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<div>__NOTOC__<br />
{{Infobox_Disease<br />
| Name = Central Cord Syndrome<br />
| Image = Cord.svg<br />
| Caption = Central cord syndrome is top diagram<br />
| Width = 100px<br />
| DiseasesDB = 33409<br />
| ICD10 =<br />
| ICD9 = {{ICD9|952.18}}<br />
| ICDO = <br />
| OMIM = <br />
| MedlinePlus = <br />
| eMedicineSubj = pmr<br />
| eMedicineTopic = 22<br />
| MeshID = D020210<br />
}}<br />
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'''Central cord syndrome''' (CCS) is an [[Acute (medical)|acute]] [[cervical]] [[spinal cord injury]] (SCI), characterized by disproportionately greater motor impairment in upper compared to lower extremities, [[bladder dysfunction]], and variable degree of sensory loss below the level of injury. This syndrome is unlike a complete [[lesion]], that causes loss of all sensation and movement below the level of the injury. First described by Schneider in 1954,<ref>{{cite journal |author=Schneider RC, Cherry G, Pantek H |title=The syndrome of acute central cervical spinal cord injury; with special reference to the mechanisms involved in [[hyperextension]] injuries of cervical spine |journal=J. Neurosurg. |volume=11 |issue=6 |pages=546-77 |year=1954 |pmid=13222164 |doi=}}</ref> CCS has been reported to occur more frequently among older persons with cervical spondylosis who sustain hyperextension injury. Though it also may occur in persons of any age. CCS is the most common incomplete SCI syndrome.<br />
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CCS most often occurs after hyperextension injury in an individual with long-standing [[cervical spondylosis]]. Historically, spinal cord damage was believed to originate from concussion or contusion of the cord with stasis of [[axoplasmic]] flow, causing [[edematous]] injury rather than destructive [[hematomyelia]]. More recently, autopsy studies have demonstrated that CCS may be caused by bleeding into the central part of the cord, portending less favorable prognosis. Studies also have shown that CCS probably is associated with axonal disruption in the [[lateral column]]s at the level of the injury to the spinal cord with relative preservation of the [[grey matter]]. <br />
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In the US the [[prevalence]] rate is 15.7-25% however this syndrome is generally associated with favorable prognosis for some degree of neurologic and functional recovery. CCS predominantly affects men more than women, similar to all other SCI. <br />
==Historical Perspective==<br />
*Central Cord Syndrome was first described by Schneider , et al in 1954.<ref name="GuestEleraky2002">{{cite journal|last1=Guest|first1=James|last2=Eleraky|first2=Mohammed A.|last3=Apostolides|first3=Paul J.|last4=Dickman|first4=Curtis A.|last5=Sonntag|first5=Volker K. H.|title=Traumatic central cord syndrome: results of surgical management|journal=Journal of Neurosurgery: Spine|volume=97|issue=1|year=2002|pages=25–32|issn=1547-5654|doi=10.3171/spi.2002.97.1.0025}}</ref><br />
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*Quencer, et al was the first to discover the association between neuroradiological and pathologic findings and the development of Central Cord Syndrome.<ref name="GuestEleraky2002">{{cite journal|last1=Guest|first1=James|last2=Eleraky|first2=Mohammed A.|last3=Apostolides|first3=Paul J.|last4=Dickman|first4=Curtis A.|last5=Sonntag|first5=Volker K. H.|title=Traumatic central cord syndrome: results of surgical management|journal=Journal of Neurosurgery: Spine|volume=97|issue=1|year=2002|pages=25–32|issn=1547-5654|doi=10.3171/spi.2002.97.1.0025}}</ref><br />
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*Raynor and Koplik described that the central part of the spinal cord was most affected when a moderate force was applied in an anterior posterior direction using the stress analysis theory.<ref name="GuestEleraky2002">{{cite journal|last1=Guest|first1=James|last2=Eleraky|first2=Mohammed A.|last3=Apostolides|first3=Paul J.|last4=Dickman|first4=Curtis A.|last5=Sonntag|first5=Volker K. H.|title=Traumatic central cord syndrome: results of surgical management|journal=Journal of Neurosurgery: Spine|volume=97|issue=1|year=2002|pages=25–32|issn=1547-5654|doi=10.3171/spi.2002.97.1.0025}}</ref><br />
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*In early 1970s surgical treatment was suggested by Quencer, et al to treat Central Cord syndrome.<ref name="GuestEleraky2002">{{cite journal|last1=Guest|first1=James|last2=Eleraky|first2=Mohammed A.|last3=Apostolides|first3=Paul J.|last4=Dickman|first4=Curtis A.|last5=Sonntag|first5=Volker K. H.|title=Traumatic central cord syndrome: results of surgical management|journal=Journal of Neurosurgery: Spine|volume=97|issue=1|year=2002|pages=25–32|issn=1547-5654|doi=10.3171/spi.2002.97.1.0025}}</ref><br />
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==Classification==<br />
There is no established system for the classification of Central Cord Syndrome.<br />
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==Pathophysiology==<br />
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It is thought that Central Cord Syndrome is the result of Compression of the spinothalamic and corticospinal tracts of the spinal cord, is caused by either<ref name="HarropSharan2006">{{cite journal|last1=Harrop|first1=James S.|last2=Sharan|first2=Ashwini|last3=Ratliff|first3=Jonathon|title=Central cord injury: pathophysiology, management, and outcomes|journal=The Spine Journal|volume=6|issue=6|year=2006|pages=S198–S206|issn=15299430|doi=10.1016/j.spinee.2006.04.006}}</ref>. <br />
*Hyperextension injury.<ref name="HarropSharan2006">{{cite journal|last1=Harrop|first1=James S.|last2=Sharan|first2=Ashwini|last3=Ratliff|first3=Jonathon|title=Central cord injury: pathophysiology, management, and outcomes|journal=The Spine Journal|volume=6|issue=6|year=2006|pages=S198–S206|issn=15299430|doi=10.1016/j.spinee.2006.04.006}}</ref><br />
*Cervical spondylosis.<ref name="HarropSharan2006">{{cite journal|last1=Harrop|first1=James S.|last2=Sharan|first2=Ashwini|last3=Ratliff|first3=Jonathon|title=Central cord injury: pathophysiology, management, and outcomes|journal=The Spine Journal|volume=6|issue=6|year=2006|pages=S198–S206|issn=15299430|doi=10.1016/j.spinee.2006.04.006}}</ref><br />
*Arterial ischemia to the spinal cord<ref name="HarropSharan2006">{{cite journal|last1=Harrop|first1=James S.|last2=Sharan|first2=Ashwini|last3=Ratliff|first3=Jonathon|title=Central cord injury: pathophysiology, management, and outcomes|journal=The Spine Journal|volume=6|issue=6|year=2006|pages=S198–S206|issn=15299430|doi=10.1016/j.spinee.2006.04.006}}</ref><br />
*Central intraparenchymal spinal cord hematoma <ref name="HarropSharan2006">{{cite journal|last1=Harrop|first1=James S.|last2=Sharan|first2=Ashwini|last3=Ratliff|first3=Jonathon|title=Central cord injury: pathophysiology, management, and outcomes|journal=The Spine Journal|volume=6|issue=6|year=2006|pages=S198–S206|issn=15299430|doi=10.1016/j.spinee.2006.04.006}}</ref><br />
*Isolated injury to the decussating CorticoSpinal tracts in the brain stem. <ref name="HarropSharan2006">{{cite journal|last1=Harrop|first1=James S.|last2=Sharan|first2=Ashwini|last3=Ratliff|first3=Jonathon|title=Central cord injury: pathophysiology, management, and outcomes|journal=The Spine Journal|volume=6|issue=6|year=2006|pages=S198–S206|issn=15299430|doi=10.1016/j.spinee.2006.04.006}}</ref><br />
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==Causes==<br />
Central Cord Syndrome can be caused by <br />
*Trauma( MVA, Falls, Diving)<ref name="HarropSharan2006">{{cite journal|last1=Harrop|first1=James S.|last2=Sharan|first2=Ashwini|last3=Ratliff|first3=Jonathon|title=Central cord injury: pathophysiology, management, and outcomes|journal=The Spine Journal|volume=6|issue=6|year=2006|pages=S198–S206|issn=15299430|doi=10.1016/j.spinee.2006.04.006}}</ref><br />
*Preexisting cervical spondylosis <ref name="HarropSharan2006">{{cite journal|last1=Harrop|first1=James S.|last2=Sharan|first2=Ashwini|last3=Ratliff|first3=Jonathon|title=Central cord injury: pathophysiology, management, and outcomes|journal=The Spine Journal|volume=6|issue=6|year=2006|pages=S198–S206|issn=15299430|doi=10.1016/j.spinee.2006.04.006}}</ref><br />
*Ischemia<ref name="HarropSharan2006">{{cite journal|last1=Harrop|first1=James S.|last2=Sharan|first2=Ashwini|last3=Ratliff|first3=Jonathon|title=Central cord injury: pathophysiology, management, and outcomes|journal=The Spine Journal|volume=6|issue=6|year=2006|pages=S198–S206|issn=15299430|doi=10.1016/j.spinee.2006.04.006}}</ref><br />
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==Differentiating Central Cord Syndrome from other Diseases==<br />
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Central Cord Syndrome must be differentiated from<br />
* Devic's Syndrome.<ref name="EpsteinHollingsworth2015">{{cite journal|last1=Epstein|first1=NancyE|last2=Hollingsworth|first2=Renee|title=Diagnosis and management of traumatic cervical central spinal cord injury: A review|journal=Surgical Neurology International|volume=6|issue=5|year=2015|pages=140|issn=2152-7806|doi=10.4103/2152-7806.156552}}</ref> <br />
* Primary Sjogren syndrome involving the Central Nervous System.<ref name="EpsteinHollingsworth2015">{{cite journal|last1=Epstein|first1=NancyE|last2=Hollingsworth|first2=Renee|title=Diagnosis and management of traumatic cervical central spinal cord injury: A review|journal=Surgical Neurology International|volume=6|issue=5|year=2015|pages=140|issn=2152-7806|doi=10.4103/2152-7806.156552}}</ref> <br />
* Multiple Sclerosis.<ref name="EpsteinHollingsworth2015">{{cite journal|last1=Epstein|first1=NancyE|last2=Hollingsworth|first2=Renee|title=Diagnosis and management of traumatic cervical central spinal cord injury: A review|journal=Surgical Neurology International|volume=6|issue=5|year=2015|pages=140|issn=2152-7806|doi=10.4103/2152-7806.156552}}</ref><br />
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The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].<br />
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== See also ==<br />
[[Spinal cord injury]]<br />
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== References ==<br />
<references/><br />
*http://health.enotes.com/neurological-disorders-encyclopedia/central-cord-syndrome<br />
*http://www.ninds.nih.gov/disorders/central_cord/central_cord.htm<br />
<br />
{{disease-stub}}<br />
{{Lesions of spinal cord and brainstem}}<br />
[[Category:Disease stubs]]<br />
[[Category:Syndromes]]<br />
{{WikiDoc Help Menu}}</div>Abdulkareem Opeoluwalukanhttps://www.wikidoc.org/index.php?title=Central_cord_syndrome&diff=1647344Central cord syndrome2020-08-05T01:12:00Z<p>Abdulkareem Opeoluwalukan: /* Causes */</p>
<hr />
<div>__NOTOC__<br />
{{Infobox_Disease<br />
| Name = Central Cord Syndrome<br />
| Image = Cord.svg<br />
| Caption = Central cord syndrome is top diagram<br />
| Width = 100px<br />
| DiseasesDB = 33409<br />
| ICD10 =<br />
| ICD9 = {{ICD9|952.18}}<br />
| ICDO = <br />
| OMIM = <br />
| MedlinePlus = <br />
| eMedicineSubj = pmr<br />
| eMedicineTopic = 22<br />
| MeshID = D020210<br />
}}<br />
<br />
'''Central cord syndrome''' (CCS) is an [[Acute (medical)|acute]] [[cervical]] [[spinal cord injury]] (SCI), characterized by disproportionately greater motor impairment in upper compared to lower extremities, [[bladder dysfunction]], and variable degree of sensory loss below the level of injury. This syndrome is unlike a complete [[lesion]], that causes loss of all sensation and movement below the level of the injury. First described by Schneider in 1954,<ref>{{cite journal |author=Schneider RC, Cherry G, Pantek H |title=The syndrome of acute central cervical spinal cord injury; with special reference to the mechanisms involved in [[hyperextension]] injuries of cervical spine |journal=J. Neurosurg. |volume=11 |issue=6 |pages=546-77 |year=1954 |pmid=13222164 |doi=}}</ref> CCS has been reported to occur more frequently among older persons with cervical spondylosis who sustain hyperextension injury. Though it also may occur in persons of any age. CCS is the most common incomplete SCI syndrome.<br />
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CCS most often occurs after hyperextension injury in an individual with long-standing [[cervical spondylosis]]. Historically, spinal cord damage was believed to originate from concussion or contusion of the cord with stasis of [[axoplasmic]] flow, causing [[edematous]] injury rather than destructive [[hematomyelia]]. More recently, autopsy studies have demonstrated that CCS may be caused by bleeding into the central part of the cord, portending less favorable prognosis. Studies also have shown that CCS probably is associated with axonal disruption in the [[lateral column]]s at the level of the injury to the spinal cord with relative preservation of the [[grey matter]]. <br />
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In the US the [[prevalence]] rate is 15.7-25% however this syndrome is generally associated with favorable prognosis for some degree of neurologic and functional recovery. CCS predominantly affects men more than women, similar to all other SCI. <br />
==Historical Perspective==<br />
*Central Cord Syndrome was first described by Schneider , et al in 1954.<ref name="GuestEleraky2002">{{cite journal|last1=Guest|first1=James|last2=Eleraky|first2=Mohammed A.|last3=Apostolides|first3=Paul J.|last4=Dickman|first4=Curtis A.|last5=Sonntag|first5=Volker K. H.|title=Traumatic central cord syndrome: results of surgical management|journal=Journal of Neurosurgery: Spine|volume=97|issue=1|year=2002|pages=25–32|issn=1547-5654|doi=10.3171/spi.2002.97.1.0025}}</ref><br />
<br />
*Quencer, et al was the first to discover the association between neuroradiological and pathologic findings and the development of Central Cord Syndrome.<ref name="GuestEleraky2002">{{cite journal|last1=Guest|first1=James|last2=Eleraky|first2=Mohammed A.|last3=Apostolides|first3=Paul J.|last4=Dickman|first4=Curtis A.|last5=Sonntag|first5=Volker K. H.|title=Traumatic central cord syndrome: results of surgical management|journal=Journal of Neurosurgery: Spine|volume=97|issue=1|year=2002|pages=25–32|issn=1547-5654|doi=10.3171/spi.2002.97.1.0025}}</ref><br />
<br />
*Raynor and Koplik described that the central part of the spinal cord was most affected when a moderate force was applied in an anterior posterior direction using the stress analysis theory.<ref name="GuestEleraky2002">{{cite journal|last1=Guest|first1=James|last2=Eleraky|first2=Mohammed A.|last3=Apostolides|first3=Paul J.|last4=Dickman|first4=Curtis A.|last5=Sonntag|first5=Volker K. H.|title=Traumatic central cord syndrome: results of surgical management|journal=Journal of Neurosurgery: Spine|volume=97|issue=1|year=2002|pages=25–32|issn=1547-5654|doi=10.3171/spi.2002.97.1.0025}}</ref><br />
<br />
*In early 1970s surgical treatment was suggested by Quencer, et al to treat Central Cord syndrome.<ref name="GuestEleraky2002">{{cite journal|last1=Guest|first1=James|last2=Eleraky|first2=Mohammed A.|last3=Apostolides|first3=Paul J.|last4=Dickman|first4=Curtis A.|last5=Sonntag|first5=Volker K. H.|title=Traumatic central cord syndrome: results of surgical management|journal=Journal of Neurosurgery: Spine|volume=97|issue=1|year=2002|pages=25–32|issn=1547-5654|doi=10.3171/spi.2002.97.1.0025}}</ref><br />
<br />
==Classification==<br />
There is no established system for the classification of Central Cord Syndrome.<br />
<br />
==Pathophysiology==<br />
<br />
It is thought that Central Cord Syndrome is the result of Compression of the spinothalamic and corticospinal tracts of the spinal cord, is caused by either<ref name="HarropSharan2006">{{cite journal|last1=Harrop|first1=James S.|last2=Sharan|first2=Ashwini|last3=Ratliff|first3=Jonathon|title=Central cord injury: pathophysiology, management, and outcomes|journal=The Spine Journal|volume=6|issue=6|year=2006|pages=S198–S206|issn=15299430|doi=10.1016/j.spinee.2006.04.006}}</ref>. <br />
*Hyperextension injury.<ref name="HarropSharan2006">{{cite journal|last1=Harrop|first1=James S.|last2=Sharan|first2=Ashwini|last3=Ratliff|first3=Jonathon|title=Central cord injury: pathophysiology, management, and outcomes|journal=The Spine Journal|volume=6|issue=6|year=2006|pages=S198–S206|issn=15299430|doi=10.1016/j.spinee.2006.04.006}}</ref><br />
*Cervical spondylosis.<ref name="HarropSharan2006">{{cite journal|last1=Harrop|first1=James S.|last2=Sharan|first2=Ashwini|last3=Ratliff|first3=Jonathon|title=Central cord injury: pathophysiology, management, and outcomes|journal=The Spine Journal|volume=6|issue=6|year=2006|pages=S198–S206|issn=15299430|doi=10.1016/j.spinee.2006.04.006}}</ref><br />
*Arterial ischemia to the spinal cord<ref name="HarropSharan2006">{{cite journal|last1=Harrop|first1=James S.|last2=Sharan|first2=Ashwini|last3=Ratliff|first3=Jonathon|title=Central cord injury: pathophysiology, management, and outcomes|journal=The Spine Journal|volume=6|issue=6|year=2006|pages=S198–S206|issn=15299430|doi=10.1016/j.spinee.2006.04.006}}</ref><br />
*Central intraparenchymal spinal cord hematoma <ref name="HarropSharan2006">{{cite journal|last1=Harrop|first1=James S.|last2=Sharan|first2=Ashwini|last3=Ratliff|first3=Jonathon|title=Central cord injury: pathophysiology, management, and outcomes|journal=The Spine Journal|volume=6|issue=6|year=2006|pages=S198–S206|issn=15299430|doi=10.1016/j.spinee.2006.04.006}}</ref><br />
*Isolated injury to the decussating CorticoSpinal tracts in the brain stem. <ref name="HarropSharan2006">{{cite journal|last1=Harrop|first1=James S.|last2=Sharan|first2=Ashwini|last3=Ratliff|first3=Jonathon|title=Central cord injury: pathophysiology, management, and outcomes|journal=The Spine Journal|volume=6|issue=6|year=2006|pages=S198–S206|issn=15299430|doi=10.1016/j.spinee.2006.04.006}}</ref><br />
<br />
==Causes==<br />
Central Cord Syndrome can be caused by <br />
*Trauma( MVA, Falls, Diving)<ref name="HarropSharan2006">{{cite journal|last1=Harrop|first1=James S.|last2=Sharan|first2=Ashwini|last3=Ratliff|first3=Jonathon|title=Central cord injury: pathophysiology, management, and outcomes|journal=The Spine Journal|volume=6|issue=6|year=2006|pages=S198–S206|issn=15299430|doi=10.1016/j.spinee.2006.04.006}}</ref><br />
*Preexisting cervical spondylosis <ref name="HarropSharan2006">{{cite journal|last1=Harrop|first1=James S.|last2=Sharan|first2=Ashwini|last3=Ratliff|first3=Jonathon|title=Central cord injury: pathophysiology, management, and outcomes|journal=The Spine Journal|volume=6|issue=6|year=2006|pages=S198–S206|issn=15299430|doi=10.1016/j.spinee.2006.04.006}}</ref><br />
*Ischemia<ref name="HarropSharan2006">{{cite journal|last1=Harrop|first1=James S.|last2=Sharan|first2=Ashwini|last3=Ratliff|first3=Jonathon|title=Central cord injury: pathophysiology, management, and outcomes|journal=The Spine Journal|volume=6|issue=6|year=2006|pages=S198–S206|issn=15299430|doi=10.1016/j.spinee.2006.04.006}}</ref><br />
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==Differentiating ((Page name)) from other Diseases==<br />
[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].<br />
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[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].<br />
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==Epidemiology and Demographics==<br />
The incidence/prevalence of [disease name] is approximately [number range] per 100,000 individuals worldwide.<br />
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In [year], the incidence/prevalence of [disease name] was estimated to be [number range] cases per 100,000 individuals worldwide.<br />
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In [year], the incidence of [disease name] is approximately [number range] per 100,000 individuals with a case-fatality rate of [number range]%.<br />
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Patients of all age groups may develop [disease name].<br />
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The incidence of [disease name] increases with age; the median age at diagnosis is [#] years.<br />
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[Disease name] commonly affects individuals younger than/older than [number of years] years of age.<br />
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[Chronic disease name] is usually first diagnosed among [age group].<br />
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[Acute disease name] commonly affects [age group].<br />
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There is no racial predilection to [disease name].<br />
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[Disease name] usually affects individuals of the [race 1] race. [Race 2] individuals are less likely to develop [disease name].<br />
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[Disease name] affects men and women equally.<br />
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[Gender 1] are more commonly affected by [disease name] than [gender 2]. The [gender 1] to [gender 2] ratio is approximately [number > 1] to 1.<br />
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The majority of [disease name] cases are reported in [geographical region].<br />
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[Disease name] is a common/rare disease that tends to affect [patient population 1] and [patient population 2].<br />
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==Risk Factors==<br />
There are no established risk factors for [disease name].<br />
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The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].<br />
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Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].<br />
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Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.<br />
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==Screening==<br />
There is insufficient evidence to recommend routine screening for [disease/malignancy].<br />
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According to the [guideline name], screening for [disease name] is not recommended.<br />
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According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].<br />
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==Natural History, Complications, and Prognosis==<br />
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].<br />
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Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].<br />
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Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.<br />
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==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].<br />
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The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].<br />
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The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].<br />
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There are no established criteria for the diagnosis of [disease name].<br />
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===History and Symptoms===<br />
The majority of patients with [disease name] are asymptomatic.<br />
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The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].<br />
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===Physical Examination===<br />
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].<br />
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Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].<br />
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The presence of [finding(s)] on physical examination is diagnostic of [disease name].<br />
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The presence of [finding(s)] on physical examination is highly suggestive of [disease name].<br />
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===Laboratory Findings===<br />
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].<br />
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Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].<br />
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[Test] is usually normal among patients with [disease name].<br />
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Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].<br />
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There are no diagnostic laboratory findings associated with [disease name].<br />
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===Electrocardiogram===<br />
There are no ECG findings associated with [disease name].<br />
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An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].<br />
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===X-ray===<br />
There are no x-ray findings associated with [disease name].<br />
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An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].<br />
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There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].<br />
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===Echocardiography or Ultrasound===<br />
There are no echocardiography/ultrasound findings associated with [disease name].<br />
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Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].<br />
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There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].<br />
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===CT scan===<br />
There are no CT scan findings associated with [disease name].<br />
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[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].<br />
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There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].<br />
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===MRI===<br />
There are no MRI findings associated with [disease name].<br />
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[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].<br />
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There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].<br />
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===Other Imaging Findings===<br />
There are no other imaging findings associated with [disease name].<br />
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[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].<br />
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===Other Diagnostic Studies===<br />
There are no other diagnostic studies associated with [disease name].<br />
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[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].<br />
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Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].<br />
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==Treatment==<br />
===Medical Therapy===<br />
There is no treatment for [disease name]; the mainstay of therapy is supportive care.<br />
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Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].<br />
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Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].<br />
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Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].<br />
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Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].<br />
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===Surgery===<br />
Surgical intervention is not recommended for the management of [disease name].<br />
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Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]<br />
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The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].<br />
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The feasibility of surgery depends on the stage of [malignancy] at diagnosis.<br />
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Surgery is the mainstay of treatment for [disease or malignancy].<br />
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===Primary Prevention===<br />
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Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].<br />
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[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].<br />
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===Secondary Prevention===<br />
There are no established measures for the secondary prevention of [disease name].<br />
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Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].<br />
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== See also ==<br />
[[Spinal cord injury]]<br />
<br />
== References ==<br />
<references/><br />
*http://health.enotes.com/neurological-disorders-encyclopedia/central-cord-syndrome<br />
*http://www.ninds.nih.gov/disorders/central_cord/central_cord.htm<br />
<br />
{{disease-stub}}<br />
{{Lesions of spinal cord and brainstem}}<br />
[[Category:Disease stubs]]<br />
[[Category:Syndromes]]<br />
{{WikiDoc Help Menu}}</div>Abdulkareem Opeoluwalukanhttps://www.wikidoc.org/index.php?title=Central_cord_syndrome&diff=1647264Central cord syndrome2020-08-04T21:46:06Z<p>Abdulkareem Opeoluwalukan: /* Pathophysiology */</p>
<hr />
<div>__NOTOC__<br />
{{Infobox_Disease<br />
| Name = Central Cord Syndrome<br />
| Image = Cord.svg<br />
| Caption = Central cord syndrome is top diagram<br />
| Width = 100px<br />
| DiseasesDB = 33409<br />
| ICD10 =<br />
| ICD9 = {{ICD9|952.18}}<br />
| ICDO = <br />
| OMIM = <br />
| MedlinePlus = <br />
| eMedicineSubj = pmr<br />
| eMedicineTopic = 22<br />
| MeshID = D020210<br />
}}<br />
<br />
'''Central cord syndrome''' (CCS) is an [[Acute (medical)|acute]] [[cervical]] [[spinal cord injury]] (SCI), characterized by disproportionately greater motor impairment in upper compared to lower extremities, [[bladder dysfunction]], and variable degree of sensory loss below the level of injury. This syndrome is unlike a complete [[lesion]], that causes loss of all sensation and movement below the level of the injury. First described by Schneider in 1954,<ref>{{cite journal |author=Schneider RC, Cherry G, Pantek H |title=The syndrome of acute central cervical spinal cord injury; with special reference to the mechanisms involved in [[hyperextension]] injuries of cervical spine |journal=J. Neurosurg. |volume=11 |issue=6 |pages=546-77 |year=1954 |pmid=13222164 |doi=}}</ref> CCS has been reported to occur more frequently among older persons with cervical spondylosis who sustain hyperextension injury. Though it also may occur in persons of any age. CCS is the most common incomplete SCI syndrome.<br />
<br />
CCS most often occurs after hyperextension injury in an individual with long-standing [[cervical spondylosis]]. Historically, spinal cord damage was believed to originate from concussion or contusion of the cord with stasis of [[axoplasmic]] flow, causing [[edematous]] injury rather than destructive [[hematomyelia]]. More recently, autopsy studies have demonstrated that CCS may be caused by bleeding into the central part of the cord, portending less favorable prognosis. Studies also have shown that CCS probably is associated with axonal disruption in the [[lateral column]]s at the level of the injury to the spinal cord with relative preservation of the [[grey matter]]. <br />
<br />
In the US the [[prevalence]] rate is 15.7-25% however this syndrome is generally associated with favorable prognosis for some degree of neurologic and functional recovery. CCS predominantly affects men more than women, similar to all other SCI. <br />
==Historical Perspective==<br />
*Central Cord Syndrome was first described by Schneider , et al in 1954.<ref name="GuestEleraky2002">{{cite journal|last1=Guest|first1=James|last2=Eleraky|first2=Mohammed A.|last3=Apostolides|first3=Paul J.|last4=Dickman|first4=Curtis A.|last5=Sonntag|first5=Volker K. H.|title=Traumatic central cord syndrome: results of surgical management|journal=Journal of Neurosurgery: Spine|volume=97|issue=1|year=2002|pages=25–32|issn=1547-5654|doi=10.3171/spi.2002.97.1.0025}}</ref><br />
<br />
*Quencer, et al was the first to discover the association between neuroradiological and pathologic findings and the development of Central Cord Syndrome.<ref name="GuestEleraky2002">{{cite journal|last1=Guest|first1=James|last2=Eleraky|first2=Mohammed A.|last3=Apostolides|first3=Paul J.|last4=Dickman|first4=Curtis A.|last5=Sonntag|first5=Volker K. H.|title=Traumatic central cord syndrome: results of surgical management|journal=Journal of Neurosurgery: Spine|volume=97|issue=1|year=2002|pages=25–32|issn=1547-5654|doi=10.3171/spi.2002.97.1.0025}}</ref><br />
<br />
*Raynor and Koplik described that the central part of the spinal cord was most affected when a moderate force was applied in an anterior posterior direction using the stress analysis theory.<ref name="GuestEleraky2002">{{cite journal|last1=Guest|first1=James|last2=Eleraky|first2=Mohammed A.|last3=Apostolides|first3=Paul J.|last4=Dickman|first4=Curtis A.|last5=Sonntag|first5=Volker K. H.|title=Traumatic central cord syndrome: results of surgical management|journal=Journal of Neurosurgery: Spine|volume=97|issue=1|year=2002|pages=25–32|issn=1547-5654|doi=10.3171/spi.2002.97.1.0025}}</ref><br />
<br />
*In early 1970s surgical treatment was suggested by Quencer, et al to treat Central Cord syndrome.<ref name="GuestEleraky2002">{{cite journal|last1=Guest|first1=James|last2=Eleraky|first2=Mohammed A.|last3=Apostolides|first3=Paul J.|last4=Dickman|first4=Curtis A.|last5=Sonntag|first5=Volker K. H.|title=Traumatic central cord syndrome: results of surgical management|journal=Journal of Neurosurgery: Spine|volume=97|issue=1|year=2002|pages=25–32|issn=1547-5654|doi=10.3171/spi.2002.97.1.0025}}</ref><br />
<br />
==Classification==<br />
There is no established system for the classification of Central Cord Syndrome.<br />
<br />
