Tetralogy of Fallot classically consists of the combination of ail except -

Ans. is 'd' i.e., Left ventricular hypertrophy Tetralogy of Falloto TOF is the commonest congenital heart disease.o Constituents of TOF# Ventricular septal defect# Overriding or dextroposed aorta# Pulmonic stenosis# Right ventricular hypertrophy. Hemodynamics of Tetralogy of Falloto The severity of obstruction to the right ventricular outflow determines the direction of blood flow. Pulmonary stenosis SevereMild(Ejection Systolic murmur- Greater resistance to rightThe abnormality resembles anand delay in P2) ventricular outflow throughisolated VSD and the shunt may be pulmonary valveleft to right without cyanosis | As this resistance approaches the level of systemic vascular resistance Absence of shunt murmur because-(Right to left shunt predominates) the pressure difference at which this | shunt operates is low Reduced flowr of blood into pulmonary' artery i.e. pulmonary artery pressure is reduced | Cyanosis and soft P2 Clinical features of TOF:o Dvsnea on exertion and exercise intolerance - Most common,o Cyanosis usually presents after neonatal periodo Hypoxemic or cyanotic spells (Tet spells)o Commonest congenital lesion with which squatting is usedo Clubbingo Ausculatory findings:# S1-Normal# S2-Single predominantly Aortic# Muimur-Ejection systolic o TOF patients are RARELY CYANOTIC AT BIRTH*X-ray findings in TOF# Boot shaped heart (Cour en sabot)# Oligemic pulmonary fields# Normal sized heart (no cardiomegaly)