogram in Tetralogy of Fallot : A study of 142 cases, Am Heart J. 59 : 667-680, 1960.
14. 15.Rosenblum R, Mark H, Escher DIJW, Stern WZ, Young D : The differantation of pulmonic stenosis, ventricular septal defect with normal aortic root from tetralogy of Fallot. Am. Heart J. 64 : 746-764, 1962.
15. 16.Ross JP; Durrer D : Epicardial excitation in ventral atrialseptal defect. British Heart J 26 : 136-142, 1984.
16. 17.Shinebourne EA, Haworth SG, Anderson RH, Ulgur A : Differantial diagnosis of congenital heart disease in the first months of life. Archives of disease in Childhood 49 : 729-733, 1974. :
17. 18.Strang RH, Hugenholtz PG, Liebman J, Nadas AS : The vectorcardiogram inpulmonary stenosis. Correlation with the hemodynamic state in patients with and without ventricular septal defekt. Am J Cardiol 12 : 758-766, 1963.