==Pathophysiology==<br />
<br />
It is thought that Central Cord Syndrome is the result of Compression of the spinothalamic and corticospinal tracts of the spinal cord, is caused by either<ref name="HarropSharan2006">{{cite journal|last1=Harrop|first1=James S.|last2=Sharan|first2=Ashwini|last3=Ratliff|first3=Jonathon|title=Central cord injury: pathophysiology, management, and outcomes|journal=The Spine Journal|volume=6|issue=6|year=2006|pages=S198–S206|issn=15299430|doi=10.1016/j.spinee.2006.04.006}}</ref>. <br />
*Hyperextension injury.<ref name="HarropSharan2006">{{cite journal|last1=Harrop|first1=James S.|last2=Sharan|first2=Ashwini|last3=Ratliff|first3=Jonathon|title=Central cord injury: pathophysiology, management, and outcomes|journal=The Spine Journal|volume=6|issue=6|year=2006|pages=S198–S206|issn=15299430|doi=10.1016/j.spinee.2006.04.006}}</ref><br />
*Cervical spondylosis.<ref name="HarropSharan2006">{{cite journal|last1=Harrop|first1=James S.|last2=Sharan|first2=Ashwini|last3=Ratliff|first3=Jonathon|title=Central cord injury: pathophysiology, management, and outcomes|journal=The Spine Journal|volume=6|issue=6|year=2006|pages=S198–S206|issn=15299430|doi=10.1016/j.spinee.2006.04.006}}</ref><br />
*Arterial ischemia to the spinal cord<ref name="HarropSharan2006">{{cite journal|last1=Harrop|first1=James S.|last2=Sharan|first2=Ashwini|last3=Ratliff|first3=Jonathon|title=Central cord injury: pathophysiology, management, and outcomes|journal=The Spine Journal|volume=6|issue=6|year=2006|pages=S198–S206|issn=15299430|doi=10.1016/j.spinee.2006.04.006}}</ref><br />
*Central intraparenchymal spinal cord hematoma <ref name="HarropSharan2006">{{cite journal|last1=Harrop|first1=James S.|last2=Sharan|first2=Ashwini|last3=Ratliff|first3=Jonathon|title=Central cord injury: pathophysiology, management, and outcomes|journal=The Spine Journal|volume=6|issue=6|year=2006|pages=S198–S206|issn=15299430|doi=10.1016/j.spinee.2006.04.006}}</ref><br />
*Isolated injury to the decussating CorticoSpinal tracts in the brain stem. <ref name="HarropSharan2006">{{cite journal|last1=Harrop|first1=James S.|last2=Sharan|first2=Ashwini|last3=Ratliff|first3=Jonathon|title=Central cord injury: pathophysiology, management, and outcomes|journal=The Spine Journal|volume=6|issue=6|year=2006|pages=S198–S206|issn=15299430|doi=10.1016/j.spinee.2006.04.006}}</ref><br />
<br />
==Causes==<br />
Disease name] may be caused by [cause1], [cause2], or [cause3].<br />
<br />
OR<br />
<br />
Common causes of [disease] include [cause1], [cause2], and [cause3].<br />
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OR<br />
<br />
The most common cause of [disease name] is [cause 1]. Less common causes of [disease name] include [cause 2], [cause 3], and [cause 4].<br />
<br />
OR<br />
<br />
The cause of [disease name] has not been identified. To review risk factors for the development of [disease name], click [[Pericarditis causes#Overview|here]].<br />
<br />
==Differentiating ((Page name)) from other Diseases==<br />
[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].<br />
<br />
OR<br />
<br />
[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].<br />
<br />
==Epidemiology and Demographics==<br />
The incidence/prevalence of [disease name] is approximately [number range] per 100,000 individuals worldwide.<br />
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OR<br />
<br />
In [year], the incidence/prevalence of [disease name] was estimated to be [number range] cases per 100,000 individuals worldwide.<br />
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OR<br />
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In [year], the incidence of [disease name] is approximately [number range] per 100,000 individuals with a case-fatality rate of [number range]%.<br />
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Patients of all age groups may develop [disease name].<br />
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OR<br />
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The incidence of [disease name] increases with age; the median age at diagnosis is [#] years.<br />
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OR<br />
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[Disease name] commonly affects individuals younger than/older than [number of years] years of age.<br />
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OR <br />
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[Chronic disease name] is usually first diagnosed among [age group].<br />
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[Acute disease name] commonly affects [age group].<br />
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There is no racial predilection to [disease name].<br />
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[Disease name] usually affects individuals of the [race 1] race. [Race 2] individuals are less likely to develop [disease name].<br />
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[Disease name] affects men and women equally.<br />
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OR<br />
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[Gender 1] are more commonly affected by [disease name] than [gender 2]. The [gender 1] to [gender 2] ratio is approximately [number > 1] to 1.<br />
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<br />
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The majority of [disease name] cases are reported in [geographical region].<br />
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OR<br />
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[Disease name] is a common/rare disease that tends to affect [patient population 1] and [patient population 2].<br />
<br />
==Risk Factors==<br />
There are no established risk factors for [disease name].<br />
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OR<br />
<br />
The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].<br />
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OR<br />
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Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].<br />
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OR<br />
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Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.<br />
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==Screening==<br />
There is insufficient evidence to recommend routine screening for [disease/malignancy].<br />
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OR<br />
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According to the [guideline name], screening for [disease name] is not recommended.<br />
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OR<br />
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According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].<br />
<br />
==Natural History, Complications, and Prognosis==<br />
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].<br />
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OR<br />
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Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].<br />
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Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.<br />
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==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].<br />
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OR<br />
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The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].<br />
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The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].<br />
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OR<br />
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There are no established criteria for the diagnosis of [disease name].<br />
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===History and Symptoms===<br />
The majority of patients with [disease name] are asymptomatic.<br />
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OR<br />
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The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].<br />
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===Physical Examination===<br />
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].<br />
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OR<br />
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Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].<br />
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The presence of [finding(s)] on physical examination is diagnostic of [disease name].<br />
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The presence of [finding(s)] on physical examination is highly suggestive of [disease name].<br />
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===Laboratory Findings===<br />
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].<br />
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Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].<br />
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[Test] is usually normal among patients with [disease name].<br />
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Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].<br />
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There are no diagnostic laboratory findings associated with [disease name].<br />
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===Electrocardiogram===<br />
There are no ECG findings associated with [disease name].<br />
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OR<br />
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An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].<br />
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===X-ray===<br />
There are no x-ray findings associated with [disease name].<br />
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OR<br />
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An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].<br />
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OR<br />
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There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].<br />
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===Echocardiography or Ultrasound===<br />
There are no echocardiography/ultrasound findings associated with [disease name].<br />
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OR<br />
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Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].<br />
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OR<br />
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There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].<br />
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===CT scan===<br />
There are no CT scan findings associated with [disease name].<br />
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OR<br />
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[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].<br />
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OR<br />
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There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].<br />
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===MRI===<br />
There are no MRI findings associated with [disease name].<br />
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OR<br />
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[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].<br />
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OR<br />
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There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].<br />
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===Other Imaging Findings===<br />
There are no other imaging findings associated with [disease name].<br />
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OR<br />
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[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].<br />
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===Other Diagnostic Studies===<br />
There are no other diagnostic studies associated with [disease name].<br />
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OR<br />
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[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].<br />
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OR<br />
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Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].<br />
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==Treatment==<br />
===Medical Therapy===<br />
There is no treatment for [disease name]; the mainstay of therapy is supportive care.<br />
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OR<br />
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Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].<br />
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OR<br />
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The majority of cases of [disease name] are self-limited and require only supportive care.<br />
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OR<br />
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[Disease name] is a medical emergency and requires prompt treatment.<br />
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OR<br />
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The mainstay of treatment for [disease name] is [therapy].<br />
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OR<br />
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The optimal therapy for [malignancy name] depends on the stage at diagnosis.<br />
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OR<br />
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[Therapy] is recommended among all patients who develop [disease name].<br />
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Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].<br />
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OR<br />
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Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].<br />
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Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].<br />
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OR<br />
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Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].<br />
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===Surgery===<br />
Surgical intervention is not recommended for the management of [disease name].<br />
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OR<br />
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Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]<br />
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OR<br />
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The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].<br />
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OR<br />
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The feasibility of surgery depends on the stage of [malignancy] at diagnosis.<br />
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OR<br />
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Surgery is the mainstay of treatment for [disease or malignancy].<br />
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===Primary Prevention===<br />
There are no established measures for the primary prevention of [disease name].<br />
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OR<br />
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There are no available vaccines against [disease name].<br />
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OR<br />
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Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].<br />
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OR<br />
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[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].<br />
<br />
===Secondary Prevention===<br />
There are no established measures for the secondary prevention of [disease name].<br />
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OR<br />
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Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].<br />
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== See also ==<br />
[[Spinal cord injury]]<br />
<br />
== References ==<br />
<references/><br />
*http://health.enotes.com/neurological-disorders-encyclopedia/central-cord-syndrome<br />
*http://www.ninds.nih.gov/disorders/central_cord/central_cord.htm<br />
<br />
{{disease-stub}}<br />
{{Lesions of spinal cord and brainstem}}<br />
[[Category:Disease stubs]]<br />
[[Category:Syndromes]]<br />
{{WikiDoc Help Menu}}</div>Abdulkareem Opeoluwalukanhttps://www.wikidoc.org/index.php?title=Central_cord_syndrome&diff=1647258Central cord syndrome2020-08-04T21:25:22Z<p>Abdulkareem Opeoluwalukan: /* Pathophysiology */</p>
<hr />
<div>__NOTOC__<br />
{{Infobox_Disease<br />
| Name = Central Cord Syndrome<br />
| Image = Cord.svg<br />
| Caption = Central cord syndrome is top diagram<br />
| Width = 100px<br />
| DiseasesDB = 33409<br />
| ICD10 =<br />
| ICD9 = {{ICD9|952.18}}<br />
| ICDO = <br />
| OMIM = <br />
| MedlinePlus = <br />
| eMedicineSubj = pmr<br />
| eMedicineTopic = 22<br />
| MeshID = D020210<br />
}}<br />
<br />
'''Central cord syndrome''' (CCS) is an [[Acute (medical)|acute]] [[cervical]] [[spinal cord injury]] (SCI), characterized by disproportionately greater motor impairment in upper compared to lower extremities, [[bladder dysfunction]], and variable degree of sensory loss below the level of injury. This syndrome is unlike a complete [[lesion]], that causes loss of all sensation and movement below the level of the injury. First described by Schneider in 1954,<ref>{{cite journal |author=Schneider RC, Cherry G, Pantek H |title=The syndrome of acute central cervical spinal cord injury; with special reference to the mechanisms involved in [[hyperextension]] injuries of cervical spine |journal=J. Neurosurg. |volume=11 |issue=6 |pages=546-77 |year=1954 |pmid=13222164 |doi=}}</ref> CCS has been reported to occur more frequently among older persons with cervical spondylosis who sustain hyperextension injury. Though it also may occur in persons of any age. CCS is the most common incomplete SCI syndrome.<br />
<br />
CCS most often occurs after hyperextension injury in an individual with long-standing [[cervical spondylosis]]. Historically, spinal cord damage was believed to originate from concussion or contusion of the cord with stasis of [[axoplasmic]] flow, causing [[edematous]] injury rather than destructive [[hematomyelia]]. More recently, autopsy studies have demonstrated that CCS may be caused by bleeding into the central part of the cord, portending less favorable prognosis. Studies also have shown that CCS probably is associated with axonal disruption in the [[lateral column]]s at the level of the injury to the spinal cord with relative preservation of the [[grey matter]]. <br />
<br />
In the US the [[prevalence]] rate is 15.7-25% however this syndrome is generally associated with favorable prognosis for some degree of neurologic and functional recovery. CCS predominantly affects men more than women, similar to all other SCI. <br />
==Historical Perspective==<br />
*Central Cord Syndrome was first described by Schneider , et al in 1954.<ref name="GuestEleraky2002">{{cite journal|last1=Guest|first1=James|last2=Eleraky|first2=Mohammed A.|last3=Apostolides|first3=Paul J.|last4=Dickman|first4=Curtis A.|last5=Sonntag|first5=Volker K. H.|title=Traumatic central cord syndrome: results of surgical management|journal=Journal of Neurosurgery: Spine|volume=97|issue=1|year=2002|pages=25–32|issn=1547-5654|doi=10.3171/spi.2002.97.1.0025}}</ref><br />
<br />
*Quencer, et al was the first to discover the association between neuroradiological and pathologic findings and the development of Central Cord Syndrome.<ref name="GuestEleraky2002">{{cite journal|last1=Guest|first1=James|last2=Eleraky|first2=Mohammed A.|last3=Apostolides|first3=Paul J.|last4=Dickman|first4=Curtis A.|last5=Sonntag|first5=Volker K. H.|title=Traumatic central cord syndrome: results of surgical management|journal=Journal of Neurosurgery: Spine|volume=97|issue=1|year=2002|pages=25–32|issn=1547-5654|doi=10.3171/spi.2002.97.1.0025}}</ref><br />
<br />
*Raynor and Koplik described that the central part of the spinal cord was most affected when a moderate force was applied in an anterior posterior direction using the stress analysis theory.<ref name="GuestEleraky2002">{{cite journal|last1=Guest|first1=James|last2=Eleraky|first2=Mohammed A.|last3=Apostolides|first3=Paul J.|last4=Dickman|first4=Curtis A.|last5=Sonntag|first5=Volker K. H.|title=Traumatic central cord syndrome: results of surgical management|journal=Journal of Neurosurgery: Spine|volume=97|issue=1|year=2002|pages=25–32|issn=1547-5654|doi=10.3171/spi.2002.97.1.0025}}</ref><br />
<br />
*In early 1970s surgical treatment was suggested by Quencer, et al to treat Central Cord syndrome.<ref name="GuestEleraky2002">{{cite journal|last1=Guest|first1=James|last2=Eleraky|first2=Mohammed A.|last3=Apostolides|first3=Paul J.|last4=Dickman|first4=Curtis A.|last5=Sonntag|first5=Volker K. H.|title=Traumatic central cord syndrome: results of surgical management|journal=Journal of Neurosurgery: Spine|volume=97|issue=1|year=2002|pages=25–32|issn=1547-5654|doi=10.3171/spi.2002.97.1.0025}}</ref><br />
<br />
==Classification==<br />
There is no established system for the classification of Central Cord Syndrome.<br />
<br />
==Pathophysiology==<br />
<br />
It is thought that Central Cord Syndrome is the result of Compression of the spinothalamic and corticospinal tracts of the spinal cord, is caused by either <br />
*Hyperextension injury.<br />
*Cervical spondylosis.<br />
<br />
==Causes==<br />
Disease name] may be caused by [cause1], [cause2], or [cause3].<br />
<br />
OR<br />
<br />
Common causes of [disease] include [cause1], [cause2], and [cause3].<br />
<br />
OR<br />
<br />
The most common cause of [disease name] is [cause 1]. Less common causes of [disease name] include [cause 2], [cause 3], and [cause 4].<br />
<br />
OR<br />
<br />
The cause of [disease name] has not been identified. To review risk factors for the development of [disease name], click [[Pericarditis causes#Overview|here]].<br />
<br />
==Differentiating ((Page name)) from other Diseases==<br />
[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].<br />
<br />
OR<br />
<br />
[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].<br />
<br />
==Epidemiology and Demographics==<br />
The incidence/prevalence of [disease name] is approximately [number range] per 100,000 individuals worldwide.<br />
<br />
OR<br />
<br />
In [year], the incidence/prevalence of [disease name] was estimated to be [number range] cases per 100,000 individuals worldwide.<br />
<br />
OR<br />
<br />
In [year], the incidence of [disease name] is approximately [number range] per 100,000 individuals with a case-fatality rate of [number range]%.<br />
<br />
<br />
<br />
Patients of all age groups may develop [disease name].<br />
<br />
OR<br />
<br />
The incidence of [disease name] increases with age; the median age at diagnosis is [#] years.<br />
<br />
OR<br />
<br />
[Disease name] commonly affects individuals younger than/older than [number of years] years of age.<br />
<br />
OR <br />
<br />
[Chronic disease name] is usually first diagnosed among [age group].<br />
<br />
OR<br />
<br />
[Acute disease name] commonly affects [age group].<br />
<br />
<br />
<br />
There is no racial predilection to [disease name].<br />
<br />
OR<br />
<br />
[Disease name] usually affects individuals of the [race 1] race. [Race 2] individuals are less likely to develop [disease name].<br />
<br />
<br />
<br />
[Disease name] affects men and women equally.<br />
<br />
OR<br />
<br />
[Gender 1] are more commonly affected by [disease name] than [gender 2]. The [gender 1] to [gender 2] ratio is approximately [number > 1] to 1.<br />
<br />
<br />
<br />
The majority of [disease name] cases are reported in [geographical region].<br />
<br />
OR<br />
<br />
[Disease name] is a common/rare disease that tends to affect [patient population 1] and [patient population 2].<br />
<br />
==Risk Factors==<br />
There are no established risk factors for [disease name].<br />
<br />
OR<br />
<br />
The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].<br />
<br />
OR<br />
<br />
Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].<br />
<br />
OR<br />
<br />
Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.<br />
<br />
==Screening==<br />
There is insufficient evidence to recommend routine screening for [disease/malignancy].<br />
<br />
OR<br />
<br />
According to the [guideline name], screening for [disease name] is not recommended.<br />
<br />
OR<br />
<br />
According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].<br />
<br />
==Natural History, Complications, and Prognosis==<br />
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].<br />
<br />
OR<br />
<br />
Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].<br />
<br />
OR<br />
<br />
Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.<br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].<br />
<br />
OR<br />
<br />
The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].<br />
<br />
OR<br />
<br />
The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].<br />
<br />
OR<br />
<br />
There are no established criteria for the diagnosis of [disease name].<br />
<br />
===History and Symptoms===<br />
The majority of patients with [disease name] are asymptomatic.<br />
<br />
OR<br />
<br />
The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].<br />
<br />
===Physical Examination===<br />
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].<br />
<br />
OR<br />
<br />
Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].<br />
<br />
OR<br />
<br />
The presence of [finding(s)] on physical examination is diagnostic of [disease name].<br />
<br />
OR<br />
<br />
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].<br />
<br />
===Laboratory Findings===<br />
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].<br />
<br />
OR<br />
<br />
Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].<br />
<br />
OR<br />
<br />
[Test] is usually normal among patients with [disease name].<br />
<br />
OR<br />
<br />
Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].<br />
<br />
OR<br />
<br />
There are no diagnostic laboratory findings associated with [disease name].<br />
<br />
===Electrocardiogram===<br />
There are no ECG findings associated with [disease name].<br />
<br />
OR<br />
<br />
An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].<br />
<br />
===X-ray===<br />
There are no x-ray findings associated with [disease name].<br />
<br />
OR<br />
<br />
An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].<br />
<br />
OR<br />
<br />
There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].<br />
<br />
===Echocardiography or Ultrasound===<br />
There are no echocardiography/ultrasound findings associated with [disease name].<br />
<br />
OR<br />
<br />
Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].<br />
<br />
OR<br />
<br />
There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].<br />
<br />
===CT scan===<br />
There are no CT scan findings associated with [disease name].<br />
<br />
OR<br />
<br />
[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].<br />
<br />
OR<br />
<br />
There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].<br />
<br />
===MRI===<br />
There are no MRI findings associated with [disease name].<br />
<br />
OR<br />
<br />
[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].<br />
<br />
OR<br />
<br />
There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].<br />
<br />
===Other Imaging Findings===<br />
There are no other imaging findings associated with [disease name].<br />
<br />
OR<br />
<br />
[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].<br />
<br />
===Other Diagnostic Studies===<br />
There are no other diagnostic studies associated with [disease name].<br />
<br />
OR<br />
<br />
[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].<br />
<br />
OR<br />
<br />
Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].<br />
<br />
==Treatment==<br />
===Medical Therapy===<br />
There is no treatment for [disease name]; the mainstay of therapy is supportive care.<br />
<br />
OR<br />
<br />
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].<br />
<br />
OR<br />
<br />
The majority of cases of [disease name] are self-limited and require only supportive care.<br />
<br />
OR<br />
<br />
[Disease name] is a medical emergency and requires prompt treatment.<br />
<br />
OR<br />
<br />
The mainstay of treatment for [disease name] is [therapy].<br />
<br />
OR<br />
<br />
The optimal therapy for [malignancy name] depends on the stage at diagnosis.<br />
<br />
OR<br />
<br />
[Therapy] is recommended among all patients who develop [disease name].<br />
<br />
OR<br />
<br />
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].<br />
<br />
OR<br />
<br />
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].<br />
<br />
OR<br />
<br />
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].<br />
<br />
OR<br />
<br />
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].<br />
<br />
===Surgery===<br />
Surgical intervention is not recommended for the management of [disease name].<br />
<br />
OR<br />
<br />
Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]<br />
<br />
OR<br />
<br />
The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].<br />
<br />
OR<br />
<br />
The feasibility of surgery depends on the stage of [malignancy] at diagnosis.<br />
<br />
OR<br />
<br />
Surgery is the mainstay of treatment for [disease or malignancy].<br />
<br />
===Primary Prevention===<br />
There are no established measures for the primary prevention of [disease name].<br />
<br />
OR<br />
<br />
There are no available vaccines against [disease name].<br />
<br />
OR<br />
<br />
Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].<br />
<br />
OR<br />
<br />
[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].<br />
<br />
===Secondary Prevention===<br />
There are no established measures for the secondary prevention of [disease name].<br />
<br />
OR<br />
<br />
Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].<br />
<br />
== See also ==<br />
[[Spinal cord injury]]<br />
<br />
== References ==<br />
<references/><br />
*http://health.enotes.com/neurological-disorders-encyclopedia/central-cord-syndrome<br />
*http://www.ninds.nih.gov/disorders/central_cord/central_cord.htm<br />
<br />
{{disease-stub}}<br />
{{Lesions of spinal cord and brainstem}}<br />
[[Category:Disease stubs]]<br />
[[Category:Syndromes]]<br />
{{WikiDoc Help Menu}}</div>Abdulkareem Opeoluwalukanhttps://www.wikidoc.org/index.php?title=Central_cord_syndrome&diff=1647256Central cord syndrome2020-08-04T21:14:47Z<p>Abdulkareem Opeoluwalukan: /* Classification */</p>
<hr />
<div>__NOTOC__<br />
{{Infobox_Disease<br />
| Name = Central Cord Syndrome<br />
| Image = Cord.svg<br />
| Caption = Central cord syndrome is top diagram<br />
| Width = 100px<br />
| DiseasesDB = 33409<br />
| ICD10 =<br />
| ICD9 = {{ICD9|952.18}}<br />
| ICDO = <br />
| OMIM = <br />
| MedlinePlus = <br />
| eMedicineSubj = pmr<br />
| eMedicineTopic = 22<br />
| MeshID = D020210<br />
}}<br />
<br />
'''Central cord syndrome''' (CCS) is an [[Acute (medical)|acute]] [[cervical]] [[spinal cord injury]] (SCI), characterized by disproportionately greater motor impairment in upper compared to lower extremities, [[bladder dysfunction]], and variable degree of sensory loss below the level of injury. This syndrome is unlike a complete [[lesion]], that causes loss of all sensation and movement below the level of the injury. First described by Schneider in 1954,<ref>{{cite journal |author=Schneider RC, Cherry G, Pantek H |title=The syndrome of acute central cervical spinal cord injury; with special reference to the mechanisms involved in [[hyperextension]] injuries of cervical spine |journal=J. Neurosurg. |volume=11 |issue=6 |pages=546-77 |year=1954 |pmid=13222164 |doi=}}</ref> CCS has been reported to occur more frequently among older persons with cervical spondylosis who sustain hyperextension injury. Though it also may occur in persons of any age. CCS is the most common incomplete SCI syndrome.<br />
<br />
CCS most often occurs after hyperextension injury in an individual with long-standing [[cervical spondylosis]]. Historically, spinal cord damage was believed to originate from concussion or contusion of the cord with stasis of [[axoplasmic]] flow, causing [[edematous]] injury rather than destructive [[hematomyelia]]. More recently, autopsy studies have demonstrated that CCS may be caused by bleeding into the central part of the cord, portending less favorable prognosis. Studies also have shown that CCS probably is associated with axonal disruption in the [[lateral column]]s at the level of the injury to the spinal cord with relative preservation of the [[grey matter]]. <br />
<br />
In the US the [[prevalence]] rate is 15.7-25% however this syndrome is generally associated with favorable prognosis for some degree of neurologic and functional recovery. CCS predominantly affects men more than women, similar to all other SCI. <br />
==Historical Perspective==<br />
*Central Cord Syndrome was first described by Schneider , et al in 1954.<ref name="GuestEleraky2002">{{cite journal|last1=Guest|first1=James|last2=Eleraky|first2=Mohammed A.|last3=Apostolides|first3=Paul J.|last4=Dickman|first4=Curtis A.|last5=Sonntag|first5=Volker K. H.|title=Traumatic central cord syndrome: results of surgical management|journal=Journal of Neurosurgery: Spine|volume=97|issue=1|year=2002|pages=25–32|issn=1547-5654|doi=10.3171/spi.2002.97.1.0025}}</ref><br />
<br />
