rida
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Baby born with Tetrology of Fallot, what do you need to maintain life?
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| Bela
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PDA
Actually in all R :arrow: L shunts u need PDA. So u give the pt. misoprostol, PGE.
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| bluestar
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Bela, could you please further explain this?
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| Idiopathic
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ASD and PDA are cardioprotective.
Since in tetralogy, most of the blood from the right ventricle enters the aorta (pulmonry stenosis and overriding aorta), you need a PDA so that some blood goes to the lungs (i.e. PDA is essential for long-term life in tetralogy), whereas an ASD just helps mix the blood so that some oxygenated goes into each ventricle.
PGE keeps the PDA open, which is why they give Indomethacin (cyclooxygenase inhibitor) when they want to close the PDA after birth.
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| shawn333
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this is a good answer but i dont think it is a practiced thing. however for the step it should be PGE
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| Idiopathic
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The fact that ASD and PDA are the two cardioprotective shunts is very high yield. The Rx of choice to keep a PDA open is a prostaglandin agonist, while to close it is a prostaglandin antagonist. these are all important concepts.
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| rida
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Idiopathic is absolutely right, the reason i asked thsi question was because it has been asked on previous questions, as what is protective in TOF. Thanx guys for the answerss!!!
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| bluestar
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Yeah, idiopathic and rida, thank you so much. Just want to make sure, is PDA + ASD + PGE agonist applicable to all R to L shunt? It's amazing to think that the blood flow in PDA can be bi-directional depending on what we want it to be. eg. in infantile aortic coarctation, we need PDA to shunt blood from pulmonary A to aorta and here in Tetralogy of Fallot, it's from aorta to pulmonary A
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| endrit
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asd is not a feature of teralogy of fallot. there is a vsd that shunts the blood from right to left side. anyway pda is a protective factor as long htp will not develop wich would make surgery not very succesful
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| dranuragagrawal
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u have to go for surgery
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| hiwa
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That is right the PDA is protective in TOF, but u have already a bigger shunt which is VSD. but the classic and interesting question is to maintain the patency of PDA in trans position of the great vessels which is not compatible with life without PDA
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| SeYYeDo
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how come at the beginning there is only right to left shunt not left or right?
wat i mean is when left ventricle contracts how come the blood doesnt enter right ventricle? or pulmonary artery
Edited by SeYYeDo on 07/28/08 - 11:06 AM
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| spinal shock
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guys we should keep ductua arteriosus open in transposition of great arteries not TOF it needs surgical correction of vsd and overriding aorta to prevent complications of tof mainly cor pulmonale and eisimenger syndrome
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