• Tetralogy of Fallot
    • MIldly hypoplastic pulmonary valve
    • Confluent branch pulmonary arteries
  • Tetralogy of Fallot
    • Moderately hypoplastic dysplastic pulmonary valve
    • Anterior deviation of the subpulmonary infundibulum into the right ventricular outflow tract (denoted by the star) 
    • Large perimembranous outlet VSD
  • Tetralogy of Fallot
    • Moderately hypoplastic pulmonary valve
    • Anterior deviation with hypertrophied subpulmonary infundibulum into the right ventricular outflow tract causing dynamic obstruction (denoted by the star) 
    • Large perimembranous outlet VSD
  • Tetralogy of Fallot
    • Severe dynamic subpulmonary obstruction 
    • Anterior deviation of the subpulmonary infundibulum
    • Infundibular hypertrophy with near obliteration of the right ventricular outflow tract secondary to hypertrophied infundibulum (starred structure)
  • Tetralogy of Fallot
    • Moderately hypoplastic pulmonary valve with flow turbulence consistent with pulmonary stenosis
    • Anterior deviation with hypertrophied subpulmonary infundibulum into the right ventricular outflow tract (denoted by the star) 
    • Large perimembranous outlet VSD with bidirectional shunting
    • Mild tricupid regurgitation
  • Tetralogy of Fallot
    • Mildly hypoplastic pulmonary valve
    • Anterior deviation with hypertrophied subpulmonary infundibulum into the right ventricular outflow tract (denoted by the star) causing dynamic subpulmonary stenosis with flow turbulence
    • Large perimembranous outlet VSD
  • Tetralogy of Fallot
    • Mildly hypoplastic pulmonary valve and main pulmonary artery with flow turbulence across the pulmonary valve
    • Anterior deviation of the subpulmonary infundibulum into the right ventricular outflow tract  (denoted by the star) with mild flow turbulence in the right ventricular outflow tract by color Doppler
    • Large perimembranous outlet VSD
  • Tetralogy of Fallot
    • Anterior deviation with hypertrophied subpulmonary infundibulum (denoted by the star) into the right ventricular outflow tract causing dynamic subpulmonary stenosis with flow turbulence
    • Large perimembranous outlet VSD with left to right shunting
  • Tetralogy of Fallot
    • Moderate to severe pulmonary valve stenosis in infant with tetralogy of Fallot with a peak velocity of ~4.2 meters/sec with a peak gradient of ~70 mmHg.
  • Tetralogy of Fallot
    • "Dagger-like" Doppler pattern revealing dynamic obstruction in the right ventricular outflow tract in infant with tetralogy of Fallot

Echocardiographic Assessment: Parasternal short axis

  • Assess infundibular obstruction (2D, color and spectral Doppler, spectral Doppler both pulse and continuous wave)
    • Continuous wave Doppler interrogation of the right ventricular outflow tract demonstrates high-veloctiy flow with late-peaking, dagger-shaped flow consistent with dynamic infundibular obstruction. 
    • Assess anterior deviation of infundibular septum into RVOT with dynamic obstruction
  • Assess pulmonary valve size and anatomy (2D, color, spectral Doppler both pulse and continuous wave)
  • Assess main pulmonary artery size branch pulmonary artery size and degree of the obstruction (2D, color and spectral Doppler both pulse and continuous wave)
  • Evaluate VSD anatomy (size by 2D, color, spectral both pulse and continuous wave)