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Tetralogy of Fallot — a centennial review

1988; Elsevier BV; Volume: 21; Issue: 3 Linguagem: Inglês

10.1016/0167-5273(88)90100-3

1874-1754

Robert H. Anderson, Michael Tynan,

Tracheal and airway disorders

It is one hundred years since Etienne-Louis Arthur Fallot described, in Marseille Medicale, the clinico-pathological correlates of “la maladie bleue” [l]. He noted a unifying morphology in three-quarters of the hearts from these patients, and highlighted four constant features, namely pulmonary arterial stenosis, an interventricular communication, deviation of the aorta to the right, and concentric hypertrophy of the right ventricle. This is the lesion we now recognize as “his” tetralogy. In retrospect, it is clear that examples of the malformation had been both recognized and illustrated prior to Fallot’s account, notably by Nils Stensen (discoverer of the parotid duct), John Peacock and Karl, Freiherr von Rokitansky [2]. In the hundred years since the publication (which, without question, deserves the credit for establishing the connexion between the clinical presentation and these morphologic findings), the tetralogy has come under various attacks. There have been those who have suggested that a “ tetralogy” is a collection of Greek tragedies, “tetrad” being a more appropriate description of four associated cardiac malformations [3]. Others have opined that the lesion stems from one fundamental developmental anomaly, undergrowth of the sub-pulmortary infundibulum, and that it would more appropriately be considered a “monology” [4]. Despite these criticisms, there is little doubt that the “tetralogy of Fallot” will survive as a descriptive phrase, and that all who deal with congenitally malformed hearts, whatever their specific discipline, will continue to recognize its meaning. It seemed appropriate, therefore, to review our understanding of the underlying anatomy in this, its