*Quencer, et al was the first to discover the association between neuroradiological and pathologic findings and the development of Central Cord Syndrome.<ref name="GuestEleraky2002">{{cite journal|last1=Guest|first1=James|last2=Eleraky|first2=Mohammed A.|last3=Apostolides|first3=Paul J.|last4=Dickman|first4=Curtis A.|last5=Sonntag|first5=Volker K. H.|title=Traumatic central cord syndrome: results of surgical management|journal=Journal of Neurosurgery: Spine|volume=97|issue=1|year=2002|pages=25–32|issn=1547-5654|doi=10.3171/spi.2002.97.1.0025}}</ref><br />
<br />
*Raynor and Koplik described that the central part of the spinal cord was most affected when a moderate force was applied in an anterior posterior direction using the stress analysis theory.<ref name="GuestEleraky2002">{{cite journal|last1=Guest|first1=James|last2=Eleraky|first2=Mohammed A.|last3=Apostolides|first3=Paul J.|last4=Dickman|first4=Curtis A.|last5=Sonntag|first5=Volker K. H.|title=Traumatic central cord syndrome: results of surgical management|journal=Journal of Neurosurgery: Spine|volume=97|issue=1|year=2002|pages=25–32|issn=1547-5654|doi=10.3171/spi.2002.97.1.0025}}</ref><br />
<br />
*In early 1970s surgical treatment was suggested by Quencer, et al to treat Central Cord syndrome.<ref name="GuestEleraky2002">{{cite journal|last1=Guest|first1=James|last2=Eleraky|first2=Mohammed A.|last3=Apostolides|first3=Paul J.|last4=Dickman|first4=Curtis A.|last5=Sonntag|first5=Volker K. H.|title=Traumatic central cord syndrome: results of surgical management|journal=Journal of Neurosurgery: Spine|volume=97|issue=1|year=2002|pages=25–32|issn=1547-5654|doi=10.3171/spi.2002.97.1.0025}}</ref><br />
<br />
==Classification==<br />
There is no established system for the classification of Central Cord Syndrome.<br />
<br />
==Pathophysiology==<br />
The exact pathogenesis of [disease name] is not fully understood.<br />
<br />
OR<br />
<br />
It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].<br />
<br />
OR<br />
<br />
[Pathogen name] is usually transmitted via the [transmission route] route to the human host.<br />
<br />
OR<br />
<br />
Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.<br />
<br />
OR<br />
<br />
<br />
[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].<br />
<br />
OR<br />
<br />
The progression to [disease name] usually involves the [molecular pathway].<br />
<br />
OR<br />
<br />
The pathophysiology of [disease/malignancy] depends on the histological subtype.<br />
<br />
==Causes==<br />
Disease name] may be caused by [cause1], [cause2], or [cause3].<br />
<br />
OR<br />
<br />
Common causes of [disease] include [cause1], [cause2], and [cause3].<br />
<br />
OR<br />
<br />
The most common cause of [disease name] is [cause 1]. Less common causes of [disease name] include [cause 2], [cause 3], and [cause 4].<br />
<br />
OR<br />
<br />
The cause of [disease name] has not been identified. To review risk factors for the development of [disease name], click [[Pericarditis causes#Overview|here]].<br />
<br />
==Differentiating ((Page name)) from other Diseases==<br />
[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].<br />
<br />
OR<br />
<br />
[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].<br />
<br />
==Epidemiology and Demographics==<br />
The incidence/prevalence of [disease name] is approximately [number range] per 100,000 individuals worldwide.<br />
<br />
OR<br />
<br />
In [year], the incidence/prevalence of [disease name] was estimated to be [number range] cases per 100,000 individuals worldwide.<br />
<br />
OR<br />
<br />
In [year], the incidence of [disease name] is approximately [number range] per 100,000 individuals with a case-fatality rate of [number range]%.<br />
<br />
<br />
<br />
Patients of all age groups may develop [disease name].<br />
<br />
OR<br />
<br />
The incidence of [disease name] increases with age; the median age at diagnosis is [#] years.<br />
<br />
OR<br />
<br />
[Disease name] commonly affects individuals younger than/older than [number of years] years of age.<br />
<br />
OR <br />
<br />
[Chronic disease name] is usually first diagnosed among [age group].<br />
<br />
OR<br />
<br />
[Acute disease name] commonly affects [age group].<br />
<br />
<br />
<br />
There is no racial predilection to [disease name].<br />
<br />
OR<br />
<br />
[Disease name] usually affects individuals of the [race 1] race. [Race 2] individuals are less likely to develop [disease name].<br />
<br />
<br />
<br />
[Disease name] affects men and women equally.<br />
<br />
OR<br />
<br />
[Gender 1] are more commonly affected by [disease name] than [gender 2]. The [gender 1] to [gender 2] ratio is approximately [number > 1] to 1.<br />
<br />
<br />
<br />
The majority of [disease name] cases are reported in [geographical region].<br />
<br />
OR<br />
<br />
[Disease name] is a common/rare disease that tends to affect [patient population 1] and [patient population 2].<br />
<br />
==Risk Factors==<br />
There are no established risk factors for [disease name].<br />
<br />
OR<br />
<br />
The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].<br />
<br />
OR<br />
<br />
Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].<br />
<br />
OR<br />
<br />
Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.<br />
<br />
==Screening==<br />
There is insufficient evidence to recommend routine screening for [disease/malignancy].<br />
<br />
OR<br />
<br />
According to the [guideline name], screening for [disease name] is not recommended.<br />
<br />
OR<br />
<br />
According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].<br />
<br />
==Natural History, Complications, and Prognosis==<br />
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].<br />
<br />
OR<br />
<br />
Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].<br />
<br />
OR<br />
<br />
Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.<br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].<br />
<br />
OR<br />
<br />
The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].<br />
<br />
OR<br />
<br />
The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].<br />
<br />
OR<br />
<br />
There are no established criteria for the diagnosis of [disease name].<br />
<br />
===History and Symptoms===<br />
The majority of patients with [disease name] are asymptomatic.<br />
<br />
OR<br />
<br />
The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].<br />
<br />
===Physical Examination===<br />
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].<br />
<br />
OR<br />
<br />
Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].<br />
<br />
OR<br />
<br />
The presence of [finding(s)] on physical examination is diagnostic of [disease name].<br />
<br />
OR<br />
<br />
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].<br />
<br />
===Laboratory Findings===<br />
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].<br />
<br />
OR<br />
<br />
Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].<br />
<br />
OR<br />
<br />
[Test] is usually normal among patients with [disease name].<br />
<br />
OR<br />
<br />
Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].<br />
<br />
OR<br />
<br />
There are no diagnostic laboratory findings associated with [disease name].<br />
<br />
===Electrocardiogram===<br />
There are no ECG findings associated with [disease name].<br />
<br />
OR<br />
<br />
An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].<br />
<br />
===X-ray===<br />
There are no x-ray findings associated with [disease name].<br />
<br />
OR<br />
<br />
An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].<br />
<br />
OR<br />
<br />
There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].<br />
<br />
===Echocardiography or Ultrasound===<br />
There are no echocardiography/ultrasound findings associated with [disease name].<br />
<br />
OR<br />
<br />
Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].<br />
<br />
OR<br />
<br />
There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].<br />
<br />
===CT scan===<br />
There are no CT scan findings associated with [disease name].<br />
<br />
OR<br />
<br />
[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].<br />
<br />
OR<br />
<br />
There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].<br />
<br />
===MRI===<br />
There are no MRI findings associated with [disease name].<br />
<br />
OR<br />
<br />
[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].<br />
<br />
OR<br />
<br />
There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].<br />
<br />
===Other Imaging Findings===<br />
There are no other imaging findings associated with [disease name].<br />
<br />
OR<br />
<br />
[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].<br />
<br />
===Other Diagnostic Studies===<br />
There are no other diagnostic studies associated with [disease name].<br />
<br />
OR<br />
<br />
[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].<br />
<br />
OR<br />
<br />
Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].<br />
<br />
==Treatment==<br />
===Medical Therapy===<br />
There is no treatment for [disease name]; the mainstay of therapy is supportive care.<br />
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OR<br />
<br />
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].<br />
<br />
OR<br />
<br />
The majority of cases of [disease name] are self-limited and require only supportive care.<br />
<br />
OR<br />
<br />
[Disease name] is a medical emergency and requires prompt treatment.<br />
<br />
OR<br />
<br />
The mainstay of treatment for [disease name] is [therapy].<br />
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OR<br />
<br />
The optimal therapy for [malignancy name] depends on the stage at diagnosis.<br />
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OR<br />
<br />
[Therapy] is recommended among all patients who develop [disease name].<br />
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OR<br />
<br />
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].<br />
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OR<br />
<br />
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].<br />
<br />
OR<br />
<br />
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].<br />
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OR<br />
<br />
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].<br />
<br />
===Surgery===<br />
Surgical intervention is not recommended for the management of [disease name].<br />
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OR<br />
<br />
Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]<br />
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OR<br />
<br />
The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].<br />
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OR<br />
<br />
The feasibility of surgery depends on the stage of [malignancy] at diagnosis.<br />
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OR<br />
<br />
Surgery is the mainstay of treatment for [disease or malignancy].<br />
<br />
===Primary Prevention===<br />
There are no established measures for the primary prevention of [disease name].<br />
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OR<br />
<br />
There are no available vaccines against [disease name].<br />
<br />
OR<br />
<br />
Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].<br />
<br />
OR<br />
<br />
[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].<br />
<br />
===Secondary Prevention===<br />
There are no established measures for the secondary prevention of [disease name].<br />
<br />
OR<br />
<br />
Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].<br />
<br />
== See also ==<br />
[[Spinal cord injury]]<br />
<br />
== References ==<br />
<references/><br />
*http://health.enotes.com/neurological-disorders-encyclopedia/central-cord-syndrome<br />
*http://www.ninds.nih.gov/disorders/central_cord/central_cord.htm<br />
<br />
{{disease-stub}}<br />
{{Lesions of spinal cord and brainstem}}<br />
[[Category:Disease stubs]]<br />
[[Category:Syndromes]]<br />
{{WikiDoc Help Menu}}</div>Abdulkareem Opeoluwalukanhttps://www.wikidoc.org/index.php?title=Central_cord_syndrome&diff=1647217Central cord syndrome2020-08-04T19:32:11Z<p>Abdulkareem Opeoluwalukan: /* Historical Perspective */</p>
<hr />
<div>__NOTOC__<br />
{{Infobox_Disease<br />
| Name = Central Cord Syndrome<br />
| Image = Cord.svg<br />
| Caption = Central cord syndrome is top diagram<br />
| Width = 100px<br />
| DiseasesDB = 33409<br />
| ICD10 =<br />
| ICD9 = {{ICD9|952.18}}<br />
| ICDO = <br />
| OMIM = <br />
| MedlinePlus = <br />
| eMedicineSubj = pmr<br />
| eMedicineTopic = 22<br />
| MeshID = D020210<br />
}}<br />
<br />
'''Central cord syndrome''' (CCS) is an [[Acute (medical)|acute]] [[cervical]] [[spinal cord injury]] (SCI), characterized by disproportionately greater motor impairment in upper compared to lower extremities, [[bladder dysfunction]], and variable degree of sensory loss below the level of injury. This syndrome is unlike a complete [[lesion]], that causes loss of all sensation and movement below the level of the injury. First described by Schneider in 1954,<ref>{{cite journal |author=Schneider RC, Cherry G, Pantek H |title=The syndrome of acute central cervical spinal cord injury; with special reference to the mechanisms involved in [[hyperextension]] injuries of cervical spine |journal=J. Neurosurg. |volume=11 |issue=6 |pages=546-77 |year=1954 |pmid=13222164 |doi=}}</ref> CCS has been reported to occur more frequently among older persons with cervical spondylosis who sustain hyperextension injury. Though it also may occur in persons of any age. CCS is the most common incomplete SCI syndrome.<br />
<br />
CCS most often occurs after hyperextension injury in an individual with long-standing [[cervical spondylosis]]. Historically, spinal cord damage was believed to originate from concussion or contusion of the cord with stasis of [[axoplasmic]] flow, causing [[edematous]] injury rather than destructive [[hematomyelia]]. More recently, autopsy studies have demonstrated that CCS may be caused by bleeding into the central part of the cord, portending less favorable prognosis. Studies also have shown that CCS probably is associated with axonal disruption in the [[lateral column]]s at the level of the injury to the spinal cord with relative preservation of the [[grey matter]]. <br />
<br />
In the US the [[prevalence]] rate is 15.7-25% however this syndrome is generally associated with favorable prognosis for some degree of neurologic and functional recovery. CCS predominantly affects men more than women, similar to all other SCI. <br />
==Historical Perspective==<br />
*Central Cord Syndrome was first described by Schneider , et al in 1954.<ref name="GuestEleraky2002">{{cite journal|last1=Guest|first1=James|last2=Eleraky|first2=Mohammed A.|last3=Apostolides|first3=Paul J.|last4=Dickman|first4=Curtis A.|last5=Sonntag|first5=Volker K. H.|title=Traumatic central cord syndrome: results of surgical management|journal=Journal of Neurosurgery: Spine|volume=97|issue=1|year=2002|pages=25–32|issn=1547-5654|doi=10.3171/spi.2002.97.1.0025}}</ref><br />
<br />
*Quencer, et al was the first to discover the association between neuroradiological and pathologic findings and the development of Central Cord Syndrome.<ref name="GuestEleraky2002">{{cite journal|last1=Guest|first1=James|last2=Eleraky|first2=Mohammed A.|last3=Apostolides|first3=Paul J.|last4=Dickman|first4=Curtis A.|last5=Sonntag|first5=Volker K. H.|title=Traumatic central cord syndrome: results of surgical management|journal=Journal of Neurosurgery: Spine|volume=97|issue=1|year=2002|pages=25–32|issn=1547-5654|doi=10.3171/spi.2002.97.1.0025}}</ref><br />
<br />
*Raynor and Koplik described that the central part of the spinal cord was most affected when a moderate force was applied in an anterior posterior direction using the stress analysis theory.<ref name="GuestEleraky2002">{{cite journal|last1=Guest|first1=James|last2=Eleraky|first2=Mohammed A.|last3=Apostolides|first3=Paul J.|last4=Dickman|first4=Curtis A.|last5=Sonntag|first5=Volker K. H.|title=Traumatic central cord syndrome: results of surgical management|journal=Journal of Neurosurgery: Spine|volume=97|issue=1|year=2002|pages=25–32|issn=1547-5654|doi=10.3171/spi.2002.97.1.0025}}</ref><br />
<br />
*In early 1970s surgical treatment was suggested by Quencer, et al to treat Central Cord syndrome.<ref name="GuestEleraky2002">{{cite journal|last1=Guest|first1=James|last2=Eleraky|first2=Mohammed A.|last3=Apostolides|first3=Paul J.|last4=Dickman|first4=Curtis A.|last5=Sonntag|first5=Volker K. H.|title=Traumatic central cord syndrome: results of surgical management|journal=Journal of Neurosurgery: Spine|volume=97|issue=1|year=2002|pages=25–32|issn=1547-5654|doi=10.3171/spi.2002.97.1.0025}}</ref><br />
<br />
==Classification==<br />
There is no established system for the classification of [disease name].<br />
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[Disease name] may be classified according to [classification method] into [number] subtypes/groups: [group1], [group2], [group3], and [group4].<br />
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[Disease name] may be classified into [large number > 6] subtypes based on [classification method 1], [classification method 2], and [classification method 3].<br />
[Disease name] may be classified into several subtypes based on [classification method 1], [classification method 2], and [classification method 3].<br />
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Based on the duration of symptoms, [disease name] may be classified as either acute or chronic.<br />
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OR<br />
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If the staging system involves specific and characteristic findings and features:<br />
According to the [staging system + reference], there are [number] stages of [malignancy name] based on the [finding1], [finding2], and [finding3]. Each stage is assigned a [letter/number1] and a [letter/number2] that designate the [feature1] and [feature2].<br />
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OR<br />
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The staging of [malignancy name] is based on the [staging system].<br />
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OR<br />
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There is no established system for the staging of [malignancy name].<br />
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==Pathophysiology==<br />
The exact pathogenesis of [disease name] is not fully understood.<br />
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It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].<br />
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[Pathogen name] is usually transmitted via the [transmission route] route to the human host.<br />
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OR<br />
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Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.<br />
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[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].<br />
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OR<br />
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The progression to [disease name] usually involves the [molecular pathway].<br />
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OR<br />
<br />
The pathophysiology of [disease/malignancy] depends on the histological subtype.<br />
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==Causes==<br />
Disease name] may be caused by [cause1], [cause2], or [cause3].<br />
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OR<br />
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Common causes of [disease] include [cause1], [cause2], and [cause3].<br />
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The most common cause of [disease name] is [cause 1]. Less common causes of [disease name] include [cause 2], [cause 3], and [cause 4].<br />
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OR<br />
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The cause of [disease name] has not been identified. To review risk factors for the development of [disease name], click [[Pericarditis causes#Overview|here]].<br />
<br />
==Differentiating ((Page name)) from other Diseases==<br />
[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].<br />
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OR<br />
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[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].<br />
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==Epidemiology and Demographics==<br />
The incidence/prevalence of [disease name] is approximately [number range] per 100,000 individuals worldwide.<br />
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OR<br />
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In [year], the incidence/prevalence of [disease name] was estimated to be [number range] cases per 100,000 individuals worldwide.<br />
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OR<br />
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In [year], the incidence of [disease name] is approximately [number range] per 100,000 individuals with a case-fatality rate of [number range]%.<br />
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Patients of all age groups may develop [disease name].<br />
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OR<br />
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The incidence of [disease name] increases with age; the median age at diagnosis is [#] years.<br />
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OR<br />
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[Disease name] commonly affects individuals younger than/older than [number of years] years of age.<br />
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[Chronic disease name] is usually first diagnosed among [age group].<br />
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[Acute disease name] commonly affects [age group].<br />
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There is no racial predilection to [disease name].<br />
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OR<br />
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[Disease name] usually affects individuals of the [race 1] race. [Race 2] individuals are less likely to develop [disease name].<br />
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[Disease name] affects men and women equally.<br />
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OR<br />
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[Gender 1] are more commonly affected by [disease name] than [gender 2]. The [gender 1] to [gender 2] ratio is approximately [number > 1] to 1.<br />
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The majority of [disease name] cases are reported in [geographical region].<br />
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OR<br />
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[Disease name] is a common/rare disease that tends to affect [patient population 1] and [patient population 2].<br />
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==Risk Factors==<br />
There are no established risk factors for [disease name].<br />
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OR<br />
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The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].<br />
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OR<br />
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Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].<br />
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OR<br />
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Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.<br />
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==Screening==<br />
There is insufficient evidence to recommend routine screening for [disease/malignancy].<br />
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According to the [guideline name], screening for [disease name] is not recommended.<br />
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According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].<br />
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==Natural History, Complications, and Prognosis==<br />
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].<br />
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Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].<br />
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Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.<br />
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==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].<br />
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The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].<br />
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The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].<br />
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There are no established criteria for the diagnosis of [disease name].<br />
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===History and Symptoms===<br />
The majority of patients with [disease name] are asymptomatic.<br />
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The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].<br />
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===Physical Examination===<br />
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].<br />
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Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].<br />
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The presence of [finding(s)] on physical examination is diagnostic of [disease name].<br />
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The presence of [finding(s)] on physical examination is highly suggestive of [disease name].<br />
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===Laboratory Findings===<br />
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].<br />
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Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].<br />
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[Test] is usually normal among patients with [disease name].<br />
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Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].<br />
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OR<br />
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There are no diagnostic laboratory findings associated with [disease name].<br />
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===Electrocardiogram===<br />
There are no ECG findings associated with [disease name].<br />
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OR<br />
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An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].<br />
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===X-ray===<br />
There are no x-ray findings associated with [disease name].<br />
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OR<br />
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An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].<br />
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OR<br />
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There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].<br />
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===Echocardiography or Ultrasound===<br />
There are no echocardiography/ultrasound findings associated with [disease name].<br />
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OR<br />
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Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].<br />
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OR<br />
<br />
There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].<br />
<br />
===CT scan===<br />
There are no CT scan findings associated with [disease name].<br />
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OR<br />
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[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].<br />
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OR<br />
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There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].<br />
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===MRI===<br />
There are no MRI findings associated with [disease name].<br />
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OR<br />
<br />
[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].<br />
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OR<br />
<br />
There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].<br />
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===Other Imaging Findings===<br />
There are no other imaging findings associated with [disease name].<br />
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OR<br />
<br />
[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].<br />
<br />
===Other Diagnostic Studies===<br />
There are no other diagnostic studies associated with [disease name].<br />
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OR<br />
<br />
[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].<br />
<br />
OR<br />
<br />
Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].<br />
<br />
==Treatment==<br />
===Medical Therapy===<br />
There is no treatment for [disease name]; the mainstay of therapy is supportive care.<br />
<br />
OR<br />
<br />
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].<br />
<br />
OR<br />
<br />
The majority of cases of [disease name] are self-limited and require only supportive care.<br />
<br />
OR<br />
<br />
[Disease name] is a medical emergency and requires prompt treatment.<br />
<br />
OR<br />
<br />
The mainstay of treatment for [disease name] is [therapy].<br />
<br />
OR<br />
<br />
The optimal therapy for [malignancy name] depends on the stage at diagnosis.<br />
<br />
OR<br />
<br />
[Therapy] is recommended among all patients who develop [disease name].<br />
<br />
OR<br />
<br />
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].<br />
<br />
OR<br />
<br />
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].<br />
<br />
OR<br />
<br />
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].<br />
<br />
OR<br />
<br />
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].<br />
<br />
===Surgery===<br />
Surgical intervention is not recommended for the management of [disease name].<br />
<br />
OR<br />
<br />
Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]<br />
<br />
OR<br />
<br />
The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].<br />
<br />
OR<br />
<br />
The feasibility of surgery depends on the stage of [malignancy] at diagnosis.<br />
<br />
OR<br />
<br />
Surgery is the mainstay of treatment for [disease or malignancy].<br />
<br />
===Primary Prevention===<br />
There are no established measures for the primary prevention of [disease name].<br />
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OR<br />
<br />
There are no available vaccines against [disease name].<br />
<br />
OR<br />
<br />
Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].<br />
<br />
OR<br />
<br />
[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].<br />
<br />
===Secondary Prevention===<br />
There are no established measures for the secondary prevention of [disease name].<br />
<br />
OR<br />
<br />
Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].<br />
<br />
== See also ==<br />
[[Spinal cord injury]]<br />
<br />
== References ==<br />
<references/><br />
*http://health.enotes.com/neurological-disorders-encyclopedia/central-cord-syndrome<br />
*http://www.ninds.nih.gov/disorders/central_cord/central_cord.htm<br />
<br />
{{disease-stub}}<br />
{{Lesions of spinal cord and brainstem}}<br />
[[Category:Disease stubs]]<br />
[[Category:Syndromes]]<br />
{{WikiDoc Help Menu}}</div>Abdulkareem Opeoluwalukanhttps://www.wikidoc.org/index.php?title=Pentalogy_of_Fallot&diff=1627175Pentalogy of Fallot2020-07-15T13:57:18Z<p>Abdulkareem Opeoluwalukan: /* Historical Perspective */</p>
<hr />
<div>__NOTOC__<br />
{{SI}}<br />
{{CMG}} {{AE}}[[User:Abdulkareem Opeoluwalukan|Abdulkareem Opeoluwalukan, M.D]].<br />
==Overview==<br />
Pentalogy of Fallot is defined as the occurrence of Tetralogy of Fallot plus an [[atrial septal defect]].[[File:Pentalogy_of_fallot_image_1.png |200p|thumb|center| Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa. paolo.pazzi@up.ac.za.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3984729/]]<br />
<br />
==Historical Perspective==<br />
<br />
*[[Tetrallogy of fallot|Tetralogy of fallot]] was first discovered by Niel Stenson, a Denish physician Anatomist, in 1671. <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
* The association between [[right ventricular outflow tract obstruction]] and a large [[ventricular septal defect]] and [[Tetralogy of Fallot|tetralogy of fallot]]. was made in 1888 by Etinne-Louise.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref><br />
<br />
* In 1924, Canadian, Maude Abbott was the first to discover the association between [[ventricular septal defect]] , [[Pulmonary valve stenosis|pulmonary stenosis]], [[overriding aorta]] and [[right ventricular hypertrophy]] and the development of [[tetralogy of Fallot]].<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref<br />
In 1939, the first surgical treatment was developed by Dr Helen Taussig in Johns Hopkins&amp;amp;lt;nowiki&amp;amp;gt;&&amp;amp;lt;/nowiki&amp;amp;gt;lt;nowiki&amp;lt;nowiki&amp;gt;&&amp;lt;/nowiki&amp;gt;gt;&lt;nowiki&gt;&&lt;/nowiki&gt;lt;nowiki<nowiki>&</nowiki>gt;<nowiki>&lt;nowiki&gt;<ref name="pmid30020660">&lt;/nowiki&gt;</nowiki>&lt;/nowiki&gt;&lt;/nowiki&gt;{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Classification==<br />
<br />
* There is no established system for the classification of pentalogy of fallot.<br />
<br />
<br /><br />
<br />
==Pathophysiology==<br />
<br />
It is thought that conotruncal Diseases like [[Tetralogy of Fallot|tetralogy of fallot]] and pentalogy of fallot occur as a result of <br />
<br />
* Neural Crest migration defect. <br />
* Underdevelopment of right ventricular infundibulum.<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
<br />
==Causes==<br />
