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ORIGINAL ARTICLE
Year : 2020  |  Volume : 17  |  Issue : 2  |  Page : 128-135

Morphological and clinical indices determining mode of repair in children with tetralogy of Fallot in Enugu, Nigeria


1 Department of Paediatrics, College of Medicine, University of Nigeria Teaching Hospital/ University of Nigeria, Okolobiri, Nigeria
2 Department of Paediatrics and Child Health, Niger Delta University Teaching Hospital, Okolobiri, Nigeria
3 Department of Community Medicine, Enugu State University Teaching Hospital, Enugu, Nigeria

Correspondence Address:
Dr. Josephat M Chinawa
Department of Paediatrics, University of Nigeria Teaching Hospital, ItukuOzalla, Enugu, Enugu State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njc.njc_28_20

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Background: Children with tetralogy of Fallot (TOF) present with various clinical and morphological attributes which aid in screening for primary, stage, or elective repair. Objectives: This study is aimed at determining the morphological and clinical indices that predict mode of repair among children with TOF in our locale. Materials and Methods: This was a retrospective echocardiographic review of children with TOF carried out in three different institutions over a 5-year period. Results: The mean age of presentation was 5.0 ± 5.3 years. The nutritional status revealed that 18.2% (8/44) were wasted, 25.0% had severe wasting, while 2.3% were obese. Stunting was observed in 4.5% of the patients and severe stunting in 29.5%. The mean pulmonary valve (PV) annulus of 43 of the patients assessed was 11.0 ± 5.5 mm (mean z-score: −2.03 ± 1.95). Five of them (11.6%) had values one standard deviation (1SD) below the mean of the standard population, 32.6% had values 2SD below the mean, and 27.9% had values 3SD below the mean. Of the 33 children whose right pulmonary artery (RPA) z-scores were assessed, 24.2%, 12.1%, and 12.1%, respectively, had RPA z-scores of 1SD, 2SD, and 3SD below the mean of the standard population, while 17.5% and 7.5% of 40 children whose left pulmonary arteries were assessed had z-scores of 1SD and 2SD below the standard mean, respectively. Right aortic arch and major aortopulmonary collateral arteries (MAPCAs) were seen in 8.1% and 30.5% of the children, respectively. 30.5% of the children with TOF had MAPCAs. Features of Down syndrome were observed in 4.8% (3/62) of the patients. Conclusion: A large proportion of patients present with various degrees of malnutrition with a significant low z-score for PV annulus and branch pulmonary artery diameters. The presence of right aortic arch and MAPCAs was observed in the patients. The increased rate of protein–energy malnutrition, small PV annulus, MAPCAs and presence of right aortic arch, etc., are screening tools that may assist the surgeon in selecting the various surgical options and timing in the approach of children with TOF in this locale.


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