[Angiographic-clinical correlation in Fallot's-tetralogy during childhood (author's transl)].

Thirty-eight patients with Fallot's tetralogy were investigated in order to correlate their clinical and angiographic findings. In the light of embryological knowledge about the morphogenesis of Fallot's tetralogy there are good explanations for the various modes of clinical presentation. Patients with extreme cyanosis in the newborn period show diffuse hypoplasia of their right ventricular outflow tract and pulmonary arteries because of extreme malseptation of the conus with anteposition of the infundibular septum. Patients who present with cyanosis and blue spells in infancy show infundibular narrowing and dextro- and anteposition of the ascending aorta. Conal malseptation together with malrotation of the conus seem to be the responsible factors in this patient group. Malrotation of the conus without malseptation is probably the mechanism in patients who present initially without cyanosis and signs of left to right shunting. Anteposition and overriding of the aorta are the initial angiographic signs while right ventricular hypertrophy producing infundibular narrowing and subsequent cyanosis appear later.