<br />
<br />
<br />
<br />
The cause of pentalogy of fallot has not been identified. To review risk factors for the development of pentalogy of fallot, click [[tetralogy of fallot causes#Overview|here]].<br />
<br />
==Differentiating pentalogy of fallot from other Diseases==<br />
Pentalogy of Fallot must be differentiated from other diseases that cause .<ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
===Right to left shunt=== <br />
*[[Transposition of the great vessels|Transposition of great arteries]] with [[Right ventricular outflow tract obstruction|Pulmonic stenosis]]<br />
*[[Double outlet right ventricle]] including [[Taussig-Bing syndrome|Taussig-Bing anomaly]]<br />
*[[Tricuspid atresia]]<br />
* Ebstein Anomaly<br />
*[[Pulmonary atresia]] with intact [[Interventricular septum|ventricular septum]]<br />
*Respiratory diseases<br />
<br />
* Bronchiolitis,<br />
*Viral and bacterial [[Pneumonia]]<br />
*[[Pneumothorax]] because when they are in [[Congestive heart failure|heart failure]] they present with signs of respiratory distress, [[cyanosis]] and [[failure to thrive]]<br />
<br />
=== Bidirectional shunt diseases===<br />
* Total anomalous pulmonary venous return,<br />
*[[Hypoplastic left heart syndrome]],<br />
*[[Single ventricle]]<br />
*[[Persistent truncus arteriosus|Truncus arteriosus]].<br />
<br />
==Epidemiology and Demographics==<br />
The epidemiology of pentalogy of fallot has not been well studied.<br />
<br />
==Risk Factors==<br />
<br />
<br />
<br />
<br />
Common risk factors in the development of pentalogy of fallot includes<ref name="SilvaNeves2019">{{cite journal|last1=Silva|first1=Joana A.|last2=Neves|first2=Ana L.|last3=Flor-de-Lima|first3=Filipa|last4=Soares|first4=Paulo|last5=Guimarães|first5=Hercília|title=Risk Factors and Outcomes of Tetralogy of Fallot: From Fetal to Neonatal Life|journal=Pediatric Cardiology|volume=41|issue=1|year=2019|pages=155–164|issn=0172-0643|doi=10.1007/s00246-019-02239-4}}</ref><br />
<br />
*[[Alcoholism]] in mother<br />
* Maternal [[Diabetes]]<br />
* Advanced maternal age i.e greater than 40 years <br />
*[[Malnutrition]] in pregnancy<br />
* Family history of [[Tetralogy of Fallot|tetralogy of fallot]]<br />
* Viral illness during pregnancy like [[Rubella]].<br />
* Presence of [[Down syndrome]] or [[22q11.2 deletion syndrome|DiGeorge syndrome]]<br />
<br />
==Screening==<br />
There is insufficient evidence to recommend routine screening for pentalogy of fallot.<br />
<br />
==Natural History, Complications, and Prognosis==<br />
If left untreated, patients with pentalogy of fallot may progress to develop [[Clubbing|finger clubbing]], [[stunted growth]], [[Cardiac arrhythmia|cardiac arrhythmias]], hypoplastic pulmonary artery, [[Paradoxical embolism|paradoxical emboli]] and [[polycythemia]] .<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
<br />
Prognosis is generally excellent provided the [[Ventricular septal defect|VSD]] has been closed and the [[right ventricular outflow tract]] has been relieved.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. 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C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
<br />
<br />
There are no established criteria for the diagnosis of pentalogy fallot.<br />
<br />
===History and Symptoms===<br />
<br />
The hallmark of pentalogy of fallot is [[cyanosis]]. A positive history of [[cyanosis]] and easy fatigability leading to squatting during exercise is suggestive of cyanotic congenital heart defect.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. 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A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
. The most common symptoms of pentalogy of fallot include [[cyanosis]], easy fatigabillity , and hypercyanotic spells with crying , feeding and defecating.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
==Physical Examination==<br />
Patients with Pentalogy of Fallot appear cyanotic.<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref> Physical examination of patients with Pentalogy of Fallot is usually remarkable for<br />
* Right Ventricular Heave. <ref name="ParwaniPhillips2016">{{cite journal|last1=Parwani|first1=Purvi|last2=Phillips|first2=Sabrina|title=IMPORTANCE OF PHYSICAL EXAMINATION IN ADULT PATIENTS WITH TETRALOGY OF FALLOT|journal=Journal of the American College of Cardiology|volume=67|issue=13|year=2016|pages=1101|issn=07351097|doi=10.1016/S0735-1097(16)31102-0}}</ref><br />
* Elevated Jugular Venous pressure.<ref name="ParwaniPhillips2016">{{cite journal|last1=Parwani|first1=Purvi|last2=Phillips|first2=Sabrina|title=IMPORTANCE OF PHYSICAL EXAMINATION IN ADULT PATIENTS WITH TETRALOGY OF FALLOT|journal=Journal of the American College of Cardiology|volume=67|issue=13|year=2016|pages=1101|issn=07351097|doi=10.1016/S0735-1097(16)31102-0}}</ref><br />
*[[Clubbing|Finger clubbing]]. <ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
* Displaced Apex beat<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref>.<br />
* Normal S1 with single S2.<ref name="ParwaniPhillips2016">{{cite journal|last1=Parwani|first1=Purvi|last2=Phillips|first2=Sabrina|title=IMPORTANCE OF PHYSICAL EXAMINATION IN ADULT PATIENTS WITH TETRALOGY OF FALLOT|journal=Journal of the American College of Cardiology|volume=67|issue=13|year=2016|pages=1101|issn=07351097|doi=10.1016/S0735-1097(16)31102-0}}</ref><br />
*[[Pedal edema|Peripheral edema]]<ref name="ParwaniPhillips2016">{{cite journal|last1=Parwani|first1=Purvi|last2=Phillips|first2=Sabrina|title=IMPORTANCE OF PHYSICAL EXAMINATION IN ADULT PATIENTS WITH TETRALOGY OF FALLOT|journal=Journal of the American College of Cardiology|volume=67|issue=13|year=2016|pages=1101|issn=07351097|doi=10.1016/S0735-1097(16)31102-0}}</ref>.<br />
*[[Heart murmur|Diastolic murmur]] at the left sternal border. <ref name="ParwaniPhillips2016">{{cite journal|last1=Parwani|first1=Purvi|last2=Phillips|first2=Sabrina|title=IMPORTANCE OF PHYSICAL EXAMINATION IN ADULT PATIENTS WITH TETRALOGY OF FALLOT|journal=Journal of the American College of Cardiology|volume=67|issue=13|year=2016|pages=1101|issn=07351097|doi=10.1016/S0735-1097(16)31102-0}}</ref><br />
* Systolic Murmur increasing with inspiration at the left sternal border<ref name="ParwaniPhillips2016">{{cite journal|last1=Parwani|first1=Purvi|last2=Phillips|first2=Sabrina|title=IMPORTANCE OF PHYSICAL EXAMINATION IN ADULT PATIENTS WITH TETRALOGY OF FALLOT|journal=Journal of the American College of Cardiology|volume=67|issue=13|year=2016|pages=1101|issn=07351097|doi=10.1016/S0735-1097(16)31102-0}}</ref>.<br />
<br />
===Laboratory Findings===<br />
<br />
<br />
<br />
Some patients with pentalogy of fallot may have [[polycythemia]] <br />
which is usually suggestive of worsening [[hypoxia]] and compensatory production of erythropoetin.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
.<br />
<br />
===Electrocardiogram===<br />
<br />
An ECG may be helpful in the diagnosis of pentalogy of fallot, <br />
Findings on an ECG suggestive of pentalogy of fallot include [[right axis deviation]] and [[right ventricular hypertrophy]].<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
[[File: Right_ventrriular_hypertophy.png|200p|thumb|right|Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874376/]]<br />
<br />
===X-ray===<br />
<br />
<br />
<br />
<br />
An x-ray may be helpful in the diagnosis of pentalogy of Fallot. Findings on an x-ray suggestive of pentalogy of fallot include boot shaped heart or coeur en sabot.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref> [[File:Boot_shaped_heart.png|200p|thumb|left| Typical preoperative chest X‐ray of a 16‐month‐old boy with tetralogy of Fallot.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5412831/]]<br />
<br />
<br />
<br />
<br />
.<br />
<br />
===Echocardiography or Ultrasound===<br />
<br />
<br />
<br />
<br />
Echocardiography may be helpful in the diagnosis of pentalogy of fallot. Findings on an echocardiography diagnostic of pentalogy of fallot include.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
*[[Ventricular septal defect]].<br />
* Atrial septal defect.<br />
*[[Right ventricular outflow tract obstruction]].<br />
*[[overriding aorta]] [[File:Pentalogy_of_fallot_image_2.png|200p|thumb|left | Department of Biochemistry, University of Allahabad, Allahabad-211002, India.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3299189/]]<br />
<br />
===CT scan===<br />
<br />
<br />
Thoracic [[CT angiography]] may be helpful in the diagnosis of pentalogy of fallot. Findings on CT scan diagnostic of pentalogy of fallot include. <ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
*[[ventricular septal defect]].<br />
*[[right ventricular hypertrophy]],<br />
*[[pulmonary atresia]]<br />
*[[Aortopulmonary Window|aortopulmonary]] collateral arteries.<br />
<br />
===MRI===<br />
<br />
<br />
<br />
[[Cardiovascular magnetic resonance imaging (CMR)|cardiac MRI]] may be helpful in the diagnosis of pentalogy of fallot. Findings on MRI diagnostic of pentalogy of fallot include RVOT stenosis, [[VSD,]] [[ASD,]][[Overriding aorta]], [[right ventricular hypertrophy]] and hypoplastic pulmonary arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
<br />
<br />
===Other Imaging Findings===<br />
Other imaging findings for pentalogy of fallot include [[Right ventricular angiopraphy]] which demonstrates infundibular and [[pulmonary artery]] anatomy. left ventricular angiography, which demonstrates. <ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
*[[Ventricular septal defect|VSD]]<br />
*[[Atrial septal defect|ASD]],<br />
*[[Overiding aorta]]<br />
<br />
===Other Diagnostic Studies===<br />
<br />
There are no other diagnostic studies associated with pentalogy of Fallot<br />
<br />
==Treatment==<br />
===Medical Therapy===<br />
The mainstay of treatment for pentalogy of fallot is Surgery.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
Pharmacologic medical therapy is recommended among patients with severe [[Right ventricular outflow tract obstruction|RVOTO]] and hypercyanotic spells.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
<br />
Pharmacologic medical therapies for pentalogy of fallot include.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
<br />
*[[prostaglandin E1]] in neonates with ductal dependent pulmonary blood flow<br />
*[[Morphine]] and [[ketamine]] for sedation<br />
*vasopressors like [[phenylephrine]]<br />
*[[Propranolol|propanolol]] to decrease the need for palliative surgical intervention.<br />
* iron treatment to decrease frequency of spells. <br />
<br />
Patients with hypercyanotic spells are treated with,<br />
* oxygen <br />
*volume expansion <br />
* morphine sedation.<br />
<br />
===Surgery===<br />
<br />
<br />
<br />
Surgery is the mainstay of treatment for pentalogy of fallot. interventional procedures are used to relieve pulmonary obstructions and embolize colaterals. <br />
different surgical procedures can be done to treat pentalogy of fallot and it includes.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
* Pulmonary valvotomy( for stenotic pulmonic valve)<br />
* Pulmonary valvectomy( for small and thickened pulmonic valve) <br />
* Closure of [[Atrial septal defect|ASD]]/[[Ventricular septal defect|VSD]]<br />
* Shunt surgery for severe [[cyanosis]] or in patients with frequent spells in the first year of life<br />
* Blalock -Taussig Shunt- communication between the right or left [[pulmonary artery]] and the right or left [[subclavian artery]].<br />
* Waterson-Cooley Shunt- communication between the [[ascending aorta]] with the right [[pulmonary artery]]<br />
* Potts shunt-communication between the [[descending aorta]] and left [[pulmonary artery]]<br />
* Central shunt- Communication between the main [[Pulmonary artery|pulmonary arter]]<nowiki/>y and [[ascending aorta.]]<br />
<br />
===Primary Prevention===<br />
There are no established measures for the primary prevention of pentalogy of fallot .<br />
<br />
===Secondary Prevention===<br />
There are no established measures for the secondary prevention of pentalogy of fallot<br />
==References==<br />
{{reflist|2}}<br />
<br />
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{{WikiDoc Sources}}<br />
[[Category:Cardiology]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Abdulkareem Opeoluwalukanhttps://www.wikidoc.org/index.php?title=Pentalogy_of_Fallot&diff=1624131Pentalogy of Fallot2020-07-10T23:34:02Z<p>Abdulkareem Opeoluwalukan: /* Surgery */</p>
<hr />
<div>__NOTOC__<br />
{{SI}}<br />
{{CMG}} {{AE}}[[User:Abdulkareem Opeoluwalukan|Abdulkareem Opeoluwalukan, M.D]].<br />
==Overview==<br />
Pentalogy of Fallot is defined as the occurrence of Tetralogy of Fallot plus an [[atrial septal defect]].[[File:Pentalogy_of_fallot_image_1.png |200p|thumb|center| Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa. paolo.pazzi@up.ac.za.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3984729/]]<br />
<br />
==Historical Perspective==<br />
<br />
*[[Tetrallogy of fallot|Tetralogy of fallot]] was first discovered by Niel Stenson, a Denish physician Anatomist, in 1671. <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
* The association between right ventricular outflow tract obstruction and a large [[ventricular septal defect]] and tetralogy of fallot. was made in 1888 by Etinne-Louise.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref><br />
<br />
* In 1924, Canadian, Maude Abbott was the first to discover the association between ventricular septal defect , pulmonary stenosis, overriding aorta and right ventricular hypertrophy and the development of tetralogy of Fallot.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref<br />
In 1939, the first surgical treatment was developed by Dr Helen Taussig in Johns Hopkins&amp;lt;nowiki&amp;gt;&&amp;lt;/nowiki&amp;gt;lt;nowiki&lt;nowiki&gt;&&lt;/nowiki&gt;gt;<nowiki>&</nowiki>lt;nowiki<nowiki>&</nowiki>gt;<nowiki>&lt;nowiki&gt;<ref name="pmid30020660">&lt;/nowiki&gt;</nowiki>&lt;/nowiki&gt;&lt;/nowiki&gt;{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Classification==<br />
<br />
* There is no established system for the classification of pentalogy of fallot.<br />
<br />
<br /><br />
<br />
==Pathophysiology==<br />
<br />
It is thought that conotruncal Diseases like [[Tetralogy of Fallot|tetralogy of fallot]] and pentalogy of fallot occur as a result of <br />
<br />
* Neural Crest migration defect. <br />
* Underdevelopment of right ventricular infundibulum.<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
<br />
==Causes==<br />
<br />
<br />
<br />
<br />
The cause of pentalogy of fallot has not been identified. To review risk factors for the development of pentalogy of fallot, click [[tetralogy of fallot causes#Overview|here]].<br />
<br />
==Differentiating pentalogy of fallot from other Diseases==<br />
Pentalogy of Fallot must be differentiated from other diseases that cause .<ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
===Right to left shunt=== <br />
*[[Transposition of the great vessels|Transposition of great arteries]] with Pulmonic stenosis<br />
* Double outlet right ventricle including Taussig-Bing anomaly<br />
*[[Tricuspid atresia]]<br />
* Ebstein Anomaly<br />
*[[Pulmonary atresia]] with intact ventricular septum<br />
*Respiratory diseases<br />
<br />
* Bronchiolitis,<br />
*Viral and bacterial [[Pneumonia]]<br />
*[[Pneumothorax]] because when they are in heart failure they present with signs of respiratory distress, cyanosis and failure to thrive<br />
<br />
=== Bidirectional shunt diseases===<br />
* Total anomalous pulmonary venous return,<br />
*[[Hypoplastic left heart syndrome]],<br />
* Single ventricle <br />
*[[Persistent truncus arteriosus|Truncus arteriosus]].<br />
<br />
==Epidemiology and Demographics==<br />
The epidemiology of pentalogy of fallot has not been well studied.<br />
<br />
==Risk Factors==<br />
<br />
<br />
<br />
<br />
Common risk factors in the development of pentalogy of fallot includes<ref name="SilvaNeves2019">{{cite journal|last1=Silva|first1=Joana A.|last2=Neves|first2=Ana L.|last3=Flor-de-Lima|first3=Filipa|last4=Soares|first4=Paulo|last5=Guimarães|first5=Hercília|title=Risk Factors and Outcomes of Tetralogy of Fallot: From Fetal to Neonatal Life|journal=Pediatric Cardiology|volume=41|issue=1|year=2019|pages=155–164|issn=0172-0643|doi=10.1007/s00246-019-02239-4}}</ref><br />
<br />
* Alcoholism in mother <br />
* Maternal Diabetes <br />
* Advanced maternal age i.e greater than 40 years <br />
* Malnutrition in pregnancy <br />
* Family history of tetralogy of fallot <br />
* Viral illness during pregnancy like [[Rubella]].<br />
* Presence of [[Down syndrome]] or [[22q11.2 deletion syndrome|DiGeorge syndrome]]<br />
<br />
==Screening==<br />
There is insufficient evidence to recommend routine screening for pentalogy of fallot.<br />
<br />
==Natural History, Complications, and Prognosis==<br />
If left untreated, patients with pentalogy of fallot may progress to develop finger clubbing, stunted growth, cardiac arrhythmias, hypoplastic pulmonary artery, paradoxical emboli and [[polycythemia]] .<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
<br />
Prognosis is generally excellent provided the [[Ventricular septal defect|VSD]] has been closed and the right ventricular outflow tract has been relieved.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
<br />
<br />
There are no established criteria for the diagnosis of pentalogy fallot.<br />
<br />
===History and Symptoms===<br />
<br />
The hallmark of pentalogy of fallot is cyanosis. A positive history of cyanosis and easy fatigability leading to squatting during exercise is suggestive of cyanotic congenital heart defect.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
. The most common symptoms of pentalogy of fallot include cyanosis, easy fatigabillity , and hypercyanotic spells with crying , feeding and defecating.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
==Physical Examination==<br />
Patients with Pentalogy of Fallot appear cyanotic.<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref> Physical examination of patients with Pentalogy of Fallot is usually remarkable for<br />
* Right Ventricular Heave. <ref name="ParwaniPhillips2016">{{cite journal|last1=Parwani|first1=Purvi|last2=Phillips|first2=Sabrina|title=IMPORTANCE OF PHYSICAL EXAMINATION IN ADULT PATIENTS WITH TETRALOGY OF FALLOT|journal=Journal of the American College of Cardiology|volume=67|issue=13|year=2016|pages=1101|issn=07351097|doi=10.1016/S0735-1097(16)31102-0}}</ref><br />
* Elevated Jugular Venous pressure.<ref name="ParwaniPhillips2016">{{cite journal|last1=Parwani|first1=Purvi|last2=Phillips|first2=Sabrina|title=IMPORTANCE OF PHYSICAL EXAMINATION IN ADULT PATIENTS WITH TETRALOGY OF FALLOT|journal=Journal of the American College of Cardiology|volume=67|issue=13|year=2016|pages=1101|issn=07351097|doi=10.1016/S0735-1097(16)31102-0}}</ref><br />
* Finger clubbing. <ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
* Displaced Apex beat<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref>. <br />
* Normal S1 with single S2.<ref name="ParwaniPhillips2016">{{cite journal|last1=Parwani|first1=Purvi|last2=Phillips|first2=Sabrina|title=IMPORTANCE OF PHYSICAL EXAMINATION IN ADULT PATIENTS WITH TETRALOGY OF FALLOT|journal=Journal of the American College of Cardiology|volume=67|issue=13|year=2016|pages=1101|issn=07351097|doi=10.1016/S0735-1097(16)31102-0}}</ref><br />
* Peripheral edema<ref name="ParwaniPhillips2016">{{cite journal|last1=Parwani|first1=Purvi|last2=Phillips|first2=Sabrina|title=IMPORTANCE OF PHYSICAL EXAMINATION IN ADULT PATIENTS WITH TETRALOGY OF FALLOT|journal=Journal of the American College of Cardiology|volume=67|issue=13|year=2016|pages=1101|issn=07351097|doi=10.1016/S0735-1097(16)31102-0}}</ref>. <br />
* Diastolic murmur at the left sternal border. <ref name="ParwaniPhillips2016">{{cite journal|last1=Parwani|first1=Purvi|last2=Phillips|first2=Sabrina|title=IMPORTANCE OF PHYSICAL EXAMINATION IN ADULT PATIENTS WITH TETRALOGY OF FALLOT|journal=Journal of the American College of Cardiology|volume=67|issue=13|year=2016|pages=1101|issn=07351097|doi=10.1016/S0735-1097(16)31102-0}}</ref><br />
* Systolic Murmur increasing with inspiration at the left sternal border<ref name="ParwaniPhillips2016">{{cite journal|last1=Parwani|first1=Purvi|last2=Phillips|first2=Sabrina|title=IMPORTANCE OF PHYSICAL EXAMINATION IN ADULT PATIENTS WITH TETRALOGY OF FALLOT|journal=Journal of the American College of Cardiology|volume=67|issue=13|year=2016|pages=1101|issn=07351097|doi=10.1016/S0735-1097(16)31102-0}}</ref>.<br />
<br />
===Laboratory Findings===<br />
<br />
<br />
<br />
Some patients with pentalogy of fallot may have [[polycythemia]] <br />
which is usually suggestive of worsening hypoxia and compensatory production of erythropoetin.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
.<br />
<br />
===Electrocardiogram===<br />
<br />
An ECG may be helpful in the diagnosis of pentalogy of fallot, <br />
Findings on an ECG suggestive of pentalogy of fallot include [[right axis deviation]] and right ventricular hypertrophy.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
[[File: Right_ventrriular_hypertophy.png|200p|thumb|right|Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874376/]]<br />
<br />
===X-ray===<br />
<br />
<br />
<br />
<br />
An x-ray may be helpful in the diagnosis of pentalogy of Fallot. Findings on an x-ray suggestive of pentalogy of fallot include boot shaped heart or coeur en sabot.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref> [[File:Boot_shaped_heart.png|200p|thumb|left| Typical preoperative chest X‐ray of a 16‐month‐old boy with tetralogy of Fallot.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5412831/]]<br />
<br />
<br />
<br />
<br />
.<br />
<br />
===Echocardiography or Ultrasound===<br />
<br />
<br />
<br />
<br />
Echocardiography may be helpful in the diagnosis of pentalogy of fallot. Findings on an echocardiography diagnostic of pentalogy of fallot include.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
* Ventricular septal defect.<br />
* Atrial septal defect.<br />
* Right ventricular outflow tract obstruction.<br />
* overriding aorta [[File:Pentalogy_of_fallot_image_2.png|200p|thumb|left | Department of Biochemistry, University of Allahabad, Allahabad-211002, India.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3299189/]]<br />
<br />
===CT scan===<br />
<br />
<br />
Thoracic CT angiography may be helpful in the diagnosis of pentalogy of fallot. Findings on CT scan diagnostic of pentalogy of fallot include. <ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
*ventricular septal defect.<br />
* right ventricular hypertrophy,<br />
* pulmonary atresia <br />
* aortopulmonary collateral arteries.<br />
<br />
===MRI===<br />
<br />
<br />
cardiac MRI may be helpful in the diagnosis of pentalogy of fallot. Findings on MRI diagnostic of pentalogy of fallot include RVOT stenosis, VSD, ASD,Overriding aorta, right ventricular hypertrophy and hypoplastic pulmonary arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
<br />
<br />
===Other Imaging Findings===<br />
Other imaging findings for pentalogy of fallot include Right ventricular angiopraphy which demonstrates infundibular and pulmonary artery anatomy. left ventricular angiography, which demonstrates. <ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
*VSD<br />
* ASD, <br />
* Overiding aorta<br />
<br />
===Other Diagnostic Studies===<br />
<br />
There are no other diagnostic studies associated with pentalogy of Fallot<br />
<br />
==Treatment==<br />
===Medical Therapy===<br />
The mainstay of treatment for pentalogy of fallot is Surgery.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
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Pharmacologic medical therapy is recommended among patients with severe RVOTO and hypercyanotic spells.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
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Pharmacologic medical therapies for pentalogy of fallot include.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
<br />
* prostaglandin E1 in neonates with ductal dependent pulmonary blood flow<br />
*[[Morphine]] and [[ketamine]] for sedation<br />
*vasopressors like [[phenylephrine]]<br />
*[[Propranolol|propanolol]] to decrease the need for palliative surgical intervention.<br />
* iron treatment to decrease frequency of spells. <br />
<br />
Patients with hypercyanotic spells are treated with,<br />
* oxygen <br />
*volume expansion <br />
* morphine sedation.<br />
<br />
===Surgery===<br />
<br />
<br />
<br />
Surgery is the mainstay of treatment for pentalogy of fallot. interventional procedures are used to relieve pulmonary obstructions and embolize colaterals. <br />
different surgical procedures can be done to treat pentalogy of fallot and it includes.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
* Pulmonary valvotomy( for stenotic pulmonic valve)<br />
* Pulmonary valvectomy( for small and thickened pulmonic valve) <br />
* Closure of ASD/VSD<br />
* Shunt surgery for severe cyanosis or in patients with frequent spells in the first year of life <br />
* Blalock -Taussig Shunt- communication between the right or left pulmonary artery and the right or left subclavian artery. <br />
* Waterson-Cooley Shunt- communication between the ascending aorta with the right pulmonary artery <br />
* Potts shunt-communication between the descending aorta and left pulmonary artery <br />
* Central shunt- Communication between the main pulmonary artery and ascending aorta.<br />
<br />
===Primary Prevention===<br />
There are no established measures for the primary prevention of pentalogy of fallot .<br />
<br />
===Secondary Prevention===<br />
There are no established measures for the secondary prevention of pentalogy of fallot<br />
==References==<br />
{{reflist|2}}<br />
<br />
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[[Category:Cardiology]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Abdulkareem Opeoluwalukanhttps://www.wikidoc.org/index.php?title=Pentalogy_of_Fallot&diff=1624035Pentalogy of Fallot2020-07-10T19:27:11Z<p>Abdulkareem Opeoluwalukan: /* Pathophysiology */</p>
<hr />
<div>__NOTOC__<br />
{{SI}}<br />
{{CMG}} {{AE}}[[User:Abdulkareem Opeoluwalukan|Abdulkareem Opeoluwalukan, M.D]].<br />
==Overview==<br />
Pentalogy of Fallot is defined as the occurrence of Tetralogy of Fallot plus an [[atrial septal defect]].[[File:Pentalogy_of_fallot_image_1.png |200p|thumb|center| Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa. paolo.pazzi@up.ac.za.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3984729/]]<br />
<br />
==Historical Perspective==<br />
<br />
*[[Tetrallogy of fallot|Tetralogy of fallot]] was first discovered by Niel Stenson, a Denish physician Anatomist, in 1671. <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
* The association between right ventricular outflow tract obstruction and a large [[ventricular septal defect]] and tetralogy of fallot. was made in 1888 by Etinne-Louise.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref><br />
<br />
* In 1924, Canadian, Maude Abbott was the first to discover the association between ventricular septal defect , pulmonary stenosis, overriding aorta and right ventricular hypertrophy and the development of tetralogy of Fallot.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref<br />
In 1939, the first surgical treatment was developed by Dr Helen Taussig in Johns Hopkins&amp;lt;nowiki&amp;gt;&&amp;lt;/nowiki&amp;gt;lt;nowiki&lt;nowiki&gt;&&lt;/nowiki&gt;gt;<nowiki>&</nowiki>lt;nowiki<nowiki>&</nowiki>gt;<nowiki>&lt;nowiki&gt;<ref name="pmid30020660">&lt;/nowiki&gt;</nowiki>&lt;/nowiki&gt;&lt;/nowiki&gt;{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Classification==<br />
<br />
* There is no established system for the classification of pentalogy of fallot.<br />
<br />
<br /><br />
<br />
==Pathophysiology==<br />
<br />
It is thought that conotruncal Diseases like [[Tetralogy of Fallot|tetralogy of fallot]] and pentalogy of fallot occur as a result of <br />
<br />
* Neural Crest migration defect. <br />
* Underdevelopment of right ventricular infundibulum.<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
<br />
==Causes==<br />
<br />
<br />
<br />
<br />
The cause of pentalogy of fallot has not been identified. To review risk factors for the development of pentalogy of fallot, click [[tetralogy of fallot causes#Overview|here]].<br />
<br />
==Differentiating pentalogy of fallot from other Diseases==<br />
Pentalogy of Fallot must be differentiated from other diseases that cause .<ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
===Right to left shunt=== <br />
*[[Transposition of the great vessels|Transposition of great arteries]] with Pulmonic stenosis<br />
* Double outlet right ventricle including Taussig-Bing anomaly<br />
*[[Tricuspid atresia]]<br />
* Ebstein Anomaly<br />
*[[Pulmonary atresia]] with intact ventricular septum<br />
*Respiratory diseases<br />
<br />
* Bronchiolitis,<br />
*Viral and bacterial [[Pneumonia]]<br />
*[[Pneumothorax]] because when they are in heart failure they present with signs of respiratory distress, cyanosis and failure to thrive<br />
<br />
=== Bidirectional shunt diseases===<br />
* Total anomalous pulmonary venous return,<br />
*[[Hypoplastic left heart syndrome]],<br />
* Single ventricle <br />
*[[Persistent truncus arteriosus|Truncus arteriosus]].<br />
<br />
==Epidemiology and Demographics==<br />
The epidemiology of pentalogy of fallot has not been well studied.<br />
<br />
==Risk Factors==<br />
<br />
<br />
<br />
<br />
Common risk factors in the development of pentalogy of fallot includes<ref name="SilvaNeves2019">{{cite journal|last1=Silva|first1=Joana A.|last2=Neves|first2=Ana L.|last3=Flor-de-Lima|first3=Filipa|last4=Soares|first4=Paulo|last5=Guimarães|first5=Hercília|title=Risk Factors and Outcomes of Tetralogy of Fallot: From Fetal to Neonatal Life|journal=Pediatric Cardiology|volume=41|issue=1|year=2019|pages=155–164|issn=0172-0643|doi=10.1007/s00246-019-02239-4}}</ref><br />
<br />
* Alcoholism in mother <br />
* Maternal Diabetes <br />
* Advanced maternal age i.e greater than 40 years <br />
* Malnutrition in pregnancy <br />
* Family history of tetralogy of fallot <br />
* Viral illness during pregnancy like [[Rubella]].<br />
* Presence of [[Down syndrome]] or [[22q11.2 deletion syndrome|DiGeorge syndrome]]<br />
<br />
==Screening==<br />
There is insufficient evidence to recommend routine screening for pentalogy of fallot.<br />
<br />
==Natural History, Complications, and Prognosis==<br />
If left untreated, patients with pentalogy of fallot may progress to develop finger clubbing, stunted growth, cardiac arrhythmias, hypoplastic pulmonary artery, paradoxical emboli and [[polycythemia]] .<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
<br />
Prognosis is generally excellent provided the [[Ventricular septal defect|VSD]] has been closed and the right ventricular outflow tract has been relieved.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
<br />
<br />
There are no established criteria for the diagnosis of pentalogy fallot.<br />
<br />
===History and Symptoms===<br />
<br />
The hallmark of pentalogy of fallot is cyanosis. A positive history of cyanosis and easy fatigability leading to squatting during exercise is suggestive of cyanotic congenital heart defect.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
. The most common symptoms of pentalogy of fallot include cyanosis, easy fatigabillity , and hypercyanotic spells with crying , feeding and defecating.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
==Physical Examination==<br />
Patients with Pentalogy of Fallot appear cyanotic.<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref> Physical examination of patients with Pentalogy of Fallot is usually remarkable for<br />
* Right Ventricular Heave. <ref name="ParwaniPhillips2016">{{cite journal|last1=Parwani|first1=Purvi|last2=Phillips|first2=Sabrina|title=IMPORTANCE OF PHYSICAL EXAMINATION IN ADULT PATIENTS WITH TETRALOGY OF FALLOT|journal=Journal of the American College of Cardiology|volume=67|issue=13|year=2016|pages=1101|issn=07351097|doi=10.1016/S0735-1097(16)31102-0}}</ref><br />
* Elevated Jugular Venous pressure.<ref name="ParwaniPhillips2016">{{cite journal|last1=Parwani|first1=Purvi|last2=Phillips|first2=Sabrina|title=IMPORTANCE OF PHYSICAL EXAMINATION IN ADULT PATIENTS WITH TETRALOGY OF FALLOT|journal=Journal of the American College of Cardiology|volume=67|issue=13|year=2016|pages=1101|issn=07351097|doi=10.1016/S0735-1097(16)31102-0}}</ref><br />
* Finger clubbing. <ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
* Displaced Apex beat<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref>. <br />
* Normal S1 with single S2.<ref name="ParwaniPhillips2016">{{cite journal|last1=Parwani|first1=Purvi|last2=Phillips|first2=Sabrina|title=IMPORTANCE OF PHYSICAL EXAMINATION IN ADULT PATIENTS WITH TETRALOGY OF FALLOT|journal=Journal of the American College of Cardiology|volume=67|issue=13|year=2016|pages=1101|issn=07351097|doi=10.1016/S0735-1097(16)31102-0}}</ref><br />
* Peripheral edema<ref name="ParwaniPhillips2016">{{cite journal|last1=Parwani|first1=Purvi|last2=Phillips|first2=Sabrina|title=IMPORTANCE OF PHYSICAL EXAMINATION IN ADULT PATIENTS WITH TETRALOGY OF FALLOT|journal=Journal of the American College of Cardiology|volume=67|issue=13|year=2016|pages=1101|issn=07351097|doi=10.1016/S0735-1097(16)31102-0}}</ref>. <br />
* Diastolic murmur at the left sternal border. <ref name="ParwaniPhillips2016">{{cite journal|last1=Parwani|first1=Purvi|last2=Phillips|first2=Sabrina|title=IMPORTANCE OF PHYSICAL EXAMINATION IN ADULT PATIENTS WITH TETRALOGY OF FALLOT|journal=Journal of the American College of Cardiology|volume=67|issue=13|year=2016|pages=1101|issn=07351097|doi=10.1016/S0735-1097(16)31102-0}}</ref><br />
* Systolic Murmur increasing with inspiration at the left sternal border<ref name="ParwaniPhillips2016">{{cite journal|last1=Parwani|first1=Purvi|last2=Phillips|first2=Sabrina|title=IMPORTANCE OF PHYSICAL EXAMINATION IN ADULT PATIENTS WITH TETRALOGY OF FALLOT|journal=Journal of the American College of Cardiology|volume=67|issue=13|year=2016|pages=1101|issn=07351097|doi=10.1016/S0735-1097(16)31102-0}}</ref>.<br />
