FALLO TRIADA (E. L. A. Fallot, the fr. doctor, 1850 — 1911) — the inborn heart disease caused by a stenosis of a pulmonary trunk, defect of an interatrial partition and a hypertrophy of a right ventricle. The diagrammatic representation of a triad of Fallo — see fig. 1, m, to St. Heart diseases are inborn, t. 20, p. 267. Fallo's triad makes about 1,8 — 6% of all inborn heart diseases.
Distinguish two a wedge. forms F. t. — atsianotichesky («white») and tsianotichesky («blue»). The major factors defining hemodynamic disturbances and a wedge, a picture at this defect are expressiveness of a stenosis of a pulmonary trunk, the extent of defect of an interatrial partition, size of systolic pressure in a right ventricle, a ratio of final di - astolicheskogo pressure in the right and left ventricles of heart. Essential value has the reduction of a cavity of a right ventricle which is often found at this defect. The interatrial message can be caused by secondary defect of an interatrial partition or an open oval window. The stenosis of a pulmonary trunk (valve or infundibulyarny) leads to build-up of pressure in a right ventricle of heart, a hypertrophy of its wall and to the progressing reduction of volume of a cavity. As a result pressure in the right auricle also raises and becomes higher, than in the left auricle. It causes dumping of a venous blood from right to left, development of an anoxemia and emergence of a «blue» form F. t. At less expressed stenosis of a pulmonary trunk of disturbance of a hemodynamics are defined generally by existence of defect of an interatrial partition and dumping of blood from left to right; at the same time the «white» form F develops. t.
The wedge, a picture depends on extent of disturbance of a pulmonary blood-groove, size and the direction of dumping of blood at the level of an interatrial defek-
^ Fig. The diagrammatic representation of the main stages of elimination of a valve stenosis of a pulmonary trunk at Fallo's triad:
and — the front wall of a pulmonary trunk is opened, the semilunar valves spliced in the form of a cone are visible; — a section of commissures of gates of the valve; in — a type of gates of the valve after a section of commissures; — the stitch put on a front wall of a pulmonary trunk.
that. The main complaints of the patient — fatigue, an asthma. At auscultation rough systolic noise with epicenter in the second mezhreberye to the left of a breast is listened. From the moment of development of cyanosis there is a polycythemia, concentration of hemoglobin of blood increases. On an ECG signs of an overload of a right ventricle and the right auricle come to light. On FKG decrease in amplitude of a pulmonary component II of tone or even its absence is noted. At rentgenol. a research increase in the right departments of heart, lack of a pulsation of roots of lungs, depletion of the pulmonary drawing is noticeable. The leading diagnostic method is sounding of the right departments of heart (see Catheterization of heart) and angiocardiography (see). Passing of the probe from the right auricle in left, determination of size and the direction of dumping of blood at the level of auricles, identification of a stenosis of a pulmonary trunk allows to establish the exact diagnosis.
Treatment — operational. Access to heart — a median sternotomy. Operation is made in the conditions of artificial circulation (see) and a moderate hypothermia (see the Hypothermia artificial), and if necessary with a cardioplegic cardiac standstill (see the Cardioplegia). For prevention of an air embolism the endocardiac stage of operation is begun with closing of the interatrial message, a cut taken in a two-row seam or closed by means of a patch from auto-or a ksenoperikarda. The most justified method of elimination of a stenosis of a pulmonary trunk is the valvulotomy through a wall of a trunk of a pulmonary artery (fig).
Lethality after operational treatment of a «white» form F. t. does not exceed 1 — 3%, and a «blue» form — 15 — 20% that is caused by initially serious condition of patients of this group. After operation pressure in a right ventricle considerably decreases and the hypertrophy of a myocardium decreases that causes the favorable forecast.
Bibliography: The atlas of chest surgery, under the editorship of B. V. Petrovsky, t. 1 — 2, M., 1971 — 1974; 3 and N to about in with to and y M. F. and
About from E. E mon. Problems of surgical treatment of a triad of Fallo, Cardiology, t. 22, No. 11, page 95, 1982; G i bon J. N of Gibbon's surgery of the chest, Philadelphia a. o., 1976; Herzchirurgie,
hrsg. v. E. Derra u. W. Bircks, Bd 1—2, B. u. a., 1976.
C. JI. Dzemeshkevich, P. P. Zubarev.