Tetralogy of Fallot

This case emphasises the need to carry out a full structural assessment from each of the 7 core views.

Had one looked only from the apical 4 chamber view this child’s heart may have appeared normal.

However from the parasternal long axis view it is obvious that there is a large VSD.

While VSDs are often an isolated finding, they should also ALWAYS be thought of as a marker for other structural cardiac pathology. In this case interrogation of the right ventricular outflow tract reveals turbulent flow across the pulmonary valve

And on the subcostal view the aorta can clearly be seen to be over-riding the VSD.