<br />
===Laboratory Findings===<br />
<br />
<br />
<br />
Some patients with pentalogy of fallot may have [[polycythemia]] <br />
which is usually suggestive of worsening hypoxia and compensatory production of erythropoetin.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
.<br />
<br />
===Electrocardiogram===<br />
<br />
An ECG may be helpful in the diagnosis of pentalogy of fallot, <br />
Findings on an ECG suggestive of pentalogy of fallot include [[right axis deviation]] and right ventricular hypertrophy.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
[[File: Right_ventrriular_hypertophy.png|200p|thumb|right|Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874376/]]<br />
<br />
===X-ray===<br />
<br />
<br />
<br />
<br />
An x-ray may be helpful in the diagnosis of pentalogy of Fallot. Findings on an x-ray suggestive of pentalogy of fallot include boot shaped heart or coeur en sabot.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref> [[File:Boot_shaped_heart.png|200p|thumb|left| Typical preoperative chest X‐ray of a 16‐month‐old boy with tetralogy of Fallot.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5412831/]]<br />
<br />
<br />
<br />
<br />
.<br />
<br />
===Echocardiography or Ultrasound===<br />
<br />
<br />
<br />
<br />
Echocardiography may be helpful in the diagnosis of pentalogy of fallot. Findings on an echocardiography diagnostic of pentalogy of fallot include.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
* Ventricular septal defect.<br />
* Atrial septal defect.<br />
* Right ventricular outflow tract obstruction.<br />
* overriding aorta [[File:Pentalogy_of_fallot_image_2.png|200p|thumb|left | Department of Biochemistry, University of Allahabad, Allahabad-211002, India.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3299189/]]<br />
<br />
===CT scan===<br />
<br />
<br />
Thoracic CT angiography may be helpful in the diagnosis of pentalogy of fallot. Findings on CT scan diagnostic of pentalogy of fallot include. <ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
*ventricular septal defect.<br />
* right ventricular hypertrophy,<br />
* pulmonary atresia <br />
* aortopulmonary collateral arteries.<br />
<br />
===MRI===<br />
<br />
<br />
cardiac MRI may be helpful in the diagnosis of pentalogy of fallot. Findings on MRI diagnostic of pentalogy of fallot include RVOT stenosis, VSD, ASD,Overriding aorta, right ventricular hypertrophy and hypoplastic pulmonary arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
<br />
<br />
===Other Imaging Findings===<br />
Other imaging findings for pentalogy of fallot include Right ventricular angiopraphy which demonstrates infundibular and pulmonary artery anatomy. left ventricular angiography, which demonstrates. <ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
*VSD<br />
* ASD, <br />
* Overiding aorta<br />
<br />
===Other Diagnostic Studies===<br />
<br />
There are no other diagnostic studies associated with pentalogy of Fallot<br />
<br />
==Treatment==<br />
===Medical Therapy===<br />
The mainstay of treatment for pentalogy of fallot is Surgery.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
Pharmacologic medical therapy is recommended among patients with severe RVOTO and hypercyanotic spells.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
<br />
Pharmacologic medical therapies for pentalogy of fallot include.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
<br />
* prostaglandin E1 in neonates with ductal dependent pulmonary blood flow<br />
*[[Morphine]] and [[ketamine]] for sedation<br />
*vasopressors like [[phenylephrine]]<br />
*[[Propranolol|propanolol]] to decrease the need for palliative surgical intervention.<br />
* iron treatment to decrease frequency of spells. <br />
<br />
Patients with hypercyanotic spells are treated with,<br />
* oxygen <br />
*volume expansion <br />
* morphine sedation.<br />
<br />
===Surgery===<br />
<br />
<br />
<br />
Surgery is the mainstay of treatment for pentalogy of fallot. interventional procedures are used to relieve pulmonary obstructions and embolize colaterals. <br />
different surgical procedures can be done to treat pentalogy of fallot and it includes.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
* pulmonary valvotomy( for stenotic pulmonic valve)<br />
* pulmonary valvectomy( for small and thickened pulmonic valve) <br />
* closure of ASD/VSD<br />
* shunt surgery for severe cyanosis or in patients with frequent spells in the first year of life <br />
* Blalock -Taussig Shunt- communication between the right or left pulmonary artery and the right or left subclavian artery. <br />
* Waterson-Cooley Shunt- communication between the ascending aorta with the right pulmonary artery <br />
* Potts shunt-communication between the descending aorta and left pulmonary artery <br />
* Central shunt- Communication between the main pulmonary artery and ascending aorta.<br />
<br />
===Primary Prevention===<br />
There are no established measures for the primary prevention of pentalogy of fallot .<br />
<br />
===Secondary Prevention===<br />
There are no established measures for the secondary prevention of pentalogy of fallot<br />
==References==<br />
{{reflist|2}}<br />
<br />
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{{WikiDoc Sources}}<br />
[[Category:Cardiology]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Abdulkareem Opeoluwalukanhttps://www.wikidoc.org/index.php?title=Pentalogy_of_Fallot&diff=1623985Pentalogy of Fallot2020-07-10T17:54:48Z<p>Abdulkareem Opeoluwalukan: /* Prevention of Infective Endocarditis */</p>
<hr />
<div>__NOTOC__<br />
{{SI}}<br />
{{CMG}} {{AE}}[[User:Abdulkareem Opeoluwalukan|Abdulkareem Opeoluwalukan, M.D]].<br />
==Overview==<br />
Pentalogy of Fallot is defined as the occurrence of Tetralogy of Fallot plus an [[atrial septal defect]].[[File:Pentalogy_of_fallot_image_1.png |200p|thumb|center| Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa. paolo.pazzi@up.ac.za.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3984729/]]<br />
<br />
==Historical Perspective==<br />
<br />
*[[Tetrallogy of fallot|Tetralogy of fallot]] was first discovered by Niel Stenson, a Denish physician Anatomist, in 1671. <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
* The association between right ventricular outflow tract obstruction and a large [[ventricular septal defect]] and tetralogy of fallot. was made in 1888 by Etinne-Louise.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref><br />
<br />
* In 1924, Canadian, Maude Abbott was the first to discover the association between ventricular septal defect , pulmonary stenosis, overriding aorta and right ventricular hypertrophy and the development of tetralogy of Fallot.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref<br />
In 1939, the first surgical treatment was developed by Dr Helen Taussig in Johns Hopkins&amp;lt;nowiki&amp;gt;&&amp;lt;/nowiki&amp;gt;lt;nowiki&lt;nowiki&gt;&&lt;/nowiki&gt;gt;<nowiki>&</nowiki>lt;nowiki<nowiki>&</nowiki>gt;<nowiki>&lt;nowiki&gt;<ref name="pmid30020660">&lt;/nowiki&gt;</nowiki>&lt;/nowiki&gt;&lt;/nowiki&gt;{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Classification==<br />
<br />
* There is no established system for the classification of pentalogy of fallot.<br />
<br />
<br /><br />
<br />
==Pathophysiology==<br />
<br />
It is thought that conotruncal Diseases like [[Tetralogy of Fallot|tetralogy of fallot]] and pentalogy of fallot is the result of <br />
<br />
* Neural Crest migration defect. <br />
* Underdevelopment of right ventricular infundibulum.<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
<br />
==Causes==<br />
<br />
<br />
<br />
<br />
The cause of pentalogy of fallot has not been identified. To review risk factors for the development of pentalogy of fallot, click [[tetralogy of fallot causes#Overview|here]].<br />
<br />
==Differentiating pentalogy of fallot from other Diseases==<br />
Pentalogy of Fallot must be differentiated from other diseases that cause .<ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
===Right to left shunt=== <br />
*[[Transposition of the great vessels|Transposition of great arteries]] with Pulmonic stenosis<br />
* Double outlet right ventricle including Taussig-Bing anomaly<br />
*[[Tricuspid atresia]]<br />
* Ebstein Anomaly<br />
*[[Pulmonary atresia]] with intact ventricular septum<br />
*Respiratory diseases<br />
<br />
* Bronchiolitis,<br />
*Viral and bacterial [[Pneumonia]]<br />
*[[Pneumothorax]] because when they are in heart failure they present with signs of respiratory distress, cyanosis and failure to thrive<br />
<br />
=== Bidirectional shunt diseases===<br />
* Total anomalous pulmonary venous return,<br />
*[[Hypoplastic left heart syndrome]],<br />
* Single ventricle <br />
*[[Persistent truncus arteriosus|Truncus arteriosus]].<br />
<br />
==Epidemiology and Demographics==<br />
The epidemiology of pentalogy of fallot has not been well studied.<br />
<br />
==Risk Factors==<br />
<br />
<br />
<br />
<br />
Common risk factors in the development of pentalogy of fallot includes<ref name="SilvaNeves2019">{{cite journal|last1=Silva|first1=Joana A.|last2=Neves|first2=Ana L.|last3=Flor-de-Lima|first3=Filipa|last4=Soares|first4=Paulo|last5=Guimarães|first5=Hercília|title=Risk Factors and Outcomes of Tetralogy of Fallot: From Fetal to Neonatal Life|journal=Pediatric Cardiology|volume=41|issue=1|year=2019|pages=155–164|issn=0172-0643|doi=10.1007/s00246-019-02239-4}}</ref><br />
<br />
* Alcoholism in mother <br />
* Maternal Diabetes <br />
* Advanced maternal age i.e greater than 40 years <br />
* Malnutrition in pregnancy <br />
* Family history of tetralogy of fallot <br />
* Viral illness during pregnancy like [[Rubella]].<br />
* Presence of [[Down syndrome]] or [[22q11.2 deletion syndrome|DiGeorge syndrome]]<br />
<br />
==Screening==<br />
There is insufficient evidence to recommend routine screening for pentalogy of fallot.<br />
<br />
==Natural History, Complications, and Prognosis==<br />
If left untreated, patients with pentalogy of fallot may progress to develop finger clubbing, stunted growth, cardiac arrhythmias, hypoplastic pulmonary artery, paradoxical emboli and [[polycythemia]] .<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
<br />
Prognosis is generally excellent provided the [[Ventricular septal defect|VSD]] has been closed and the right ventricular outflow tract has been relieved.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. 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A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. 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C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. 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C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
<br />
<br />
There are no established criteria for the diagnosis of pentalogy fallot.<br />
<br />
===History and Symptoms===<br />
<br />
The hallmark of pentalogy of fallot is cyanosis. A positive history of cyanosis and easy fatigability leading to squatting during exercise is suggestive of cyanotic congenital heart defect.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. 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C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
. The most common symptoms of pentalogy of fallot include cyanosis, easy fatigabillity , and hypercyanotic spells with crying , feeding and defecating.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
==Physical Examination==<br />
Patients with Pentalogy of Fallot appear cyanotic.<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref> Physical examination of patients with Pentalogy of Fallot is usually remarkable for<br />
* Right Ventricular Heave. <ref name="ParwaniPhillips2016">{{cite journal|last1=Parwani|first1=Purvi|last2=Phillips|first2=Sabrina|title=IMPORTANCE OF PHYSICAL EXAMINATION IN ADULT PATIENTS WITH TETRALOGY OF FALLOT|journal=Journal of the American College of Cardiology|volume=67|issue=13|year=2016|pages=1101|issn=07351097|doi=10.1016/S0735-1097(16)31102-0}}</ref><br />
* Elevated Jugular Venous pressure.<ref name="ParwaniPhillips2016">{{cite journal|last1=Parwani|first1=Purvi|last2=Phillips|first2=Sabrina|title=IMPORTANCE OF PHYSICAL EXAMINATION IN ADULT PATIENTS WITH TETRALOGY OF FALLOT|journal=Journal of the American College of Cardiology|volume=67|issue=13|year=2016|pages=1101|issn=07351097|doi=10.1016/S0735-1097(16)31102-0}}</ref><br />
* Finger clubbing. <ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
* Displaced Apex beat<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref>. <br />
* Normal S1 with single S2.<ref name="ParwaniPhillips2016">{{cite journal|last1=Parwani|first1=Purvi|last2=Phillips|first2=Sabrina|title=IMPORTANCE OF PHYSICAL EXAMINATION IN ADULT PATIENTS WITH TETRALOGY OF FALLOT|journal=Journal of the American College of Cardiology|volume=67|issue=13|year=2016|pages=1101|issn=07351097|doi=10.1016/S0735-1097(16)31102-0}}</ref><br />
* Peripheral edema<ref name="ParwaniPhillips2016">{{cite journal|last1=Parwani|first1=Purvi|last2=Phillips|first2=Sabrina|title=IMPORTANCE OF PHYSICAL EXAMINATION IN ADULT PATIENTS WITH TETRALOGY OF FALLOT|journal=Journal of the American College of Cardiology|volume=67|issue=13|year=2016|pages=1101|issn=07351097|doi=10.1016/S0735-1097(16)31102-0}}</ref>. <br />
* Diastolic murmur at the left sternal border. <ref name="ParwaniPhillips2016">{{cite journal|last1=Parwani|first1=Purvi|last2=Phillips|first2=Sabrina|title=IMPORTANCE OF PHYSICAL EXAMINATION IN ADULT PATIENTS WITH TETRALOGY OF FALLOT|journal=Journal of the American College of Cardiology|volume=67|issue=13|year=2016|pages=1101|issn=07351097|doi=10.1016/S0735-1097(16)31102-0}}</ref><br />
* Systolic Murmur increasing with inspiration at the left sternal border<ref name="ParwaniPhillips2016">{{cite journal|last1=Parwani|first1=Purvi|last2=Phillips|first2=Sabrina|title=IMPORTANCE OF PHYSICAL EXAMINATION IN ADULT PATIENTS WITH TETRALOGY OF FALLOT|journal=Journal of the American College of Cardiology|volume=67|issue=13|year=2016|pages=1101|issn=07351097|doi=10.1016/S0735-1097(16)31102-0}}</ref>.<br />
<br />
===Laboratory Findings===<br />
<br />
<br />
<br />
Some patients with pentalogy of fallot may have [[polycythemia]] <br />
which is usually suggestive of worsening hypoxia and compensatory production of erythropoetin.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
.<br />
<br />
===Electrocardiogram===<br />
<br />
An ECG may be helpful in the diagnosis of pentalogy of fallot, <br />
Findings on an ECG suggestive of pentalogy of fallot include [[right axis deviation]] and right ventricular hypertrophy.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
[[File: Right_ventrriular_hypertophy.png|200p|thumb|right|Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874376/]]<br />
<br />
===X-ray===<br />
<br />
<br />
<br />
<br />
An x-ray may be helpful in the diagnosis of pentalogy of Fallot. Findings on an x-ray suggestive of pentalogy of fallot include boot shaped heart or coeur en sabot.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref> [[File:Boot_shaped_heart.png|200p|thumb|left| Typical preoperative chest X‐ray of a 16‐month‐old boy with tetralogy of Fallot.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5412831/]]<br />
<br />
<br />
<br />
<br />
.<br />
<br />
===Echocardiography or Ultrasound===<br />
<br />
<br />
<br />
<br />
Echocardiography may be helpful in the diagnosis of pentalogy of fallot. Findings on an echocardiography diagnostic of pentalogy of fallot include.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
* Ventricular septal defect.<br />
* Atrial septal defect.<br />
* Right ventricular outflow tract obstruction.<br />
* overriding aorta [[File:Pentalogy_of_fallot_image_2.png|200p|thumb|left | Department of Biochemistry, University of Allahabad, Allahabad-211002, India.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3299189/]]<br />
<br />
===CT scan===<br />
<br />
<br />
Thoracic CT angiography may be helpful in the diagnosis of pentalogy of fallot. Findings on CT scan diagnostic of pentalogy of fallot include. <ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
*ventricular septal defect.<br />
* right ventricular hypertrophy,<br />
* pulmonary atresia <br />
* aortopulmonary collateral arteries.<br />
<br />
===MRI===<br />
<br />
<br />
cardiac MRI may be helpful in the diagnosis of pentalogy of fallot. Findings on MRI diagnostic of pentalogy of fallot include RVOT stenosis, VSD, ASD,Overriding aorta, right ventricular hypertrophy and hypoplastic pulmonary arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
<br />
<br />
===Other Imaging Findings===<br />
Other imaging findings for pentalogy of fallot include Right ventricular angiopraphy which demonstrates infundibular and pulmonary artery anatomy. left ventricular angiography, which demonstrates. <ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
*VSD<br />
* ASD, <br />
* Overiding aorta<br />
<br />
===Other Diagnostic Studies===<br />
<br />
There are no other diagnostic studies associated with pentalogy of Fallot<br />
<br />
==Treatment==<br />
===Medical Therapy===<br />
The mainstay of treatment for pentalogy of fallot is Surgery.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
Pharmacologic medical therapy is recommended among patients with severe RVOTO and hypercyanotic spells.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
<br />
Pharmacologic medical therapies for pentalogy of fallot include.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
<br />
* prostaglandin E1 in neonates with ductal dependent pulmonary blood flow<br />
*[[Morphine]] and [[ketamine]] for sedation<br />
*vasopressors like [[phenylephrine]]<br />
*[[Propranolol|propanolol]] to decrease the need for palliative surgical intervention.<br />
* iron treatment to decrease frequency of spells. <br />
<br />
Patients with hypercyanotic spells are treated with,<br />
* oxygen <br />
*volume expansion <br />
* morphine sedation.<br />
<br />
===Surgery===<br />
<br />
<br />
<br />
Surgery is the mainstay of treatment for pentalogy of fallot. interventional procedures are used to relieve pulmonary obstructions and embolize colaterals. <br />
different surgical procedures can be done to treat pentalogy of fallot and it includes.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
* pulmonary valvotomy( for stenotic pulmonic valve)<br />
* pulmonary valvectomy( for small and thickened pulmonic valve) <br />
* closure of ASD/VSD<br />
* shunt surgery for severe cyanosis or in patients with frequent spells in the first year of life <br />
* Blalock -Taussig Shunt- communication between the right or left pulmonary artery and the right or left subclavian artery. <br />
* Waterson-Cooley Shunt- communication between the ascending aorta with the right pulmonary artery <br />
* Potts shunt-communication between the descending aorta and left pulmonary artery <br />
* Central shunt- Communication between the main pulmonary artery and ascending aorta.<br />
<br />
===Primary Prevention===<br />
There are no established measures for the primary prevention of pentalogy of fallot .<br />
<br />
===Secondary Prevention===<br />
There are no established measures for the secondary prevention of pentalogy of fallot<br />
==References==<br />
{{reflist|2}}<br />
<br />
{{WikiDoc Help Menu}}<br />
{{WikiDoc Sources}}<br />
[[Category:Cardiology]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Abdulkareem Opeoluwalukanhttps://www.wikidoc.org/index.php?title=Pentalogy_of_Fallot&diff=1623984Pentalogy of Fallot2020-07-10T17:53:41Z<p>Abdulkareem Opeoluwalukan: /* Prevention of Cyanosis */</p>
<hr />
<div>__NOTOC__<br />
{{SI}}<br />
{{CMG}} {{AE}}[[User:Abdulkareem Opeoluwalukan|Abdulkareem Opeoluwalukan, M.D]].<br />
==Overview==<br />
Pentalogy of Fallot is defined as the occurrence of Tetralogy of Fallot plus an [[atrial septal defect]].[[File:Pentalogy_of_fallot_image_1.png |200p|thumb|center| Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa. paolo.pazzi@up.ac.za.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3984729/]]<br />
<br />
==Historical Perspective==<br />
<br />
*[[Tetrallogy of fallot|Tetralogy of fallot]] was first discovered by Niel Stenson, a Denish physician Anatomist, in 1671. <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
* The association between right ventricular outflow tract obstruction and a large [[ventricular septal defect]] and tetralogy of fallot. was made in 1888 by Etinne-Louise.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref><br />
<br />
* In 1924, Canadian, Maude Abbott was the first to discover the association between ventricular septal defect , pulmonary stenosis, overriding aorta and right ventricular hypertrophy and the development of tetralogy of Fallot.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref<br />
In 1939, the first surgical treatment was developed by Dr Helen Taussig in Johns Hopkins&amp;lt;nowiki&amp;gt;&&amp;lt;/nowiki&amp;gt;lt;nowiki&lt;nowiki&gt;&&lt;/nowiki&gt;gt;<nowiki>&</nowiki>lt;nowiki<nowiki>&</nowiki>gt;<nowiki>&lt;nowiki&gt;<ref name="pmid30020660">&lt;/nowiki&gt;</nowiki>&lt;/nowiki&gt;&lt;/nowiki&gt;{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Classification==<br />
<br />
* There is no established system for the classification of pentalogy of fallot.<br />
<br />
<br /><br />
<br />
==Pathophysiology==<br />
<br />
It is thought that conotruncal Diseases like [[Tetralogy of Fallot|tetralogy of fallot]] and pentalogy of fallot is the result of <br />
<br />
* Neural Crest migration defect. <br />
* Underdevelopment of right ventricular infundibulum.<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
<br />
==Causes==<br />
<br />
<br />
<br />
<br />
The cause of pentalogy of fallot has not been identified. To review risk factors for the development of pentalogy of fallot, click [[tetralogy of fallot causes#Overview|here]].<br />
<br />
==Differentiating pentalogy of fallot from other Diseases==<br />
Pentalogy of Fallot must be differentiated from other diseases that cause .<ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
===Right to left shunt=== <br />
*[[Transposition of the great vessels|Transposition of great arteries]] with Pulmonic stenosis<br />
* Double outlet right ventricle including Taussig-Bing anomaly<br />
*[[Tricuspid atresia]]<br />
* Ebstein Anomaly<br />
*[[Pulmonary atresia]] with intact ventricular septum<br />
*Respiratory diseases<br />
<br />
* Bronchiolitis,<br />
*Viral and bacterial [[Pneumonia]]<br />
*[[Pneumothorax]] because when they are in heart failure they present with signs of respiratory distress, cyanosis and failure to thrive<br />
<br />
=== Bidirectional shunt diseases===<br />
* Total anomalous pulmonary venous return,<br />
*[[Hypoplastic left heart syndrome]],<br />
* Single ventricle <br />
*[[Persistent truncus arteriosus|Truncus arteriosus]].<br />
<br />
==Epidemiology and Demographics==<br />
The epidemiology of pentalogy of fallot has not been well studied.<br />
<br />
==Risk Factors==<br />
<br />
<br />
<br />
<br />
Common risk factors in the development of pentalogy of fallot includes<ref name="SilvaNeves2019">{{cite journal|last1=Silva|first1=Joana A.|last2=Neves|first2=Ana L.|last3=Flor-de-Lima|first3=Filipa|last4=Soares|first4=Paulo|last5=Guimarães|first5=Hercília|title=Risk Factors and Outcomes of Tetralogy of Fallot: From Fetal to Neonatal Life|journal=Pediatric Cardiology|volume=41|issue=1|year=2019|pages=155–164|issn=0172-0643|doi=10.1007/s00246-019-02239-4}}</ref><br />
<br />
* Alcoholism in mother <br />
* Maternal Diabetes <br />
* Advanced maternal age i.e greater than 40 years <br />
* Malnutrition in pregnancy <br />
* Family history of tetralogy of fallot <br />
* Viral illness during pregnancy like [[Rubella]].<br />
* Presence of [[Down syndrome]] or [[22q11.2 deletion syndrome|DiGeorge syndrome]]<br />
<br />
==Screening==<br />
There is insufficient evidence to recommend routine screening for pentalogy of fallot.<br />
<br />
==Natural History, Complications, and Prognosis==<br />
If left untreated, patients with pentalogy of fallot may progress to develop finger clubbing, stunted growth, cardiac arrhythmias, hypoplastic pulmonary artery, paradoxical emboli and [[polycythemia]] .<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
<br />
Prognosis is generally excellent provided the [[Ventricular septal defect|VSD]] has been closed and the right ventricular outflow tract has been relieved.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
<br />
<br />
There are no established criteria for the diagnosis of pentalogy fallot.<br />
<br />
===History and Symptoms===<br />
<br />
The hallmark of pentalogy of fallot is cyanosis. A positive history of cyanosis and easy fatigability leading to squatting during exercise is suggestive of cyanotic congenital heart defect.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
. The most common symptoms of pentalogy of fallot include cyanosis, easy fatigabillity , and hypercyanotic spells with crying , feeding and defecating.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
==Physical Examination==<br />
Patients with Pentalogy of Fallot appear cyanotic.<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref> Physical examination of patients with Pentalogy of Fallot is usually remarkable for<br />
* Right Ventricular Heave. <ref name="ParwaniPhillips2016">{{cite journal|last1=Parwani|first1=Purvi|last2=Phillips|first2=Sabrina|title=IMPORTANCE OF PHYSICAL EXAMINATION IN ADULT PATIENTS WITH TETRALOGY OF FALLOT|journal=Journal of the American College of Cardiology|volume=67|issue=13|year=2016|pages=1101|issn=07351097|doi=10.1016/S0735-1097(16)31102-0}}</ref><br />
* Elevated Jugular Venous pressure.<ref name="ParwaniPhillips2016">{{cite journal|last1=Parwani|first1=Purvi|last2=Phillips|first2=Sabrina|title=IMPORTANCE OF PHYSICAL EXAMINATION IN ADULT PATIENTS WITH TETRALOGY OF FALLOT|journal=Journal of the American College of Cardiology|volume=67|issue=13|year=2016|pages=1101|issn=07351097|doi=10.1016/S0735-1097(16)31102-0}}</ref><br />
* Finger clubbing. <ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
* Displaced Apex beat<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref>. <br />
* Normal S1 with single S2.<ref name="ParwaniPhillips2016">{{cite journal|last1=Parwani|first1=Purvi|last2=Phillips|first2=Sabrina|title=IMPORTANCE OF PHYSICAL EXAMINATION IN ADULT PATIENTS WITH TETRALOGY OF FALLOT|journal=Journal of the American College of Cardiology|volume=67|issue=13|year=2016|pages=1101|issn=07351097|doi=10.1016/S0735-1097(16)31102-0}}</ref><br />
* Peripheral edema<ref name="ParwaniPhillips2016">{{cite journal|last1=Parwani|first1=Purvi|last2=Phillips|first2=Sabrina|title=IMPORTANCE OF PHYSICAL EXAMINATION IN ADULT PATIENTS WITH TETRALOGY OF FALLOT|journal=Journal of the American College of Cardiology|volume=67|issue=13|year=2016|pages=1101|issn=07351097|doi=10.1016/S0735-1097(16)31102-0}}</ref>. <br />
* Diastolic murmur at the left sternal border. <ref name="ParwaniPhillips2016">{{cite journal|last1=Parwani|first1=Purvi|last2=Phillips|first2=Sabrina|title=IMPORTANCE OF PHYSICAL EXAMINATION IN ADULT PATIENTS WITH TETRALOGY OF FALLOT|journal=Journal of the American College of Cardiology|volume=67|issue=13|year=2016|pages=1101|issn=07351097|doi=10.1016/S0735-1097(16)31102-0}}</ref><br />
* Systolic Murmur increasing with inspiration at the left sternal border<ref name="ParwaniPhillips2016">{{cite journal|last1=Parwani|first1=Purvi|last2=Phillips|first2=Sabrina|title=IMPORTANCE OF PHYSICAL EXAMINATION IN ADULT PATIENTS WITH TETRALOGY OF FALLOT|journal=Journal of the American College of Cardiology|volume=67|issue=13|year=2016|pages=1101|issn=07351097|doi=10.1016/S0735-1097(16)31102-0}}</ref>.<br />
<br />
===Laboratory Findings===<br />
<br />
<br />
<br />
Some patients with pentalogy of fallot may have [[polycythemia]] <br />
which is usually suggestive of worsening hypoxia and compensatory production of erythropoetin.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
.<br />
<br />
===Electrocardiogram===<br />
<br />
An ECG may be helpful in the diagnosis of pentalogy of fallot, <br />
Findings on an ECG suggestive of pentalogy of fallot include [[right axis deviation]] and right ventricular hypertrophy.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
[[File: Right_ventrriular_hypertophy.png|200p|thumb|right|Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874376/]]<br />
<br />
===X-ray===<br />
<br />
<br />
<br />
<br />
An x-ray may be helpful in the diagnosis of pentalogy of Fallot. Findings on an x-ray suggestive of pentalogy of fallot include boot shaped heart or coeur en sabot.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref> [[File:Boot_shaped_heart.png|200p|thumb|left| Typical preoperative chest X‐ray of a 16‐month‐old boy with tetralogy of Fallot.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5412831/]]<br />
<br />
<br />
<br />
<br />
.<br />
<br />
===Echocardiography or Ultrasound===<br />
<br />
<br />
<br />
<br />
Echocardiography may be helpful in the diagnosis of pentalogy of fallot. Findings on an echocardiography diagnostic of pentalogy of fallot include.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
* Ventricular septal defect.<br />
* Atrial septal defect.<br />
* Right ventricular outflow tract obstruction.<br />
* overriding aorta [[File:Pentalogy_of_fallot_image_2.png|200p|thumb|left | Department of Biochemistry, University of Allahabad, Allahabad-211002, India.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3299189/]]<br />
<br />
===CT scan===<br />
<br />
<br />
Thoracic CT angiography may be helpful in the diagnosis of pentalogy of fallot. Findings on CT scan diagnostic of pentalogy of fallot include. <ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
*ventricular septal defect.<br />
* right ventricular hypertrophy,<br />
* pulmonary atresia <br />
* aortopulmonary collateral arteries.<br />
<br />
===MRI===<br />
<br />
<br />
cardiac MRI may be helpful in the diagnosis of pentalogy of fallot. Findings on MRI diagnostic of pentalogy of fallot include RVOT stenosis, VSD, ASD,Overriding aorta, right ventricular hypertrophy and hypoplastic pulmonary arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
<br />
<br />
===Other Imaging Findings===<br />
Other imaging findings for pentalogy of fallot include Right ventricular angiopraphy which demonstrates infundibular and pulmonary artery anatomy. left ventricular angiography, which demonstrates. <ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
*VSD<br />
* ASD, <br />
* Overiding aorta<br />
<br />
===Other Diagnostic Studies===<br />
<br />
There are no other diagnostic studies associated with pentalogy of Fallot<br />
<br />
==Treatment==<br />
===Medical Therapy===<br />
The mainstay of treatment for pentalogy of fallot is Surgery.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
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Pharmacologic medical therapy is recommended among patients with severe RVOTO and hypercyanotic spells.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
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Pharmacologic medical therapies for pentalogy of fallot include.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
<br />
* prostaglandin E1 in neonates with ductal dependent pulmonary blood flow<br />
*[[Morphine]] and [[ketamine]] for sedation<br />
*vasopressors like [[phenylephrine]]<br />
*[[Propranolol|propanolol]] to decrease the need for palliative surgical intervention.<br />
* iron treatment to decrease frequency of spells. <br />
<br />
Patients with hypercyanotic spells are treated with,<br />
* oxygen <br />
*volume expansion <br />
* morphine sedation.<br />
<br />
===Surgery===<br />
<br />
<br />
<br />
Surgery is the mainstay of treatment for pentalogy of fallot. interventional procedures are used to relieve pulmonary obstructions and embolize colaterals. <br />
different surgical procedures can be done to treat pentalogy of fallot and it includes.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
* pulmonary valvotomy( for stenotic pulmonic valve)<br />
* pulmonary valvectomy( for small and thickened pulmonic valve) <br />
* closure of ASD/VSD<br />
* shunt surgery for severe cyanosis or in patients with frequent spells in the first year of life <br />
* Blalock -Taussig Shunt- communication between the right or left pulmonary artery and the right or left subclavian artery. <br />
* Waterson-Cooley Shunt- communication between the ascending aorta with the right pulmonary artery <br />
* Potts shunt-communication between the descending aorta and left pulmonary artery <br />
* Central shunt- Communication between the main pulmonary artery and ascending aorta.<br />
<br />
===Primary Prevention===<br />
There are no established measures for the primary prevention of pentalogy of fallot .<br />
<br />
===Secondary Prevention===<br />
There are no established measures for the secondary prevention of pentalogy of fallot<br />
===Prevention of Infective Endocarditis===<br />
Antibiotic prophylaxis should be administered before respiratory and oral procedures.<br />
<br />
==References==<br />
{{reflist|2}}<br />
<br />
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[[Category:Cardiology]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Abdulkareem Opeoluwalukanhttps://www.wikidoc.org/index.php?title=Pentalogy_of_Fallot&diff=1623964Pentalogy of Fallot2020-07-10T17:22:45Z<p>Abdulkareem Opeoluwalukan: /* Physical Examination */</p>
<hr />
<div>__NOTOC__<br />
{{SI}}<br />
{{CMG}} {{AE}}[[User:Abdulkareem Opeoluwalukan|Abdulkareem Opeoluwalukan, M.D]].<br />
==Overview==<br />
Pentalogy of Fallot is defined as the occurrence of Tetralogy of Fallot plus an [[atrial septal defect]].[[File:Pentalogy_of_fallot_image_1.png |200p|thumb|center| Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa. paolo.pazzi@up.ac.za.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3984729/]]<br />
<br />
==Historical Perspective==<br />
<br />
*[[Tetrallogy of fallot|Tetralogy of fallot]] was first discovered by Niel Stenson, a Denish physician Anatomist, in 1671. <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
