CARDIOVASCULAR JOURNAL OF AFRICA • Vol 21, No 4, July/August 2010
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AFRICA
adult life; a symptomatic quiescent period during the second
decade of life; normal or increased pulmonary vasculature in
42% of cyanotic patients and absence of this hypervascularity
in 70% of acyanotic patients; and ECG evidence of right bundle
branch block in 58% and tall peaked P waves in 66% of cyanotic
patients, and predominantly right ventricular hypertrophy in 46%
of acyanotic patients.
3
Special considerations for anaesthetic and post-operative
Fig. 4. Chest X-ray postero-anterior view.
Fig. 5. Chest X-ray lateral view.
of collateral circulation to the lungs and the progressive narrow-
ing with age of the initially mild infundibular stenosis.
In adults with TOF there are several differences noted from
the classic description of this lesion in children. These include a
very large VSD with greater frequency of combined infundibu-
lar and valvular pulmonary stenosis. Usually adults with TOF
present with congestive heart failure in 33% of cyanotic and 38%
of acyanotic patients; characteristic chest pain occurring in early
Fig. 2. Anterior abdominal wall oedema.
Fig. 3. Oedema extending up to the upper thigh.