* The association between right ventricular outflow tract obstruction and a large [[ventricular septal defect]] and tetralogy of fallot. was made in 1888 by Etinne-Louise.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref><br />
<br />
* In 1924, Canadian, Maude Abbott was the first to discover the association between ventricular septal defect , pulmonary stenosis, overriding aorta and right ventricular hypertrophy and the development of tetralogy of Fallot.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref<br />
In 1939, the first surgical treatment was developed by Dr Helen Taussig in Johns Hopkins&amp;lt;nowiki&amp;gt;&&amp;lt;/nowiki&amp;gt;lt;nowiki&lt;nowiki&gt;&&lt;/nowiki&gt;gt;<nowiki>&</nowiki>lt;nowiki<nowiki>&</nowiki>gt;<nowiki>&lt;nowiki&gt;<ref name="pmid30020660">&lt;/nowiki&gt;</nowiki>&lt;/nowiki&gt;&lt;/nowiki&gt;{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Classification==<br />
<br />
* There is no established system for the classification of pentalogy of fallot.<br />
<br />
<br /><br />
<br />
==Pathophysiology==<br />
<br />
It is thought that conotruncal Diseases like [[Tetralogy of Fallot|tetralogy of fallot]] and pentalogy of fallot is the result of <br />
<br />
* Neural Crest migration defect. <br />
* Underdevelopment of right ventricular infundibulum.<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
<br />
==Causes==<br />
<br />
<br />
<br />
<br />
The cause of pentalogy of fallot has not been identified. To review risk factors for the development of pentalogy of fallot, click [[tetralogy of fallot causes#Overview|here]].<br />
<br />
==Differentiating pentalogy of fallot from other Diseases==<br />
Pentalogy of Fallot must be differentiated from other diseases that cause .<ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
===Right to left shunt=== <br />
*[[Transposition of the great vessels|Transposition of great arteries]] with Pulmonic stenosis<br />
* Double outlet right ventricle including Taussig-Bing anomaly<br />
*[[Tricuspid atresia]]<br />
* Ebstein Anomaly<br />
*[[Pulmonary atresia]] with intact ventricular septum<br />
*Respiratory diseases<br />
<br />
* Bronchiolitis,<br />
*Viral and bacterial [[Pneumonia]]<br />
*[[Pneumothorax]] because when they are in heart failure they present with signs of respiratory distress, cyanosis and failure to thrive<br />
<br />
=== Bidirectional shunt diseases===<br />
* Total anomalous pulmonary venous return,<br />
*[[Hypoplastic left heart syndrome]],<br />
* Single ventricle <br />
*[[Persistent truncus arteriosus|Truncus arteriosus]].<br />
<br />
==Epidemiology and Demographics==<br />
The epidemiology of pentalogy of fallot has not been well studied.<br />
<br />
==Risk Factors==<br />
<br />
<br />
<br />
<br />
Common risk factors in the development of pentalogy of fallot includes<ref name="SilvaNeves2019">{{cite journal|last1=Silva|first1=Joana A.|last2=Neves|first2=Ana L.|last3=Flor-de-Lima|first3=Filipa|last4=Soares|first4=Paulo|last5=Guimarães|first5=Hercília|title=Risk Factors and Outcomes of Tetralogy of Fallot: From Fetal to Neonatal Life|journal=Pediatric Cardiology|volume=41|issue=1|year=2019|pages=155–164|issn=0172-0643|doi=10.1007/s00246-019-02239-4}}</ref><br />
<br />
* Alcoholism in mother <br />
* Maternal Diabetes <br />
* Advanced maternal age i.e greater than 40 years <br />
* Malnutrition in pregnancy <br />
* Family history of tetralogy of fallot <br />
* Viral illness during pregnancy like [[Rubella]].<br />
* Presence of [[Down syndrome]] or [[22q11.2 deletion syndrome|DiGeorge syndrome]]<br />
<br />
==Screening==<br />
There is insufficient evidence to recommend routine screening for pentalogy of fallot.<br />
<br />
==Natural History, Complications, and Prognosis==<br />
If left untreated, patients with pentalogy of fallot may progress to develop finger clubbing, stunted growth, cardiac arrhythmias, hypoplastic pulmonary artery, paradoxical emboli and [[polycythemia]] .<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
<br />
Prognosis is generally excellent provided the [[Ventricular septal defect|VSD]] has been closed and the right ventricular outflow tract has been relieved.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. 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C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
<br />
<br />
There are no established criteria for the diagnosis of pentalogy fallot.<br />
<br />
===History and Symptoms===<br />
<br />
The hallmark of pentalogy of fallot is cyanosis. A positive history of cyanosis and easy fatigability leading to squatting during exercise is suggestive of cyanotic congenital heart defect.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
. The most common symptoms of pentalogy of fallot include cyanosis, easy fatigabillity , and hypercyanotic spells with crying , feeding and defecating.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
==Physical Examination==<br />
Patients with Pentalogy of Fallot appear cyanotic.<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref> Physical examination of patients with Pentalogy of Fallot is usually remarkable for<br />
* Right Ventricular Heave. <ref name="ParwaniPhillips2016">{{cite journal|last1=Parwani|first1=Purvi|last2=Phillips|first2=Sabrina|title=IMPORTANCE OF PHYSICAL EXAMINATION IN ADULT PATIENTS WITH TETRALOGY OF FALLOT|journal=Journal of the American College of Cardiology|volume=67|issue=13|year=2016|pages=1101|issn=07351097|doi=10.1016/S0735-1097(16)31102-0}}</ref><br />
* Elevated Jugular Venous pressure.<ref name="ParwaniPhillips2016">{{cite journal|last1=Parwani|first1=Purvi|last2=Phillips|first2=Sabrina|title=IMPORTANCE OF PHYSICAL EXAMINATION IN ADULT PATIENTS WITH TETRALOGY OF FALLOT|journal=Journal of the American College of Cardiology|volume=67|issue=13|year=2016|pages=1101|issn=07351097|doi=10.1016/S0735-1097(16)31102-0}}</ref><br />
* Finger clubbing. <ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
* Displaced Apex beat<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref>. <br />
* Normal S1 with single S2.<ref name="ParwaniPhillips2016">{{cite journal|last1=Parwani|first1=Purvi|last2=Phillips|first2=Sabrina|title=IMPORTANCE OF PHYSICAL EXAMINATION IN ADULT PATIENTS WITH TETRALOGY OF FALLOT|journal=Journal of the American College of Cardiology|volume=67|issue=13|year=2016|pages=1101|issn=07351097|doi=10.1016/S0735-1097(16)31102-0}}</ref><br />
* Peripheral edema<ref name="ParwaniPhillips2016">{{cite journal|last1=Parwani|first1=Purvi|last2=Phillips|first2=Sabrina|title=IMPORTANCE OF PHYSICAL EXAMINATION IN ADULT PATIENTS WITH TETRALOGY OF FALLOT|journal=Journal of the American College of Cardiology|volume=67|issue=13|year=2016|pages=1101|issn=07351097|doi=10.1016/S0735-1097(16)31102-0}}</ref>. <br />
* Diastolic murmur at the left sternal border. <ref name="ParwaniPhillips2016">{{cite journal|last1=Parwani|first1=Purvi|last2=Phillips|first2=Sabrina|title=IMPORTANCE OF PHYSICAL EXAMINATION IN ADULT PATIENTS WITH TETRALOGY OF FALLOT|journal=Journal of the American College of Cardiology|volume=67|issue=13|year=2016|pages=1101|issn=07351097|doi=10.1016/S0735-1097(16)31102-0}}</ref><br />
* Systolic Murmur increasing with inspiration at the left sternal border<ref name="ParwaniPhillips2016">{{cite journal|last1=Parwani|first1=Purvi|last2=Phillips|first2=Sabrina|title=IMPORTANCE OF PHYSICAL EXAMINATION IN ADULT PATIENTS WITH TETRALOGY OF FALLOT|journal=Journal of the American College of Cardiology|volume=67|issue=13|year=2016|pages=1101|issn=07351097|doi=10.1016/S0735-1097(16)31102-0}}</ref>.<br />
<br />
===Laboratory Findings===<br />
<br />
<br />
<br />
Some patients with pentalogy of fallot may have [[polycythemia]] <br />
which is usually suggestive of worsening hypoxia and compensatory production of erythropoetin.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
.<br />
<br />
===Electrocardiogram===<br />
<br />
An ECG may be helpful in the diagnosis of pentalogy of fallot, <br />
Findings on an ECG suggestive of pentalogy of fallot include [[right axis deviation]] and right ventricular hypertrophy.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
[[File: Right_ventrriular_hypertophy.png|200p|thumb|right|Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874376/]]<br />
<br />
===X-ray===<br />
<br />
<br />
<br />
<br />
An x-ray may be helpful in the diagnosis of pentalogy of Fallot. Findings on an x-ray suggestive of pentalogy of fallot include boot shaped heart or coeur en sabot.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref> [[File:Boot_shaped_heart.png|200p|thumb|left| Typical preoperative chest X‐ray of a 16‐month‐old boy with tetralogy of Fallot.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5412831/]]<br />
<br />
<br />
<br />
<br />
.<br />
<br />
===Echocardiography or Ultrasound===<br />
<br />
<br />
<br />
<br />
Echocardiography may be helpful in the diagnosis of pentalogy of fallot. Findings on an echocardiography diagnostic of pentalogy of fallot include.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
* Ventricular septal defect.<br />
* Atrial septal defect.<br />
* Right ventricular outflow tract obstruction.<br />
* overriding aorta [[File:Pentalogy_of_fallot_image_2.png|200p|thumb|left | Department of Biochemistry, University of Allahabad, Allahabad-211002, India.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3299189/]]<br />
<br />
===CT scan===<br />
<br />
<br />
Thoracic CT angiography may be helpful in the diagnosis of pentalogy of fallot. Findings on CT scan diagnostic of pentalogy of fallot include. <ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
*ventricular septal defect.<br />
* right ventricular hypertrophy,<br />
* pulmonary atresia <br />
* aortopulmonary collateral arteries.<br />
<br />
===MRI===<br />
<br />
<br />
cardiac MRI may be helpful in the diagnosis of pentalogy of fallot. Findings on MRI diagnostic of pentalogy of fallot include RVOT stenosis, VSD, ASD,Overriding aorta, right ventricular hypertrophy and hypoplastic pulmonary arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
<br />
<br />
===Other Imaging Findings===<br />
Other imaging findings for pentalogy of fallot include Right ventricular angiopraphy which demonstrates infundibular and pulmonary artery anatomy. left ventricular angiography, which demonstrates. <ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
*VSD<br />
* ASD, <br />
* Overiding aorta<br />
<br />
===Other Diagnostic Studies===<br />
<br />
There are no other diagnostic studies associated with pentalogy of Fallot<br />
<br />
==Treatment==<br />
===Medical Therapy===<br />
The mainstay of treatment for pentalogy of fallot is Surgery.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
Pharmacologic medical therapy is recommended among patients with severe RVOTO and hypercyanotic spells.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
<br />
Pharmacologic medical therapies for pentalogy of fallot include.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
<br />
* prostaglandin E1 in neonates with ductal dependent pulmonary blood flow<br />
*[[Morphine]] and [[ketamine]] for sedation<br />
*vasopressors like [[phenylephrine]]<br />
*[[Propranolol|propanolol]] to decrease the need for palliative surgical intervention.<br />
* iron treatment to decrease frequency of spells. <br />
<br />
Patients with hypercyanotic spells are treated with,<br />
* oxygen <br />
*volume expansion <br />
* morphine sedation.<br />
<br />
===Surgery===<br />
<br />
<br />
<br />
Surgery is the mainstay of treatment for pentalogy of fallot. interventional procedures are used to relieve pulmonary obstructions and embolize colaterals. <br />
different surgical procedures can be done to treat pentalogy of fallot and it includes.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
* pulmonary valvotomy( for stenotic pulmonic valve)<br />
* pulmonary valvectomy( for small and thickened pulmonic valve) <br />
* closure of ASD/VSD<br />
* shunt surgery for severe cyanosis or in patients with frequent spells in the first year of life <br />
* Blalock -Taussig Shunt- communication between the right or left pulmonary artery and the right or left subclavian artery. <br />
* Waterson-Cooley Shunt- communication between the ascending aorta with the right pulmonary artery <br />
* Potts shunt-communication between the descending aorta and left pulmonary artery <br />
* Central shunt- Communication between the main pulmonary artery and ascending aorta.<br />
<br />
===Primary Prevention===<br />
There are no established measures for the primary prevention of pentalogy of fallot .<br />
<br />
===Secondary Prevention===<br />
There are no established measures for the secondary prevention of pentalogy of fallot<br />
===Prevention of Cyanosis===<br />
The following factors may reduce systemic vascular resistance (SVR) and exacerbate shunting which in turn exacerbate cyanosis and should be avoided if at all possible:<br />
<br />
*Acidosis<br />
*Bathing in hot water<br />
*Fever<br />
*Stress<br />
*Infection<br />
*Posture (upright, not squatting)<br />
*Exercise<br />
*[[Beta-adrenergic agonist|Beta-adrenergic agonists]]<br />
*[[Dehydration]]<br />
*Closure of the [[patent ductus arteriosus]]<br />
<br />
===Prevention of Infective Endocarditis===<br />
Antibiotic prophylaxis should be administered before respiratory and oral procedures.<br />
<br />
==References==<br />
{{reflist|2}}<br />
<br />
{{WikiDoc Help Menu}}<br />
{{WikiDoc Sources}}<br />
[[Category:Cardiology]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Abdulkareem Opeoluwalukanhttps://www.wikidoc.org/index.php?title=Pentalogy_of_Fallot&diff=1623950Pentalogy of Fallot2020-07-10T16:50:35Z<p>Abdulkareem Opeoluwalukan: /* Risk Factors */</p>
<hr />
<div>__NOTOC__<br />
{{SI}}<br />
{{CMG}} {{AE}}[[User:Abdulkareem Opeoluwalukan|Abdulkareem Opeoluwalukan, M.D]].<br />
==Overview==<br />
Pentalogy of Fallot is defined as the occurrence of Tetralogy of Fallot plus an [[atrial septal defect]].[[File:Pentalogy_of_fallot_image_1.png |200p|thumb|center| Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa. paolo.pazzi@up.ac.za.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3984729/]]<br />
<br />
==Historical Perspective==<br />
<br />
*[[Tetrallogy of fallot|Tetralogy of fallot]] was first discovered by Niel Stenson, a Denish physician Anatomist, in 1671. <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
* The association between right ventricular outflow tract obstruction and a large [[ventricular septal defect]] and tetralogy of fallot. was made in 1888 by Etinne-Louise.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref><br />
<br />
* In 1924, Canadian, Maude Abbott was the first to discover the association between ventricular septal defect , pulmonary stenosis, overriding aorta and right ventricular hypertrophy and the development of tetralogy of Fallot.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref<br />
In 1939, the first surgical treatment was developed by Dr Helen Taussig in Johns Hopkins&amp;lt;nowiki&amp;gt;&&amp;lt;/nowiki&amp;gt;lt;nowiki&lt;nowiki&gt;&&lt;/nowiki&gt;gt;<nowiki>&</nowiki>lt;nowiki<nowiki>&</nowiki>gt;<nowiki>&lt;nowiki&gt;<ref name="pmid30020660">&lt;/nowiki&gt;</nowiki>&lt;/nowiki&gt;&lt;/nowiki&gt;{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Classification==<br />
<br />
* There is no established system for the classification of pentalogy of fallot.<br />
<br />
<br /><br />
<br />
==Pathophysiology==<br />
<br />
It is thought that conotruncal Diseases like [[Tetralogy of Fallot|tetralogy of fallot]] and pentalogy of fallot is the result of <br />
<br />
* Neural Crest migration defect. <br />
* Underdevelopment of right ventricular infundibulum.<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
<br />
==Causes==<br />
<br />
<br />
<br />
<br />
The cause of pentalogy of fallot has not been identified. To review risk factors for the development of pentalogy of fallot, click [[tetralogy of fallot causes#Overview|here]].<br />
<br />
==Differentiating pentalogy of fallot from other Diseases==<br />
Pentalogy of Fallot must be differentiated from other diseases that cause .<ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
===Right to left shunt=== <br />
*[[Transposition of the great vessels|Transposition of great arteries]] with Pulmonic stenosis<br />
* Double outlet right ventricle including Taussig-Bing anomaly<br />
*[[Tricuspid atresia]]<br />
* Ebstein Anomaly<br />
*[[Pulmonary atresia]] with intact ventricular septum<br />
*Respiratory diseases<br />
<br />
* Bronchiolitis,<br />
*Viral and bacterial [[Pneumonia]]<br />
*[[Pneumothorax]] because when they are in heart failure they present with signs of respiratory distress, cyanosis and failure to thrive<br />
<br />
=== Bidirectional shunt diseases===<br />
* Total anomalous pulmonary venous return,<br />
*[[Hypoplastic left heart syndrome]],<br />
* Single ventricle <br />
*[[Persistent truncus arteriosus|Truncus arteriosus]].<br />
<br />
==Epidemiology and Demographics==<br />
The epidemiology of pentalogy of fallot has not been well studied.<br />
<br />
==Risk Factors==<br />
<br />
<br />
<br />
<br />
Common risk factors in the development of pentalogy of fallot includes<ref name="SilvaNeves2019">{{cite journal|last1=Silva|first1=Joana A.|last2=Neves|first2=Ana L.|last3=Flor-de-Lima|first3=Filipa|last4=Soares|first4=Paulo|last5=Guimarães|first5=Hercília|title=Risk Factors and Outcomes of Tetralogy of Fallot: From Fetal to Neonatal Life|journal=Pediatric Cardiology|volume=41|issue=1|year=2019|pages=155–164|issn=0172-0643|doi=10.1007/s00246-019-02239-4}}</ref><br />
<br />
* Alcoholism in mother <br />
* Maternal Diabetes <br />
* Advanced maternal age i.e greater than 40 years <br />
* Malnutrition in pregnancy <br />
* Family history of tetralogy of fallot <br />
* Viral illness during pregnancy like [[Rubella]].<br />
* Presence of [[Down syndrome]] or [[22q11.2 deletion syndrome|DiGeorge syndrome]]<br />
<br />
==Screening==<br />
There is insufficient evidence to recommend routine screening for pentalogy of fallot.<br />
<br />
==Natural History, Complications, and Prognosis==<br />
If left untreated, patients with pentalogy of fallot may progress to develop finger clubbing, stunted growth, cardiac arrhythmias, hypoplastic pulmonary artery, paradoxical emboli and [[polycythemia]] .<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
<br />
Prognosis is generally excellent provided the [[Ventricular septal defect|VSD]] has been closed and the right ventricular outflow tract has been relieved.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
<br />
<br />
There are no established criteria for the diagnosis of pentalogy fallot.<br />
<br />
===History and Symptoms===<br />
<br />
The hallmark of pentalogy of fallot is cyanosis. A positive history of cyanosis and easy fatigability leading to squatting during exercise is suggestive of cyanotic congenital heart defect.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
. The most common symptoms of pentalogy of fallot include cyanosis, easy fatigabillity , and hypercyanotic spells with crying , feeding and defecating.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
==Physical Examination==<br />
<br />
=== Appearance===<br />
* patients with pentalogy of fallot usually appear small due to failure to thrive. <br />
* patients may be found in squatting position( compensatory mechanism)<br />
<br />
=== Vital Signs===<br />
* Tachycardia with regular pulse <br />
* Tachypnea <br />
* low grade fever in patients with concomitant infective [[endocarditis]]<br />
<br />
=== HEENT===<br />
* Retinal vessel engorgement may be present<br />
<br />
=== Heart===<br />
<br />
A thrill may be present at left sternal border.<br />
*A right ventricular impulse may be prominent.<br />
*Second heart sound (S2) is single as P2 is absent.<br />
*A harsh systolic ejection murmur best heard at the left sternal border is usually present.<br />
*P2 is faint and delayed in mild cyanosis and inaudible in severe cyanosis.<br />
*A diastolic murmur may be heard due to aortic regurgitation.<br />
<br />
=== Extremities===<br />
*Clubbing<br />
*Cyanosis is most prominent at lips and nail beds<br />
<br />
===Laboratory Findings===<br />
<br />
<br />
<br />
Some patients with pentalogy of fallot may have [[polycythemia]] <br />
which is usually suggestive of worsening hypoxia and compensatory production of erythropoetin.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
.<br />
<br />
===Electrocardiogram===<br />
<br />
An ECG may be helpful in the diagnosis of pentalogy of fallot, <br />
Findings on an ECG suggestive of pentalogy of fallot include [[right axis deviation]] and right ventricular hypertrophy.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
[[File: Right_ventrriular_hypertophy.png|200p|thumb|right|Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874376/]]<br />
<br />
===X-ray===<br />
<br />
<br />
<br />
<br />
An x-ray may be helpful in the diagnosis of pentalogy of Fallot. Findings on an x-ray suggestive of pentalogy of fallot include boot shaped heart or coeur en sabot.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref> [[File:Boot_shaped_heart.png|200p|thumb|left| Typical preoperative chest X‐ray of a 16‐month‐old boy with tetralogy of Fallot.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5412831/]]<br />
<br />
<br />
<br />
<br />
.<br />
<br />
===Echocardiography or Ultrasound===<br />
<br />
<br />
<br />
<br />
Echocardiography may be helpful in the diagnosis of pentalogy of fallot. Findings on an echocardiography diagnostic of pentalogy of fallot include.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
* Ventricular septal defect.<br />
* Atrial septal defect.<br />
* Right ventricular outflow tract obstruction.<br />
* overriding aorta [[File:Pentalogy_of_fallot_image_2.png|200p|thumb|left | Department of Biochemistry, University of Allahabad, Allahabad-211002, India.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3299189/]]<br />
<br />
===CT scan===<br />
<br />
<br />
Thoracic CT angiography may be helpful in the diagnosis of pentalogy of fallot. Findings on CT scan diagnostic of pentalogy of fallot include. <ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
*ventricular septal defect.<br />
* right ventricular hypertrophy,<br />
* pulmonary atresia <br />
* aortopulmonary collateral arteries.<br />
<br />
===MRI===<br />
<br />
<br />
cardiac MRI may be helpful in the diagnosis of pentalogy of fallot. Findings on MRI diagnostic of pentalogy of fallot include RVOT stenosis, VSD, ASD,Overriding aorta, right ventricular hypertrophy and hypoplastic pulmonary arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
<br />
<br />
===Other Imaging Findings===<br />
Other imaging findings for pentalogy of fallot include Right ventricular angiopraphy which demonstrates infundibular and pulmonary artery anatomy. left ventricular angiography, which demonstrates. <ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
*VSD<br />
* ASD, <br />
* Overiding aorta<br />
<br />
===Other Diagnostic Studies===<br />
<br />
There are no other diagnostic studies associated with pentalogy of Fallot<br />
<br />
==Treatment==<br />
===Medical Therapy===<br />
The mainstay of treatment for pentalogy of fallot is Surgery.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
Pharmacologic medical therapy is recommended among patients with severe RVOTO and hypercyanotic spells.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
<br />
Pharmacologic medical therapies for pentalogy of fallot include.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
<br />
* prostaglandin E1 in neonates with ductal dependent pulmonary blood flow<br />
*[[Morphine]] and [[ketamine]] for sedation<br />
*vasopressors like [[phenylephrine]]<br />
*[[Propranolol|propanolol]] to decrease the need for palliative surgical intervention.<br />
* iron treatment to decrease frequency of spells. <br />
<br />
Patients with hypercyanotic spells are treated with,<br />
* oxygen <br />
*volume expansion <br />
* morphine sedation.<br />
<br />
===Surgery===<br />
<br />
<br />
<br />
Surgery is the mainstay of treatment for pentalogy of fallot. interventional procedures are used to relieve pulmonary obstructions and embolize colaterals. <br />
different surgical procedures can be done to treat pentalogy of fallot and it includes.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
* pulmonary valvotomy( for stenotic pulmonic valve)<br />
* pulmonary valvectomy( for small and thickened pulmonic valve) <br />
* closure of ASD/VSD<br />
* shunt surgery for severe cyanosis or in patients with frequent spells in the first year of life <br />
* Blalock -Taussig Shunt- communication between the right or left pulmonary artery and the right or left subclavian artery. <br />
* Waterson-Cooley Shunt- communication between the ascending aorta with the right pulmonary artery <br />
* Potts shunt-communication between the descending aorta and left pulmonary artery <br />
* Central shunt- Communication between the main pulmonary artery and ascending aorta.<br />
<br />
===Primary Prevention===<br />
There are no established measures for the primary prevention of pentalogy of fallot .<br />
<br />
===Secondary Prevention===<br />
There are no established measures for the secondary prevention of pentalogy of fallot<br />
===Prevention of Cyanosis===<br />
The following factors may reduce systemic vascular resistance (SVR) and exacerbate shunting which in turn exacerbate cyanosis and should be avoided if at all possible:<br />
<br />
*Acidosis<br />
*Bathing in hot water<br />
*Fever<br />
*Stress<br />
*Infection<br />
*Posture (upright, not squatting)<br />
*Exercise<br />
*[[Beta-adrenergic agonist|Beta-adrenergic agonists]]<br />
*[[Dehydration]]<br />
*Closure of the [[patent ductus arteriosus]]<br />
<br />
===Prevention of Infective Endocarditis===<br />
Antibiotic prophylaxis should be administered before respiratory and oral procedures.<br />
<br />
==References==<br />
{{reflist|2}}<br />
<br />
{{WikiDoc Help Menu}}<br />
{{WikiDoc Sources}}<br />
[[Category:Cardiology]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Abdulkareem Opeoluwalukanhttps://www.wikidoc.org/index.php?title=Pentalogy_of_Fallot&diff=1623946Pentalogy of Fallot2020-07-10T16:43:51Z<p>Abdulkareem Opeoluwalukan: /* Bidirectional shunt diseases */</p>
<hr />
<div>__NOTOC__<br />
{{SI}}<br />
{{CMG}} {{AE}}[[User:Abdulkareem Opeoluwalukan|Abdulkareem Opeoluwalukan, M.D]].<br />
==Overview==<br />
Pentalogy of Fallot is defined as the occurrence of Tetralogy of Fallot plus an [[atrial septal defect]].[[File:Pentalogy_of_fallot_image_1.png |200p|thumb|center| Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa. paolo.pazzi@up.ac.za.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3984729/]]<br />
<br />
==Historical Perspective==<br />
<br />
*[[Tetrallogy of fallot|Tetralogy of fallot]] was first discovered by Niel Stenson, a Denish physician Anatomist, in 1671. <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
* The association between right ventricular outflow tract obstruction and a large [[ventricular septal defect]] and tetralogy of fallot. was made in 1888 by Etinne-Louise.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref><br />
<br />
* In 1924, Canadian, Maude Abbott was the first to discover the association between ventricular septal defect , pulmonary stenosis, overriding aorta and right ventricular hypertrophy and the development of tetralogy of Fallot.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref<br />
In 1939, the first surgical treatment was developed by Dr Helen Taussig in Johns Hopkins&amp;lt;nowiki&amp;gt;&&amp;lt;/nowiki&amp;gt;lt;nowiki&lt;nowiki&gt;&&lt;/nowiki&gt;gt;<nowiki>&</nowiki>lt;nowiki<nowiki>&</nowiki>gt;<nowiki>&lt;nowiki&gt;<ref name="pmid30020660">&lt;/nowiki&gt;</nowiki>&lt;/nowiki&gt;&lt;/nowiki&gt;{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Classification==<br />
<br />
* There is no established system for the classification of pentalogy of fallot.<br />
<br />
<br /><br />
<br />
==Pathophysiology==<br />
<br />
It is thought that conotruncal Diseases like [[Tetralogy of Fallot|tetralogy of fallot]] and pentalogy of fallot is the result of <br />
<br />
* Neural Crest migration defect. <br />
* Underdevelopment of right ventricular infundibulum.<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
<br />
==Causes==<br />
<br />
<br />
<br />
<br />
The cause of pentalogy of fallot has not been identified. To review risk factors for the development of pentalogy of fallot, click [[tetralogy of fallot causes#Overview|here]].<br />
<br />
==Differentiating pentalogy of fallot from other Diseases==<br />
Pentalogy of Fallot must be differentiated from other diseases that cause .<ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
===Right to left shunt=== <br />
*[[Transposition of the great vessels|Transposition of great arteries]] with Pulmonic stenosis<br />
* Double outlet right ventricle including Taussig-Bing anomaly<br />
*[[Tricuspid atresia]]<br />
* Ebstein Anomaly<br />
*[[Pulmonary atresia]] with intact ventricular septum<br />
*Respiratory diseases<br />
<br />
* Bronchiolitis,<br />
*Viral and bacterial [[Pneumonia]]<br />
*[[Pneumothorax]] because when they are in heart failure they present with signs of respiratory distress, cyanosis and failure to thrive<br />
<br />
=== Bidirectional shunt diseases===<br />
* Total anomalous pulmonary venous return,<br />
*[[Hypoplastic left heart syndrome]],<br />
* Single ventricle <br />
*[[Persistent truncus arteriosus|Truncus arteriosus]].<br />
<br />
==Epidemiology and Demographics==<br />
The epidemiology of pentalogy of fallot has not been well studied.<br />
<br />
==Risk Factors==<br />
<br />
<br />
<br />
<br />
Common risk factors in the development of pentalogy of fallot includes<ref name="SilvaNeves2019">{{cite journal|last1=Silva|first1=Joana A.|last2=Neves|first2=Ana L.|last3=Flor-de-Lima|first3=Filipa|last4=Soares|first4=Paulo|last5=Guimarães|first5=Hercília|title=Risk Factors and Outcomes of Tetralogy of Fallot: From Fetal to Neonatal Life|journal=Pediatric Cardiology|volume=41|issue=1|year=2019|pages=155–164|issn=0172-0643|doi=10.1007/s00246-019-02239-4}}</ref><br />
<br />
* Alcoholism in mother <br />
* Maternal Diabetes <br />
* Advanced maternal age i.e greater than 40 years <br />
* Malnutrition in pregnancy <br />
* Family history of tetralogy of fallot <br />
* Viral illness during pregnancy like [[Rubella]].<br />
* presence of [[Down syndrome]] or [[22q11.2 deletion syndrome|DiGeorge syndrome]]<br />
<br />
==Screening==<br />
There is insufficient evidence to recommend routine screening for pentalogy of fallot.<br />
<br />
==Natural History, Complications, and Prognosis==<br />
If left untreated, patients with pentalogy of fallot may progress to develop finger clubbing, stunted growth, cardiac arrhythmias, hypoplastic pulmonary artery, paradoxical emboli and [[polycythemia]] .<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
<br />
Prognosis is generally excellent provided the [[Ventricular septal defect|VSD]] has been closed and the right ventricular outflow tract has been relieved.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
<br />
<br />
There are no established criteria for the diagnosis of pentalogy fallot.<br />
<br />
===History and Symptoms===<br />
<br />
The hallmark of pentalogy of fallot is cyanosis. A positive history of cyanosis and easy fatigability leading to squatting during exercise is suggestive of cyanotic congenital heart defect.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
. The most common symptoms of pentalogy of fallot include cyanosis, easy fatigabillity , and hypercyanotic spells with crying , feeding and defecating.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
==Physical Examination==<br />
<br />
=== Appearance===<br />
* patients with pentalogy of fallot usually appear small due to failure to thrive. <br />
* patients may be found in squatting position( compensatory mechanism)<br />
<br />
=== Vital Signs===<br />
* Tachycardia with regular pulse <br />
* Tachypnea <br />
* low grade fever in patients with concomitant infective [[endocarditis]]<br />
<br />
=== HEENT===<br />
* Retinal vessel engorgement may be present<br />
<br />
=== Heart===<br />
<br />
A thrill may be present at left sternal border.<br />
*A right ventricular impulse may be prominent.<br />
*Second heart sound (S2) is single as P2 is absent.<br />
*A harsh systolic ejection murmur best heard at the left sternal border is usually present.<br />
*P2 is faint and delayed in mild cyanosis and inaudible in severe cyanosis.<br />
*A diastolic murmur may be heard due to aortic regurgitation.<br />
<br />
=== Extremities===<br />
*Clubbing<br />
*Cyanosis is most prominent at lips and nail beds<br />
<br />
===Laboratory Findings===<br />
<br />
<br />
<br />
Some patients with pentalogy of fallot may have [[polycythemia]] <br />
which is usually suggestive of worsening hypoxia and compensatory production of erythropoetin.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
.<br />
<br />
===Electrocardiogram===<br />
<br />
An ECG may be helpful in the diagnosis of pentalogy of fallot, <br />
Findings on an ECG suggestive of pentalogy of fallot include [[right axis deviation]] and right ventricular hypertrophy.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
[[File: Right_ventrriular_hypertophy.png|200p|thumb|right|Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874376/]]<br />
<br />
===X-ray===<br />
<br />
<br />
<br />
<br />
An x-ray may be helpful in the diagnosis of pentalogy of Fallot. Findings on an x-ray suggestive of pentalogy of fallot include boot shaped heart or coeur en sabot.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref> [[File:Boot_shaped_heart.png|200p|thumb|left| Typical preoperative chest X‐ray of a 16‐month‐old boy with tetralogy of Fallot.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5412831/]]<br />
<br />
<br />
<br />
<br />
.<br />
<br />
===Echocardiography or Ultrasound===<br />
<br />
<br />
<br />
<br />
Echocardiography may be helpful in the diagnosis of pentalogy of fallot. Findings on an echocardiography diagnostic of pentalogy of fallot include.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
* Ventricular septal defect.<br />
* Atrial septal defect.<br />
* Right ventricular outflow tract obstruction.<br />
* overriding aorta [[File:Pentalogy_of_fallot_image_2.png|200p|thumb|left | Department of Biochemistry, University of Allahabad, Allahabad-211002, India.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3299189/]]<br />
<br />
===CT scan===<br />
<br />
<br />
Thoracic CT angiography may be helpful in the diagnosis of pentalogy of fallot. Findings on CT scan diagnostic of pentalogy of fallot include. <ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
*ventricular septal defect.<br />
* right ventricular hypertrophy,<br />
* pulmonary atresia <br />
* aortopulmonary collateral arteries.<br />
<br />
===MRI===<br />
<br />
<br />
cardiac MRI may be helpful in the diagnosis of pentalogy of fallot. Findings on MRI diagnostic of pentalogy of fallot include RVOT stenosis, VSD, ASD,Overriding aorta, right ventricular hypertrophy and hypoplastic pulmonary arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
<br />
<br />
===Other Imaging Findings===<br />
Other imaging findings for pentalogy of fallot include Right ventricular angiopraphy which demonstrates infundibular and pulmonary artery anatomy. left ventricular angiography, which demonstrates. <ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
*VSD<br />
* ASD, <br />
* Overiding aorta<br />
<br />
===Other Diagnostic Studies===<br />
<br />
There are no other diagnostic studies associated with pentalogy of Fallot<br />
<br />
==Treatment==<br />
===Medical Therapy===<br />
The mainstay of treatment for pentalogy of fallot is Surgery.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
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Pharmacologic medical therapy is recommended among patients with severe RVOTO and hypercyanotic spells.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
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Pharmacologic medical therapies for pentalogy of fallot include.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
<br />
* prostaglandin E1 in neonates with ductal dependent pulmonary blood flow<br />
*[[Morphine]] and [[ketamine]] for sedation<br />
*vasopressors like [[phenylephrine]]<br />
*[[Propranolol|propanolol]] to decrease the need for palliative surgical intervention.<br />
* iron treatment to decrease frequency of spells. <br />
<br />
Patients with hypercyanotic spells are treated with,<br />
* oxygen <br />
*volume expansion <br />
* morphine sedation.<br />
<br />
===Surgery===<br />
<br />
<br />
<br />
Surgery is the mainstay of treatment for pentalogy of fallot. interventional procedures are used to relieve pulmonary obstructions and embolize colaterals. <br />
different surgical procedures can be done to treat pentalogy of fallot and it includes.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
* pulmonary valvotomy( for stenotic pulmonic valve)<br />
* pulmonary valvectomy( for small and thickened pulmonic valve) <br />
* closure of ASD/VSD<br />
* shunt surgery for severe cyanosis or in patients with frequent spells in the first year of life <br />
* Blalock -Taussig Shunt- communication between the right or left pulmonary artery and the right or left subclavian artery. <br />
* Waterson-Cooley Shunt- communication between the ascending aorta with the right pulmonary artery <br />
* Potts shunt-communication between the descending aorta and left pulmonary artery <br />
* Central shunt- Communication between the main pulmonary artery and ascending aorta.<br />
<br />
===Primary Prevention===<br />
There are no established measures for the primary prevention of pentalogy of fallot .<br />
<br />
===Secondary Prevention===<br />
There are no established measures for the secondary prevention of pentalogy of fallot<br />
===Prevention of Cyanosis===<br />
The following factors may reduce systemic vascular resistance (SVR) and exacerbate shunting which in turn exacerbate cyanosis and should be avoided if at all possible:<br />
<br />
*Acidosis<br />
*Bathing in hot water<br />
*Fever<br />
*Stress<br />
*Infection<br />
*Posture (upright, not squatting)<br />
*Exercise<br />
*[[Beta-adrenergic agonist|Beta-adrenergic agonists]]<br />
*[[Dehydration]]<br />
*Closure of the [[patent ductus arteriosus]]<br />
<br />
===Prevention of Infective Endocarditis===<br />
Antibiotic prophylaxis should be administered before respiratory and oral procedures.<br />
<br />
==References==<br />
{{reflist|2}}<br />
<br />
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[[Category:Cardiology]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Abdulkareem Opeoluwalukanhttps://www.wikidoc.org/index.php?title=Pentalogy_of_Fallot&diff=1623945Pentalogy of Fallot2020-07-10T16:42:27Z<p>Abdulkareem Opeoluwalukan: /* Right to left shunt */</p>
<hr />
<div>__NOTOC__<br />
{{SI}}<br />
{{CMG}} {{AE}}[[User:Abdulkareem Opeoluwalukan|Abdulkareem Opeoluwalukan, M.D]].<br />
==Overview==<br />
Pentalogy of Fallot is defined as the occurrence of Tetralogy of Fallot plus an [[atrial septal defect]].[[File:Pentalogy_of_fallot_image_1.png |200p|thumb|center| Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa. paolo.pazzi@up.ac.za.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3984729/]]<br />
<br />
==Historical Perspective==<br />
<br />
*[[Tetrallogy of fallot|Tetralogy of fallot]] was first discovered by Niel Stenson, a Denish physician Anatomist, in 1671. <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
* The association between right ventricular outflow tract obstruction and a large [[ventricular septal defect]] and tetralogy of fallot. was made in 1888 by Etinne-Louise.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref><br />
<br />
* In 1924, Canadian, Maude Abbott was the first to discover the association between ventricular septal defect , pulmonary stenosis, overriding aorta and right ventricular hypertrophy and the development of tetralogy of Fallot.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref<br />
In 1939, the first surgical treatment was developed by Dr Helen Taussig in Johns Hopkins&amp;lt;nowiki&amp;gt;&&amp;lt;/nowiki&amp;gt;lt;nowiki&lt;nowiki&gt;&&lt;/nowiki&gt;gt;<nowiki>&</nowiki>lt;nowiki<nowiki>&</nowiki>gt;<nowiki>&lt;nowiki&gt;<ref name="pmid30020660">&lt;/nowiki&gt;</nowiki>&lt;/nowiki&gt;&lt;/nowiki&gt;{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Classification==<br />
<br />
* There is no established system for the classification of pentalogy of fallot.<br />
<br />
<br /><br />
<br />
==Pathophysiology==<br />
<br />
It is thought that conotruncal Diseases like [[Tetralogy of Fallot|tetralogy of fallot]] and pentalogy of fallot is the result of <br />
<br />
* Neural Crest migration defect. <br />
* Underdevelopment of right ventricular infundibulum.<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
<br />
==Causes==<br />
<br />
<br />
<br />
<br />
The cause of pentalogy of fallot has not been identified. To review risk factors for the development of pentalogy of fallot, click [[tetralogy of fallot causes#Overview|here]].<br />
<br />
==Differentiating pentalogy of fallot from other Diseases==<br />
Pentalogy of Fallot must be differentiated from other diseases that cause .<ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
===Right to left shunt=== <br />
*[[Transposition of the great vessels|Transposition of great arteries]] with Pulmonic stenosis<br />
* Double outlet right ventricle including Taussig-Bing anomaly<br />
*[[Tricuspid atresia]]<br />
* Ebstein Anomaly<br />
*[[Pulmonary atresia]] with intact ventricular septum<br />
*Respiratory diseases<br />
<br />
* Bronchiolitis,<br />
*Viral and bacterial [[Pneumonia]]<br />
*[[Pneumothorax]] because when they are in heart failure they present with signs of respiratory distress, cyanosis and failure to thrive<br />
<br />
=== Bidirectional shunt diseases===<br />
* Total anomalous pulmonary venous return,<br />
*[[Hypoplastic left heart syndrome]],<br />
* Single ventricle <br />
*[[Persistent truncus arteriosus|truncus arteriosus]].<br />
<br />
==Epidemiology and Demographics==<br />
The epidemiology of pentalogy of fallot has not been well studied.<br />
<br />
==Risk Factors==<br />
<br />
<br />
<br />
<br />
Common risk factors in the development of pentalogy of fallot includes<ref name="SilvaNeves2019">{{cite journal|last1=Silva|first1=Joana A.|last2=Neves|first2=Ana L.|last3=Flor-de-Lima|first3=Filipa|last4=Soares|first4=Paulo|last5=Guimarães|first5=Hercília|title=Risk Factors and Outcomes of Tetralogy of Fallot: From Fetal to Neonatal Life|journal=Pediatric Cardiology|volume=41|issue=1|year=2019|pages=155–164|issn=0172-0643|doi=10.1007/s00246-019-02239-4}}</ref><br />
<br />
* Alcoholism in mother <br />
* Maternal Diabetes <br />
* Advanced maternal age i.e greater than 40 years <br />
* Malnutrition in pregnancy <br />
* Family history of tetralogy of fallot <br />
* Viral illness during pregnancy like [[Rubella]].<br />
* presence of [[Down syndrome]] or [[22q11.2 deletion syndrome|DiGeorge syndrome]]<br />
<br />
==Screening==<br />
There is insufficient evidence to recommend routine screening for pentalogy of fallot.<br />
<br />
==Natural History, Complications, and Prognosis==<br />
If left untreated, patients with pentalogy of fallot may progress to develop finger clubbing, stunted growth, cardiac arrhythmias, hypoplastic pulmonary artery, paradoxical emboli and [[polycythemia]] .<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
<br />
Prognosis is generally excellent provided the [[Ventricular septal defect|VSD]] has been closed and the right ventricular outflow tract has been relieved.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. 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C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
<br />
<br />
There are no established criteria for the diagnosis of pentalogy fallot.<br />
<br />
===History and Symptoms===<br />
<br />
The hallmark of pentalogy of fallot is cyanosis. A positive history of cyanosis and easy fatigability leading to squatting during exercise is suggestive of cyanotic congenital heart defect.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
. The most common symptoms of pentalogy of fallot include cyanosis, easy fatigabillity , and hypercyanotic spells with crying , feeding and defecating.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
==Physical Examination==<br />
<br />
=== Appearance===<br />
* patients with pentalogy of fallot usually appear small due to failure to thrive. <br />
* patients may be found in squatting position( compensatory mechanism)<br />
<br />
=== Vital Signs===<br />
* Tachycardia with regular pulse <br />
* Tachypnea <br />
* low grade fever in patients with concomitant infective [[endocarditis]]<br />
<br />
=== HEENT===<br />
* Retinal vessel engorgement may be present<br />
<br />
=== Heart===<br />
<br />
A thrill may be present at left sternal border.<br />
*A right ventricular impulse may be prominent.<br />
*Second heart sound (S2) is single as P2 is absent.<br />
*A harsh systolic ejection murmur best heard at the left sternal border is usually present.<br />
*P2 is faint and delayed in mild cyanosis and inaudible in severe cyanosis.<br />
*A diastolic murmur may be heard due to aortic regurgitation.<br />
<br />
=== Extremities===<br />
*Clubbing<br />
*Cyanosis is most prominent at lips and nail beds<br />
<br />
===Laboratory Findings===<br />
<br />
<br />
<br />
Some patients with pentalogy of fallot may have [[polycythemia]] <br />
which is usually suggestive of worsening hypoxia and compensatory production of erythropoetin.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
.<br />
<br />
===Electrocardiogram===<br />
<br />
An ECG may be helpful in the diagnosis of pentalogy of fallot, <br />
Findings on an ECG suggestive of pentalogy of fallot include [[right axis deviation]] and right ventricular hypertrophy.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
[[File: Right_ventrriular_hypertophy.png|200p|thumb|right|Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874376/]]<br />
<br />
===X-ray===<br />
<br />
<br />
<br />
<br />
An x-ray may be helpful in the diagnosis of pentalogy of Fallot. Findings on an x-ray suggestive of pentalogy of fallot include boot shaped heart or coeur en sabot.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref> [[File:Boot_shaped_heart.png|200p|thumb|left| Typical preoperative chest X‐ray of a 16‐month‐old boy with tetralogy of Fallot.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5412831/]]<br />
<br />
<br />
<br />
<br />
.<br />
<br />
===Echocardiography or Ultrasound===<br />
<br />
<br />
<br />
<br />
Echocardiography may be helpful in the diagnosis of pentalogy of fallot. Findings on an echocardiography diagnostic of pentalogy of fallot include.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
* Ventricular septal defect.<br />
* Atrial septal defect.<br />
* Right ventricular outflow tract obstruction.<br />
* overriding aorta [[File:Pentalogy_of_fallot_image_2.png|200p|thumb|left | Department of Biochemistry, University of Allahabad, Allahabad-211002, India.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3299189/]]<br />
<br />
===CT scan===<br />
<br />
<br />
Thoracic CT angiography may be helpful in the diagnosis of pentalogy of fallot. Findings on CT scan diagnostic of pentalogy of fallot include. <ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
*ventricular septal defect.<br />
* right ventricular hypertrophy,<br />
* pulmonary atresia <br />
* aortopulmonary collateral arteries.<br />
<br />
===MRI===<br />
<br />
<br />
cardiac MRI may be helpful in the diagnosis of pentalogy of fallot. Findings on MRI diagnostic of pentalogy of fallot include RVOT stenosis, VSD, ASD,Overriding aorta, right ventricular hypertrophy and hypoplastic pulmonary arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
<br />
<br />
===Other Imaging Findings===<br />
Other imaging findings for pentalogy of fallot include Right ventricular angiopraphy which demonstrates infundibular and pulmonary artery anatomy. left ventricular angiography, which demonstrates. <ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
*VSD<br />
* ASD, <br />
* Overiding aorta<br />
<br />
===Other Diagnostic Studies===<br />
<br />
There are no other diagnostic studies associated with pentalogy of Fallot<br />
<br />
==Treatment==<br />
===Medical Therapy===<br />
The mainstay of treatment for pentalogy of fallot is Surgery.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
Pharmacologic medical therapy is recommended among patients with severe RVOTO and hypercyanotic spells.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
<br />
Pharmacologic medical therapies for pentalogy of fallot include.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
<br />
* prostaglandin E1 in neonates with ductal dependent pulmonary blood flow<br />
*[[Morphine]] and [[ketamine]] for sedation<br />
*vasopressors like [[phenylephrine]]<br />
*[[Propranolol|propanolol]] to decrease the need for palliative surgical intervention.<br />
* iron treatment to decrease frequency of spells. <br />
<br />
Patients with hypercyanotic spells are treated with,<br />
* oxygen <br />
*volume expansion <br />
* morphine sedation.<br />
<br />
===Surgery===<br />
<br />
<br />
<br />
Surgery is the mainstay of treatment for pentalogy of fallot. interventional procedures are used to relieve pulmonary obstructions and embolize colaterals. <br />
different surgical procedures can be done to treat pentalogy of fallot and it includes.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
* pulmonary valvotomy( for stenotic pulmonic valve)<br />
* pulmonary valvectomy( for small and thickened pulmonic valve) <br />
* closure of ASD/VSD<br />
* shunt surgery for severe cyanosis or in patients with frequent spells in the first year of life <br />
* Blalock -Taussig Shunt- communication between the right or left pulmonary artery and the right or left subclavian artery. <br />
* Waterson-Cooley Shunt- communication between the ascending aorta with the right pulmonary artery <br />
* Potts shunt-communication between the descending aorta and left pulmonary artery <br />
* Central shunt- Communication between the main pulmonary artery and ascending aorta.<br />
<br />
===Primary Prevention===<br />
There are no established measures for the primary prevention of pentalogy of fallot .<br />
<br />
===Secondary Prevention===<br />
There are no established measures for the secondary prevention of pentalogy of fallot<br />
===Prevention of Cyanosis===<br />
The following factors may reduce systemic vascular resistance (SVR) and exacerbate shunting which in turn exacerbate cyanosis and should be avoided if at all possible:<br />
<br />
*Acidosis<br />
*Bathing in hot water<br />
*Fever<br />
*Stress<br />
*Infection<br />
*Posture (upright, not squatting)<br />
*Exercise<br />
*[[Beta-adrenergic agonist|Beta-adrenergic agonists]]<br />
*[[Dehydration]]<br />
*Closure of the [[patent ductus arteriosus]]<br />
<br />
===Prevention of Infective Endocarditis===<br />
Antibiotic prophylaxis should be administered before respiratory and oral procedures.<br />
<br />
==References==<br />
{{reflist|2}}<br />
<br />
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[[Category:Cardiology]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Abdulkareem Opeoluwalukanhttps://www.wikidoc.org/index.php?title=Pentalogy_of_Fallot&diff=1623944Pentalogy of Fallot2020-07-10T16:38:31Z<p>Abdulkareem Opeoluwalukan: /* right to left shunt */</p>
<hr />
<div>__NOTOC__<br />
{{SI}}<br />
{{CMG}} {{AE}}[[User:Abdulkareem Opeoluwalukan|Abdulkareem Opeoluwalukan, M.D]].<br />
==Overview==<br />
Pentalogy of Fallot is defined as the occurrence of Tetralogy of Fallot plus an [[atrial septal defect]].[[File:Pentalogy_of_fallot_image_1.png |200p|thumb|center| Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa. paolo.pazzi@up.ac.za.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3984729/]]<br />
<br />
==Historical Perspective==<br />
<br />
*[[Tetrallogy of fallot|Tetralogy of fallot]] was first discovered by Niel Stenson, a Denish physician Anatomist, in 1671. <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
* The association between right ventricular outflow tract obstruction and a large [[ventricular septal defect]] and tetralogy of fallot. was made in 1888 by Etinne-Louise.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref><br />
<br />
* In 1924, Canadian, Maude Abbott was the first to discover the association between ventricular septal defect , pulmonary stenosis, overriding aorta and right ventricular hypertrophy and the development of tetralogy of Fallot.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref<br />
In 1939, the first surgical treatment was developed by Dr Helen Taussig in Johns Hopkins&amp;lt;nowiki&amp;gt;&&amp;lt;/nowiki&amp;gt;lt;nowiki&lt;nowiki&gt;&&lt;/nowiki&gt;gt;<nowiki>&</nowiki>lt;nowiki<nowiki>&</nowiki>gt;<nowiki>&lt;nowiki&gt;<ref name="pmid30020660">&lt;/nowiki&gt;</nowiki>&lt;/nowiki&gt;&lt;/nowiki&gt;{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Classification==<br />
<br />
* There is no established system for the classification of pentalogy of fallot.<br />
<br />
<br /><br />
<br />
==Pathophysiology==<br />
<br />
It is thought that conotruncal Diseases like [[Tetralogy of Fallot|tetralogy of fallot]] and pentalogy of fallot is the result of <br />
<br />
* Neural Crest migration defect. <br />
* Underdevelopment of right ventricular infundibulum.<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
<br />
==Causes==<br />
<br />
<br />
<br />
<br />
The cause of pentalogy of fallot has not been identified. To review risk factors for the development of pentalogy of fallot, click [[tetralogy of fallot causes#Overview|here]].<br />
<br />
==Differentiating pentalogy of fallot from other Diseases==<br />
Pentalogy of Fallot must be differentiated from other diseases that cause .<ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
===Right to left shunt=== <br />
*[[Transposition of the great vessels|transposition of great arteries]] with pulmonic stenosis<br />
* Double outlet right ventricle including Taussig-Bing anomaly<br />
*[[Tricuspid atresia]]<br />
* Ebstein Anomaly<br />
*[[Pulmonary atresia]] with intact ventricular septum<br />
*Respiratory diseases<br />
<br />
* Bronchiolitis,<br />
*Viral and bacterial [[Pneumonia]]<br />
*[[Pneumothorax]] because when they are in heart failure they present with signs of respiratory distress, cyanosis and failure to thrive<br />
<br />
=== Bidirectional shunt diseases===<br />
* Total anomalous pulmonary venous return,<br />
*[[Hypoplastic left heart syndrome]],<br />
* Single ventricle <br />
*[[Persistent truncus arteriosus|truncus arteriosus]].<br />
<br />
==Epidemiology and Demographics==<br />
The epidemiology of pentalogy of fallot has not been well studied.<br />
<br />
==Risk Factors==<br />
<br />
<br />
<br />
<br />
Common risk factors in the development of pentalogy of fallot includes<ref name="SilvaNeves2019">{{cite journal|last1=Silva|first1=Joana A.|last2=Neves|first2=Ana L.|last3=Flor-de-Lima|first3=Filipa|last4=Soares|first4=Paulo|last5=Guimarães|first5=Hercília|title=Risk Factors and Outcomes of Tetralogy of Fallot: From Fetal to Neonatal Life|journal=Pediatric Cardiology|volume=41|issue=1|year=2019|pages=155–164|issn=0172-0643|doi=10.1007/s00246-019-02239-4}}</ref><br />
<br />
* Alcoholism in mother <br />
* Maternal Diabetes <br />
* Advanced maternal age i.e greater than 40 years <br />
* Malnutrition in pregnancy <br />
* Family history of tetralogy of fallot <br />
* Viral illness during pregnancy like [[Rubella]].<br />
* presence of [[Down syndrome]] or [[22q11.2 deletion syndrome|DiGeorge syndrome]]<br />
<br />
==Screening==<br />
There is insufficient evidence to recommend routine screening for pentalogy of fallot.<br />
<br />
==Natural History, Complications, and Prognosis==<br />
If left untreated, patients with pentalogy of fallot may progress to develop finger clubbing, stunted growth, cardiac arrhythmias, hypoplastic pulmonary artery, paradoxical emboli and [[polycythemia]] .<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
<br />
Prognosis is generally excellent provided the [[Ventricular septal defect|VSD]] has been closed and the right ventricular outflow tract has been relieved.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. 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C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
<br />
<br />
There are no established criteria for the diagnosis of pentalogy fallot.<br />
<br />
===History and Symptoms===<br />
<br />
The hallmark of pentalogy of fallot is cyanosis. A positive history of cyanosis and easy fatigability leading to squatting during exercise is suggestive of cyanotic congenital heart defect.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
. The most common symptoms of pentalogy of fallot include cyanosis, easy fatigabillity , and hypercyanotic spells with crying , feeding and defecating.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
==Physical Examination==<br />
<br />
=== Appearance===<br />
* patients with pentalogy of fallot usually appear small due to failure to thrive. <br />
* patients may be found in squatting position( compensatory mechanism)<br />
<br />
=== Vital Signs===<br />
* Tachycardia with regular pulse <br />
* Tachypnea <br />
* low grade fever in patients with concomitant infective [[endocarditis]]<br />
<br />
=== HEENT===<br />
* Retinal vessel engorgement may be present<br />
<br />
=== Heart===<br />
<br />
A thrill may be present at left sternal border.<br />
*A right ventricular impulse may be prominent.<br />
*Second heart sound (S2) is single as P2 is absent.<br />
*A harsh systolic ejection murmur best heard at the left sternal border is usually present.<br />
*P2 is faint and delayed in mild cyanosis and inaudible in severe cyanosis.<br />
*A diastolic murmur may be heard due to aortic regurgitation.<br />
<br />
=== Extremities===<br />
*Clubbing<br />
*Cyanosis is most prominent at lips and nail beds<br />
<br />
===Laboratory Findings===<br />
<br />
<br />
<br />
Some patients with pentalogy of fallot may have [[polycythemia]] <br />
which is usually suggestive of worsening hypoxia and compensatory production of erythropoetin.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
.<br />
<br />
===Electrocardiogram===<br />
<br />
An ECG may be helpful in the diagnosis of pentalogy of fallot, <br />
Findings on an ECG suggestive of pentalogy of fallot include [[right axis deviation]] and right ventricular hypertrophy.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
[[File: Right_ventrriular_hypertophy.png|200p|thumb|right|Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874376/]]<br />
<br />
===X-ray===<br />
<br />
<br />
<br />
<br />
An x-ray may be helpful in the diagnosis of pentalogy of Fallot. Findings on an x-ray suggestive of pentalogy of fallot include boot shaped heart or coeur en sabot.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref> [[File:Boot_shaped_heart.png|200p|thumb|left| Typical preoperative chest X‐ray of a 16‐month‐old boy with tetralogy of Fallot.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5412831/]]<br />
<br />
<br />
<br />
<br />
.<br />
<br />
===Echocardiography or Ultrasound===<br />
<br />
<br />
<br />
<br />
Echocardiography may be helpful in the diagnosis of pentalogy of fallot. Findings on an echocardiography diagnostic of pentalogy of fallot include.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
* Ventricular septal defect.<br />
* Atrial septal defect.<br />
* Right ventricular outflow tract obstruction.<br />
* overriding aorta [[File:Pentalogy_of_fallot_image_2.png|200p|thumb|left | Department of Biochemistry, University of Allahabad, Allahabad-211002, India.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3299189/]]<br />
<br />
===CT scan===<br />
<br />
<br />
Thoracic CT angiography may be helpful in the diagnosis of pentalogy of fallot. Findings on CT scan diagnostic of pentalogy of fallot include. <ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
*ventricular septal defect.<br />
* right ventricular hypertrophy,<br />
* pulmonary atresia <br />
* aortopulmonary collateral arteries.<br />
<br />
===MRI===<br />
<br />
<br />
cardiac MRI may be helpful in the diagnosis of pentalogy of fallot. Findings on MRI diagnostic of pentalogy of fallot include RVOT stenosis, VSD, ASD,Overriding aorta, right ventricular hypertrophy and hypoplastic pulmonary arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
<br />
<br />
===Other Imaging Findings===<br />
Other imaging findings for pentalogy of fallot include Right ventricular angiopraphy which demonstrates infundibular and pulmonary artery anatomy. left ventricular angiography, which demonstrates. <ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
*VSD<br />
* ASD, <br />
* Overiding aorta<br />
<br />
===Other Diagnostic Studies===<br />
<br />
There are no other diagnostic studies associated with pentalogy of Fallot<br />
<br />
==Treatment==<br />
===Medical Therapy===<br />
The mainstay of treatment for pentalogy of fallot is Surgery.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
Pharmacologic medical therapy is recommended among patients with severe RVOTO and hypercyanotic spells.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
<br />
Pharmacologic medical therapies for pentalogy of fallot include.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
<br />
* prostaglandin E1 in neonates with ductal dependent pulmonary blood flow<br />
*[[Morphine]] and [[ketamine]] for sedation<br />
*vasopressors like [[phenylephrine]]<br />
*[[Propranolol|propanolol]] to decrease the need for palliative surgical intervention.<br />
* iron treatment to decrease frequency of spells. <br />
<br />
Patients with hypercyanotic spells are treated with,<br />
* oxygen <br />
*volume expansion <br />
* morphine sedation.<br />
<br />
===Surgery===<br />
<br />
<br />
<br />
Surgery is the mainstay of treatment for pentalogy of fallot. interventional procedures are used to relieve pulmonary obstructions and embolize colaterals. <br />
different surgical procedures can be done to treat pentalogy of fallot and it includes.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
* pulmonary valvotomy( for stenotic pulmonic valve)<br />
* pulmonary valvectomy( for small and thickened pulmonic valve) <br />
* closure of ASD/VSD<br />
* shunt surgery for severe cyanosis or in patients with frequent spells in the first year of life <br />
* Blalock -Taussig Shunt- communication between the right or left pulmonary artery and the right or left subclavian artery. <br />
* Waterson-Cooley Shunt- communication between the ascending aorta with the right pulmonary artery <br />
* Potts shunt-communication between the descending aorta and left pulmonary artery <br />
* Central shunt- Communication between the main pulmonary artery and ascending aorta.<br />
<br />
===Primary Prevention===<br />
There are no established measures for the primary prevention of pentalogy of fallot .<br />
<br />
===Secondary Prevention===<br />
There are no established measures for the secondary prevention of pentalogy of fallot<br />
===Prevention of Cyanosis===<br />
The following factors may reduce systemic vascular resistance (SVR) and exacerbate shunting which in turn exacerbate cyanosis and should be avoided if at all possible:<br />
<br />
*Acidosis<br />
*Bathing in hot water<br />
*Fever<br />
*Stress<br />
*Infection<br />
*Posture (upright, not squatting)<br />
*Exercise<br />
*[[Beta-adrenergic agonist|Beta-adrenergic agonists]]<br />
*[[Dehydration]]<br />
*Closure of the [[patent ductus arteriosus]]<br />
<br />
===Prevention of Infective Endocarditis===<br />
Antibiotic prophylaxis should be administered before respiratory and oral procedures.<br />
<br />
==References==<br />
{{reflist|2}}<br />
<br />
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[[Category:Cardiology]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Abdulkareem Opeoluwalukanhttps://www.wikidoc.org/index.php?title=Pentalogy_of_Fallot&diff=1623940Pentalogy of Fallot2020-07-10T16:36:45Z<p>Abdulkareem Opeoluwalukan: /* Differentiating pentalogy of fallot from other Diseases */</p>
<hr />
<div>__NOTOC__<br />
{{SI}}<br />
{{CMG}} {{AE}}[[User:Abdulkareem Opeoluwalukan|Abdulkareem Opeoluwalukan, M.D]].<br />
==Overview==<br />
Pentalogy of Fallot is defined as the occurrence of Tetralogy of Fallot plus an [[atrial septal defect]].[[File:Pentalogy_of_fallot_image_1.png |200p|thumb|center| Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa. paolo.pazzi@up.ac.za.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3984729/]]<br />
<br />
==Historical Perspective==<br />
<br />
*[[Tetrallogy of fallot|Tetralogy of fallot]] was first discovered by Niel Stenson, a Denish physician Anatomist, in 1671. <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
* The association between right ventricular outflow tract obstruction and a large [[ventricular septal defect]] and tetralogy of fallot. was made in 1888 by Etinne-Louise.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref><br />
<br />
* In 1924, Canadian, Maude Abbott was the first to discover the association between ventricular septal defect , pulmonary stenosis, overriding aorta and right ventricular hypertrophy and the development of tetralogy of Fallot.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref<br />
In 1939, the first surgical treatment was developed by Dr Helen Taussig in Johns Hopkins&amp;lt;nowiki&amp;gt;&&amp;lt;/nowiki&amp;gt;lt;nowiki&lt;nowiki&gt;&&lt;/nowiki&gt;gt;<nowiki>&</nowiki>lt;nowiki<nowiki>&</nowiki>gt;<nowiki>&lt;nowiki&gt;<ref name="pmid30020660">&lt;/nowiki&gt;</nowiki>&lt;/nowiki&gt;&lt;/nowiki&gt;{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Classification==<br />
<br />
* There is no established system for the classification of pentalogy of fallot.<br />
<br />
<br /><br />
<br />
==Pathophysiology==<br />
<br />
It is thought that conotruncal Diseases like [[Tetralogy of Fallot|tetralogy of fallot]] and pentalogy of fallot is the result of <br />
<br />
* Neural Crest migration defect. <br />
* Underdevelopment of right ventricular infundibulum.<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
<br />
==Causes==<br />
<br />
<br />
<br />
<br />
The cause of pentalogy of fallot has not been identified. To review risk factors for the development of pentalogy of fallot, click [[tetralogy of fallot causes#Overview|here]].<br />
<br />
==Differentiating pentalogy of fallot from other Diseases==<br />
Pentalogy of Fallot must be differentiated from other diseases that cause .<ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
===right to left shunt=== <br />
*[[Transposition of the great vessels|transposition of great arteries]] with pulmonic stenosis<br />
* Double outlet right ventricle including Taussig-Bing anomaly<br />
*[[Tricuspid atresia]]<br />
* Ebstein Anomaly<br />
*[[Pulmonary atresia]] with intact ventricular septum<br />
*Respiratory diseases<br />
<br />
* Bronchiolitis,<br />
*Viral and bacterial [[pneumonia]]<br />
*[[Pneumothorax]] because when they are in heart failure they present with signs of respiratory distress, cyanosis and failure to thrive<br />
<br />
=== Bidirectional shunt diseases===<br />
* Total anomalous pulmonary venous return,<br />
*[[Hypoplastic left heart syndrome]],<br />
* Single ventricle <br />
*[[Persistent truncus arteriosus|truncus arteriosus]].<br />
<br />
==Epidemiology and Demographics==<br />
The epidemiology of pentalogy of fallot has not been well studied.<br />
<br />
==Risk Factors==<br />
<br />
<br />
<br />
<br />
Common risk factors in the development of pentalogy of fallot includes<ref name="SilvaNeves2019">{{cite journal|last1=Silva|first1=Joana A.|last2=Neves|first2=Ana L.|last3=Flor-de-Lima|first3=Filipa|last4=Soares|first4=Paulo|last5=Guimarães|first5=Hercília|title=Risk Factors and Outcomes of Tetralogy of Fallot: From Fetal to Neonatal Life|journal=Pediatric Cardiology|volume=41|issue=1|year=2019|pages=155–164|issn=0172-0643|doi=10.1007/s00246-019-02239-4}}</ref><br />
<br />
* Alcoholism in mother <br />
* Maternal Diabetes <br />
* Advanced maternal age i.e greater than 40 years <br />
* Malnutrition in pregnancy <br />
* Family history of tetralogy of fallot <br />
* Viral illness during pregnancy like [[Rubella]].<br />
* presence of [[Down syndrome]] or [[22q11.2 deletion syndrome|DiGeorge syndrome]]<br />
<br />
==Screening==<br />
There is insufficient evidence to recommend routine screening for pentalogy of fallot.<br />
<br />
==Natural History, Complications, and Prognosis==<br />
If left untreated, patients with pentalogy of fallot may progress to develop finger clubbing, stunted growth, cardiac arrhythmias, hypoplastic pulmonary artery, paradoxical emboli and [[polycythemia]] .<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
<br />
Prognosis is generally excellent provided the [[Ventricular septal defect|VSD]] has been closed and the right ventricular outflow tract has been relieved.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. 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C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
<br />
<br />
There are no established criteria for the diagnosis of pentalogy fallot.<br />
<br />
===History and Symptoms===<br />
<br />
The hallmark of pentalogy of fallot is cyanosis. A positive history of cyanosis and easy fatigability leading to squatting during exercise is suggestive of cyanotic congenital heart defect.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
. The most common symptoms of pentalogy of fallot include cyanosis, easy fatigabillity , and hypercyanotic spells with crying , feeding and defecating.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
==Physical Examination==<br />
<br />
=== Appearance===<br />
* patients with pentalogy of fallot usually appear small due to failure to thrive. <br />
* patients may be found in squatting position( compensatory mechanism)<br />
<br />
=== Vital Signs===<br />
* Tachycardia with regular pulse <br />
* Tachypnea <br />
* low grade fever in patients with concomitant infective [[endocarditis]]<br />
<br />
=== HEENT===<br />
* Retinal vessel engorgement may be present<br />
<br />
=== Heart===<br />
<br />
A thrill may be present at left sternal border.<br />
*A right ventricular impulse may be prominent.<br />
*Second heart sound (S2) is single as P2 is absent.<br />
*A harsh systolic ejection murmur best heard at the left sternal border is usually present.<br />
*P2 is faint and delayed in mild cyanosis and inaudible in severe cyanosis.<br />
*A diastolic murmur may be heard due to aortic regurgitation.<br />
<br />
=== Extremities===<br />
*Clubbing<br />
*Cyanosis is most prominent at lips and nail beds<br />
<br />
===Laboratory Findings===<br />
<br />
<br />
<br />
Some patients with pentalogy of fallot may have [[polycythemia]] <br />
which is usually suggestive of worsening hypoxia and compensatory production of erythropoetin.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
.<br />
<br />
===Electrocardiogram===<br />
<br />
An ECG may be helpful in the diagnosis of pentalogy of fallot, <br />
Findings on an ECG suggestive of pentalogy of fallot include [[right axis deviation]] and right ventricular hypertrophy.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
[[File: Right_ventrriular_hypertophy.png|200p|thumb|right|Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874376/]]<br />
<br />
===X-ray===<br />
<br />
<br />
<br />
<br />
An x-ray may be helpful in the diagnosis of pentalogy of Fallot. Findings on an x-ray suggestive of pentalogy of fallot include boot shaped heart or coeur en sabot.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref> [[File:Boot_shaped_heart.png|200p|thumb|left| Typical preoperative chest X‐ray of a 16‐month‐old boy with tetralogy of Fallot.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5412831/]]<br />
<br />
<br />
<br />
<br />
.<br />
<br />
===Echocardiography or Ultrasound===<br />
<br />
<br />
<br />
<br />
Echocardiography may be helpful in the diagnosis of pentalogy of fallot. Findings on an echocardiography diagnostic of pentalogy of fallot include.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
* Ventricular septal defect.<br />
* Atrial septal defect.<br />
* Right ventricular outflow tract obstruction.<br />
* overriding aorta [[File:Pentalogy_of_fallot_image_2.png|200p|thumb|left | Department of Biochemistry, University of Allahabad, Allahabad-211002, India.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3299189/]]<br />
<br />
===CT scan===<br />
<br />
<br />
Thoracic CT angiography may be helpful in the diagnosis of pentalogy of fallot. Findings on CT scan diagnostic of pentalogy of fallot include. <ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
*ventricular septal defect.<br />
* right ventricular hypertrophy,<br />
* pulmonary atresia <br />
* aortopulmonary collateral arteries.<br />
<br />
===MRI===<br />
<br />
<br />
cardiac MRI may be helpful in the diagnosis of pentalogy of fallot. Findings on MRI diagnostic of pentalogy of fallot include RVOT stenosis, VSD, ASD,Overriding aorta, right ventricular hypertrophy and hypoplastic pulmonary arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
<br />
<br />
===Other Imaging Findings===<br />
Other imaging findings for pentalogy of fallot include Right ventricular angiopraphy which demonstrates infundibular and pulmonary artery anatomy. left ventricular angiography, which demonstrates. <ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
*VSD<br />
* ASD, <br />
* Overiding aorta<br />
<br />
===Other Diagnostic Studies===<br />
<br />
There are no other diagnostic studies associated with pentalogy of Fallot<br />
<br />
==Treatment==<br />
===Medical Therapy===<br />
The mainstay of treatment for pentalogy of fallot is Surgery.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
Pharmacologic medical therapy is recommended among patients with severe RVOTO and hypercyanotic spells.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
<br />
Pharmacologic medical therapies for pentalogy of fallot include.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
<br />
* prostaglandin E1 in neonates with ductal dependent pulmonary blood flow<br />
*[[Morphine]] and [[ketamine]] for sedation<br />
*vasopressors like [[phenylephrine]]<br />
*[[Propranolol|propanolol]] to decrease the need for palliative surgical intervention.<br />
* iron treatment to decrease frequency of spells. <br />
<br />
Patients with hypercyanotic spells are treated with,<br />
* oxygen <br />
*volume expansion <br />
* morphine sedation.<br />
<br />
===Surgery===<br />
<br />
<br />
<br />
Surgery is the mainstay of treatment for pentalogy of fallot. interventional procedures are used to relieve pulmonary obstructions and embolize colaterals. <br />
different surgical procedures can be done to treat pentalogy of fallot and it includes.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
* pulmonary valvotomy( for stenotic pulmonic valve)<br />
* pulmonary valvectomy( for small and thickened pulmonic valve) <br />
* closure of ASD/VSD<br />
* shunt surgery for severe cyanosis or in patients with frequent spells in the first year of life <br />
* Blalock -Taussig Shunt- communication between the right or left pulmonary artery and the right or left subclavian artery. <br />
* Waterson-Cooley Shunt- communication between the ascending aorta with the right pulmonary artery <br />
* Potts shunt-communication between the descending aorta and left pulmonary artery <br />
* Central shunt- Communication between the main pulmonary artery and ascending aorta.<br />
<br />
===Primary Prevention===<br />
There are no established measures for the primary prevention of pentalogy of fallot .<br />
<br />
===Secondary Prevention===<br />
There are no established measures for the secondary prevention of pentalogy of fallot<br />
===Prevention of Cyanosis===<br />
The following factors may reduce systemic vascular resistance (SVR) and exacerbate shunting which in turn exacerbate cyanosis and should be avoided if at all possible:<br />
<br />
*Acidosis<br />
*Bathing in hot water<br />
*Fever<br />
*Stress<br />
*Infection<br />
*Posture (upright, not squatting)<br />
*Exercise<br />
*[[Beta-adrenergic agonist|Beta-adrenergic agonists]]<br />
*[[Dehydration]]<br />
*Closure of the [[patent ductus arteriosus]]<br />
<br />
===Prevention of Infective Endocarditis===<br />
Antibiotic prophylaxis should be administered before respiratory and oral procedures.<br />
<br />
==References==<br />
{{reflist|2}}<br />
<br />
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[[Category:Cardiology]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Abdulkareem Opeoluwalukanhttps://www.wikidoc.org/index.php?title=Pentalogy_of_Fallot&diff=1623933Pentalogy of Fallot2020-07-10T16:33:49Z<p>Abdulkareem Opeoluwalukan: /* Differentiating pentalogy of fallot from other Diseases */</p>
<hr />
<div>__NOTOC__<br />
{{SI}}<br />
{{CMG}} {{AE}}[[User:Abdulkareem Opeoluwalukan|Abdulkareem Opeoluwalukan, M.D]].<br />
==Overview==<br />
Pentalogy of Fallot is defined as the occurrence of Tetralogy of Fallot plus an [[atrial septal defect]].[[File:Pentalogy_of_fallot_image_1.png |200p|thumb|center| Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa. paolo.pazzi@up.ac.za.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3984729/]]<br />
<br />
==Historical Perspective==<br />
<br />
*[[Tetrallogy of fallot|Tetralogy of fallot]] was first discovered by Niel Stenson, a Denish physician Anatomist, in 1671. <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
* The association between right ventricular outflow tract obstruction and a large [[ventricular septal defect]] and tetralogy of fallot. was made in 1888 by Etinne-Louise.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref><br />
<br />
* In 1924, Canadian, Maude Abbott was the first to discover the association between ventricular septal defect , pulmonary stenosis, overriding aorta and right ventricular hypertrophy and the development of tetralogy of Fallot.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref<br />
In 1939, the first surgical treatment was developed by Dr Helen Taussig in Johns Hopkins&amp;lt;nowiki&amp;gt;&&amp;lt;/nowiki&amp;gt;lt;nowiki&lt;nowiki&gt;&&lt;/nowiki&gt;gt;<nowiki>&</nowiki>lt;nowiki<nowiki>&</nowiki>gt;<nowiki>&lt;nowiki&gt;<ref name="pmid30020660">&lt;/nowiki&gt;</nowiki>&lt;/nowiki&gt;&lt;/nowiki&gt;{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Classification==<br />
<br />
* There is no established system for the classification of pentalogy of fallot.<br />
<br />
<br /><br />
<br />
==Pathophysiology==<br />
<br />
It is thought that conotruncal Diseases like [[Tetralogy of Fallot|tetralogy of fallot]] and pentalogy of fallot is the result of <br />
<br />
* Neural Crest migration defect. <br />
* Underdevelopment of right ventricular infundibulum.<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
<br />
==Causes==<br />
<br />
<br />
<br />
<br />
The cause of pentalogy of fallot has not been identified. To review risk factors for the development of pentalogy of fallot, click [[tetralogy of fallot causes#Overview|here]].<br />
<br />
==Differentiating pentalogy of fallot from other Diseases==<br />
pentalogy of Fallot must be differentiated from other diseases that cause .<ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
===right to left shunt=== <br />
*[[Transposition of the great vessels|transposition of great arteries]] with pulmonic stenosis<br />
* double outlet right ventricle including Taussig-Bing anomaly<br />
*[[tricuspid atresia]]<br />
* Ebstein Anomaly<br />
*[[pulmonary atresia]] with intact ventricular septum<br />
*Respiratory diseases<br />
<br />
* Bronchiolitis,<br />
*viral and bacterial [[pneumonia]]<br />
*[[pneumothorax]] because when they are in heart failure they present with signs of respiratory distress, cyanosis and failure to thrive<br />
<br />
=== Bidirectional shunt diseases===<br />
* total anomalous pulmonary venous return,<br />
*[[hypoplastic left heart syndrome]],<br />
* single ventricle <br />
*[[Persistent truncus arteriosus|truncus arteriosus]].<br />
<br />
==Epidemiology and Demographics==<br />
The epidemiology of pentalogy of fallot has not been well studied.<br />
<br />
==Risk Factors==<br />
<br />
<br />
<br />
<br />
Common risk factors in the development of pentalogy of fallot includes<ref name="SilvaNeves2019">{{cite journal|last1=Silva|first1=Joana A.|last2=Neves|first2=Ana L.|last3=Flor-de-Lima|first3=Filipa|last4=Soares|first4=Paulo|last5=Guimarães|first5=Hercília|title=Risk Factors and Outcomes of Tetralogy of Fallot: From Fetal to Neonatal Life|journal=Pediatric Cardiology|volume=41|issue=1|year=2019|pages=155–164|issn=0172-0643|doi=10.1007/s00246-019-02239-4}}</ref><br />
<br />
* Alcoholism in mother <br />
* Maternal Diabetes <br />
* Advanced maternal age i.e greater than 40 years <br />
* Malnutrition in pregnancy <br />
* Family history of tetralogy of fallot <br />
* Viral illness during pregnancy like [[Rubella]].<br />
* presence of [[Down syndrome]] or [[22q11.2 deletion syndrome|DiGeorge syndrome]]<br />
<br />
==Screening==<br />
There is insufficient evidence to recommend routine screening for pentalogy of fallot.<br />
<br />
==Natural History, Complications, and Prognosis==<br />
If left untreated, patients with pentalogy of fallot may progress to develop finger clubbing, stunted growth, cardiac arrhythmias, hypoplastic pulmonary artery, paradoxical emboli and [[polycythemia]] .<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
<br />
Prognosis is generally excellent provided the [[Ventricular septal defect|VSD]] has been closed and the right ventricular outflow tract has been relieved.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. 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C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
<br />
<br />
There are no established criteria for the diagnosis of pentalogy fallot.<br />
<br />
===History and Symptoms===<br />
<br />
The hallmark of pentalogy of fallot is cyanosis. A positive history of cyanosis and easy fatigability leading to squatting during exercise is suggestive of cyanotic congenital heart defect.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
. The most common symptoms of pentalogy of fallot include cyanosis, easy fatigabillity , and hypercyanotic spells with crying , feeding and defecating.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
==Physical Examination==<br />
<br />
=== Appearance===<br />
* patients with pentalogy of fallot usually appear small due to failure to thrive. <br />
* patients may be found in squatting position( compensatory mechanism)<br />
<br />
=== Vital Signs===<br />
* Tachycardia with regular pulse <br />
* Tachypnea <br />
* low grade fever in patients with concomitant infective [[endocarditis]]<br />
<br />
=== HEENT===<br />
* Retinal vessel engorgement may be present<br />
<br />
=== Heart===<br />
<br />
A thrill may be present at left sternal border.<br />
*A right ventricular impulse may be prominent.<br />
*Second heart sound (S2) is single as P2 is absent.<br />
*A harsh systolic ejection murmur best heard at the left sternal border is usually present.<br />
*P2 is faint and delayed in mild cyanosis and inaudible in severe cyanosis.<br />
*A diastolic murmur may be heard due to aortic regurgitation.<br />
<br />
=== Extremities===<br />
*Clubbing<br />
*Cyanosis is most prominent at lips and nail beds<br />
<br />
===Laboratory Findings===<br />
<br />
<br />
<br />
Some patients with pentalogy of fallot may have [[polycythemia]] <br />
which is usually suggestive of worsening hypoxia and compensatory production of erythropoetin.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
.<br />
<br />
===Electrocardiogram===<br />
<br />
An ECG may be helpful in the diagnosis of pentalogy of fallot, <br />
Findings on an ECG suggestive of pentalogy of fallot include [[right axis deviation]] and right ventricular hypertrophy.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
[[File: Right_ventrriular_hypertophy.png|200p|thumb|right|Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874376/]]<br />
<br />
===X-ray===<br />
<br />
<br />
<br />
<br />
An x-ray may be helpful in the diagnosis of pentalogy of Fallot. Findings on an x-ray suggestive of pentalogy of fallot include boot shaped heart or coeur en sabot.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref> [[File:Boot_shaped_heart.png|200p|thumb|left| Typical preoperative chest X‐ray of a 16‐month‐old boy with tetralogy of Fallot.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5412831/]]<br />
<br />
<br />
<br />
<br />
.<br />
<br />
===Echocardiography or Ultrasound===<br />
<br />
<br />
<br />
<br />
Echocardiography may be helpful in the diagnosis of pentalogy of fallot. Findings on an echocardiography diagnostic of pentalogy of fallot include.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
* Ventricular septal defect.<br />
* Atrial septal defect.<br />
* Right ventricular outflow tract obstruction.<br />
* overriding aorta [[File:Pentalogy_of_fallot_image_2.png|200p|thumb|left | Department of Biochemistry, University of Allahabad, Allahabad-211002, India.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3299189/]]<br />
<br />
===CT scan===<br />
<br />
<br />
Thoracic CT angiography may be helpful in the diagnosis of pentalogy of fallot. Findings on CT scan diagnostic of pentalogy of fallot include. <ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
*ventricular septal defect.<br />
* right ventricular hypertrophy,<br />
* pulmonary atresia <br />
* aortopulmonary collateral arteries.<br />
<br />
===MRI===<br />
<br />
<br />
cardiac MRI may be helpful in the diagnosis of pentalogy of fallot. Findings on MRI diagnostic of pentalogy of fallot include RVOT stenosis, VSD, ASD,Overriding aorta, right ventricular hypertrophy and hypoplastic pulmonary arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
<br />
<br />
===Other Imaging Findings===<br />
Other imaging findings for pentalogy of fallot include Right ventricular angiopraphy which demonstrates infundibular and pulmonary artery anatomy. left ventricular angiography, which demonstrates. <ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
*VSD<br />
* ASD, <br />
* Overiding aorta<br />
<br />
===Other Diagnostic Studies===<br />
<br />
There are no other diagnostic studies associated with pentalogy of Fallot<br />
<br />
==Treatment==<br />
===Medical Therapy===<br />
The mainstay of treatment for pentalogy of fallot is Surgery.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
Pharmacologic medical therapy is recommended among patients with severe RVOTO and hypercyanotic spells.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
<br />
Pharmacologic medical therapies for pentalogy of fallot include.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
<br />
* prostaglandin E1 in neonates with ductal dependent pulmonary blood flow<br />
*[[Morphine]] and [[ketamine]] for sedation<br />
*vasopressors like [[phenylephrine]]<br />
*[[Propranolol|propanolol]] to decrease the need for palliative surgical intervention.<br />
* iron treatment to decrease frequency of spells. <br />
<br />
Patients with hypercyanotic spells are treated with,<br />
* oxygen <br />
*volume expansion <br />
* morphine sedation.<br />
<br />
===Surgery===<br />
<br />
<br />
<br />
Surgery is the mainstay of treatment for pentalogy of fallot. interventional procedures are used to relieve pulmonary obstructions and embolize colaterals. <br />
different surgical procedures can be done to treat pentalogy of fallot and it includes.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
* pulmonary valvotomy( for stenotic pulmonic valve)<br />
* pulmonary valvectomy( for small and thickened pulmonic valve) <br />
* closure of ASD/VSD<br />
* shunt surgery for severe cyanosis or in patients with frequent spells in the first year of life <br />
* Blalock -Taussig Shunt- communication between the right or left pulmonary artery and the right or left subclavian artery. <br />
* Waterson-Cooley Shunt- communication between the ascending aorta with the right pulmonary artery <br />
* Potts shunt-communication between the descending aorta and left pulmonary artery <br />
* Central shunt- Communication between the main pulmonary artery and ascending aorta.<br />
<br />
===Primary Prevention===<br />
There are no established measures for the primary prevention of pentalogy of fallot .<br />
<br />
===Secondary Prevention===<br />
There are no established measures for the secondary prevention of pentalogy of fallot<br />
===Prevention of Cyanosis===<br />
The following factors may reduce systemic vascular resistance (SVR) and exacerbate shunting which in turn exacerbate cyanosis and should be avoided if at all possible:<br />
<br />
*Acidosis<br />
*Bathing in hot water<br />
*Fever<br />
*Stress<br />
*Infection<br />
*Posture (upright, not squatting)<br />
*Exercise<br />
*[[Beta-adrenergic agonist|Beta-adrenergic agonists]]<br />
*[[Dehydration]]<br />
*Closure of the [[patent ductus arteriosus]]<br />
<br />
===Prevention of Infective Endocarditis===<br />
Antibiotic prophylaxis should be administered before respiratory and oral procedures.<br />
<br />
==References==<br />
{{reflist|2}}<br />
<br />
{{WikiDoc Help Menu}}<br />
{{WikiDoc Sources}}<br />
[[Category:Cardiology]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Abdulkareem Opeoluwalukanhttps://www.wikidoc.org/index.php?title=Pentalogy_of_Fallot&diff=1623930Pentalogy of Fallot2020-07-10T16:29:07Z<p>Abdulkareem Opeoluwalukan: /* X-ray */</p>
<hr />
<div>__NOTOC__<br />
{{SI}}<br />
{{CMG}} {{AE}}[[User:Abdulkareem Opeoluwalukan|Abdulkareem Opeoluwalukan, M.D]].<br />
==Overview==<br />
Pentalogy of Fallot is defined as the occurrence of Tetralogy of Fallot plus an [[atrial septal defect]].[[File:Pentalogy_of_fallot_image_1.png |200p|thumb|center| Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa. paolo.pazzi@up.ac.za.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3984729/]]<br />
<br />
==Historical Perspective==<br />
<br />
*[[Tetrallogy of fallot|Tetralogy of fallot]] was first discovered by Niel Stenson, a Denish physician Anatomist, in 1671. <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
* The association between right ventricular outflow tract obstruction and a large [[ventricular septal defect]] and tetralogy of fallot. was made in 1888 by Etinne-Louise.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref><br />
<br />
* In 1924, Canadian, Maude Abbott was the first to discover the association between ventricular septal defect , pulmonary stenosis, overriding aorta and right ventricular hypertrophy and the development of tetralogy of Fallot.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref<br />
In 1939, the first surgical treatment was developed by Dr Helen Taussig in Johns Hopkins&amp;lt;nowiki&amp;gt;&&amp;lt;/nowiki&amp;gt;lt;nowiki&lt;nowiki&gt;&&lt;/nowiki&gt;gt;<nowiki>&</nowiki>lt;nowiki<nowiki>&</nowiki>gt;<nowiki>&lt;nowiki&gt;<ref name="pmid30020660">&lt;/nowiki&gt;</nowiki>&lt;/nowiki&gt;&lt;/nowiki&gt;{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Classification==<br />
<br />
* There is no established system for the classification of pentalogy of fallot.<br />
<br />
<br /><br />
<br />
==Pathophysiology==<br />
<br />
It is thought that conotruncal Diseases like [[Tetralogy of Fallot|tetralogy of fallot]] and pentalogy of fallot is the result of <br />
<br />
* Neural Crest migration defect. <br />
* Underdevelopment of right ventricular infundibulum.<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
<br />
==Causes==<br />
<br />
<br />
<br />
<br />
The cause of pentalogy of fallot has not been identified. To review risk factors for the development of pentalogy of fallot, click [[tetralogy of fallot causes#Overview|here]].<br />
<br />
==Differentiating pentalogy of fallot from other Diseases==<br />
pentalogy of Fallot must be differentiated from other diseases that cause .<br />
<br />
===right to left shunt=== <br />
*[[Transposition of the great vessels|transposition of great arteries]] with pulmonic stenosis<br />
* double outlet right ventricle including Taussig-Bing anomaly<br />
*[[tricuspid atresia]]<br />
* Ebstein Anomaly<br />
*[[pulmonary atresia]] with intact ventricular septum<br />
*Respiratory diseases<br />
<br />
* Bronchiolitis,<br />
*viral and bacterial [[pneumonia]]<br />
*[[pneumothorax]] because when they are in heart failure they present with signs of respiratory distress, cyanosis and failure to thrive<br />
<br />
=== Bidirectional shunt diseases===<br />
* total anomalous pulmonary venous return,<br />
*[[hypoplastic left heart syndrome]],<br />
* single ventricle <br />
*[[Persistent truncus arteriosus|truncus arteriosus]] <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Epidemiology and Demographics==<br />
The epidemiology of pentalogy of fallot has not been well studied.<br />
<br />
==Risk Factors==<br />
<br />
<br />
<br />
<br />
Common risk factors in the development of pentalogy of fallot includes<ref name="SilvaNeves2019">{{cite journal|last1=Silva|first1=Joana A.|last2=Neves|first2=Ana L.|last3=Flor-de-Lima|first3=Filipa|last4=Soares|first4=Paulo|last5=Guimarães|first5=Hercília|title=Risk Factors and Outcomes of Tetralogy of Fallot: From Fetal to Neonatal Life|journal=Pediatric Cardiology|volume=41|issue=1|year=2019|pages=155–164|issn=0172-0643|doi=10.1007/s00246-019-02239-4}}</ref><br />
<br />
* Alcoholism in mother <br />
* Maternal Diabetes <br />
* Advanced maternal age i.e greater than 40 years <br />
* Malnutrition in pregnancy <br />
* Family history of tetralogy of fallot <br />
* Viral illness during pregnancy like [[Rubella]].<br />
* presence of [[Down syndrome]] or [[22q11.2 deletion syndrome|DiGeorge syndrome]]<br />
<br />
==Screening==<br />
There is insufficient evidence to recommend routine screening for pentalogy of fallot.<br />
<br />
==Natural History, Complications, and Prognosis==<br />
If left untreated, patients with pentalogy of fallot may progress to develop finger clubbing, stunted growth, cardiac arrhythmias, hypoplastic pulmonary artery, paradoxical emboli and [[polycythemia]] .<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
<br />
Prognosis is generally excellent provided the [[Ventricular septal defect|VSD]] has been closed and the right ventricular outflow tract has been relieved.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. 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C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
<br />
<br />
There are no established criteria for the diagnosis of pentalogy fallot.<br />
<br />
===History and Symptoms===<br />
<br />
The hallmark of pentalogy of fallot is cyanosis. A positive history of cyanosis and easy fatigability leading to squatting during exercise is suggestive of cyanotic congenital heart defect.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
. The most common symptoms of pentalogy of fallot include cyanosis, easy fatigabillity , and hypercyanotic spells with crying , feeding and defecating.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
==Physical Examination==<br />
<br />
=== Appearance===<br />
* patients with pentalogy of fallot usually appear small due to failure to thrive. <br />
* patients may be found in squatting position( compensatory mechanism)<br />
<br />
=== Vital Signs===<br />
* Tachycardia with regular pulse <br />
* Tachypnea <br />
* low grade fever in patients with concomitant infective [[endocarditis]]<br />
<br />
=== HEENT===<br />
* Retinal vessel engorgement may be present<br />
<br />
=== Heart===<br />
<br />
A thrill may be present at left sternal border.<br />
*A right ventricular impulse may be prominent.<br />
*Second heart sound (S2) is single as P2 is absent.<br />
*A harsh systolic ejection murmur best heard at the left sternal border is usually present.<br />
*P2 is faint and delayed in mild cyanosis and inaudible in severe cyanosis.<br />
*A diastolic murmur may be heard due to aortic regurgitation.<br />
<br />
=== Extremities===<br />
*Clubbing<br />
*Cyanosis is most prominent at lips and nail beds<br />
<br />
===Laboratory Findings===<br />
<br />
<br />
<br />
Some patients with pentalogy of fallot may have [[polycythemia]] <br />
which is usually suggestive of worsening hypoxia and compensatory production of erythropoetin.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
.<br />
<br />
===Electrocardiogram===<br />
<br />
An ECG may be helpful in the diagnosis of pentalogy of fallot, <br />
Findings on an ECG suggestive of pentalogy of fallot include [[right axis deviation]] and right ventricular hypertrophy.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
[[File: Right_ventrriular_hypertophy.png|200p|thumb|right|Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874376/]]<br />
<br />
===X-ray===<br />
<br />
<br />
<br />
<br />
An x-ray may be helpful in the diagnosis of pentalogy of Fallot. Findings on an x-ray suggestive of pentalogy of fallot include boot shaped heart or coeur en sabot.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref> [[File:Boot_shaped_heart.png|200p|thumb|left| Typical preoperative chest X‐ray of a 16‐month‐old boy with tetralogy of Fallot.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5412831/]]<br />
<br />
<br />
<br />
<br />
.<br />
<br />
===Echocardiography or Ultrasound===<br />
<br />
<br />
<br />
<br />
Echocardiography may be helpful in the diagnosis of pentalogy of fallot. Findings on an echocardiography diagnostic of pentalogy of fallot include.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
* Ventricular septal defect.<br />
* Atrial septal defect.<br />
* Right ventricular outflow tract obstruction.<br />
* overriding aorta [[File:Pentalogy_of_fallot_image_2.png|200p|thumb|left | Department of Biochemistry, University of Allahabad, Allahabad-211002, India.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3299189/]]<br />
<br />
===CT scan===<br />
<br />
<br />
Thoracic CT angiography may be helpful in the diagnosis of pentalogy of fallot. Findings on CT scan diagnostic of pentalogy of fallot include. <ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
*ventricular septal defect.<br />
* right ventricular hypertrophy,<br />
* pulmonary atresia <br />
* aortopulmonary collateral arteries.<br />
<br />
===MRI===<br />
<br />
<br />
cardiac MRI may be helpful in the diagnosis of pentalogy of fallot. Findings on MRI diagnostic of pentalogy of fallot include RVOT stenosis, VSD, ASD,Overriding aorta, right ventricular hypertrophy and hypoplastic pulmonary arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
<br />
<br />
===Other Imaging Findings===<br />
Other imaging findings for pentalogy of fallot include Right ventricular angiopraphy which demonstrates infundibular and pulmonary artery anatomy. left ventricular angiography, which demonstrates. <ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
*VSD<br />
* ASD, <br />
* Overiding aorta<br />
<br />
===Other Diagnostic Studies===<br />
<br />
There are no other diagnostic studies associated with pentalogy of Fallot<br />
<br />
==Treatment==<br />
===Medical Therapy===<br />
The mainstay of treatment for pentalogy of fallot is Surgery.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
Pharmacologic medical therapy is recommended among patients with severe RVOTO and hypercyanotic spells.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
<br />
Pharmacologic medical therapies for pentalogy of fallot include.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
<br />
* prostaglandin E1 in neonates with ductal dependent pulmonary blood flow<br />
*[[Morphine]] and [[ketamine]] for sedation<br />
*vasopressors like [[phenylephrine]]<br />
*[[Propranolol|propanolol]] to decrease the need for palliative surgical intervention.<br />
* iron treatment to decrease frequency of spells. <br />
<br />
Patients with hypercyanotic spells are treated with,<br />
* oxygen <br />
*volume expansion <br />
* morphine sedation.<br />
<br />
===Surgery===<br />
<br />
<br />
<br />
Surgery is the mainstay of treatment for pentalogy of fallot. interventional procedures are used to relieve pulmonary obstructions and embolize colaterals. <br />
different surgical procedures can be done to treat pentalogy of fallot and it includes.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
* pulmonary valvotomy( for stenotic pulmonic valve)<br />
* pulmonary valvectomy( for small and thickened pulmonic valve) <br />
* closure of ASD/VSD<br />
* shunt surgery for severe cyanosis or in patients with frequent spells in the first year of life <br />
* Blalock -Taussig Shunt- communication between the right or left pulmonary artery and the right or left subclavian artery. <br />
* Waterson-Cooley Shunt- communication between the ascending aorta with the right pulmonary artery <br />
* Potts shunt-communication between the descending aorta and left pulmonary artery <br />
* Central shunt- Communication between the main pulmonary artery and ascending aorta.<br />
<br />
===Primary Prevention===<br />
There are no established measures for the primary prevention of pentalogy of fallot .<br />
<br />
===Secondary Prevention===<br />
There are no established measures for the secondary prevention of pentalogy of fallot<br />
===Prevention of Cyanosis===<br />
The following factors may reduce systemic vascular resistance (SVR) and exacerbate shunting which in turn exacerbate cyanosis and should be avoided if at all possible:<br />
<br />
*Acidosis<br />
*Bathing in hot water<br />
*Fever<br />
*Stress<br />
*Infection<br />
*Posture (upright, not squatting)<br />
*Exercise<br />
*[[Beta-adrenergic agonist|Beta-adrenergic agonists]]<br />
*[[Dehydration]]<br />
*Closure of the [[patent ductus arteriosus]]<br />
<br />
===Prevention of Infective Endocarditis===<br />
Antibiotic prophylaxis should be administered before respiratory and oral procedures.<br />
<br />
==References==<br />
{{reflist|2}}<br />
<br />
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{{WikiDoc Sources}}<br />
[[Category:Cardiology]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Abdulkareem Opeoluwalukanhttps://www.wikidoc.org/index.php?title=Pentalogy_of_Fallot&diff=1623929Pentalogy of Fallot2020-07-10T16:27:22Z<p>Abdulkareem Opeoluwalukan: /* Other Imaging Findings */</p>
<hr />
<div>__NOTOC__<br />
{{SI}}<br />
{{CMG}} {{AE}}[[User:Abdulkareem Opeoluwalukan|Abdulkareem Opeoluwalukan, M.D]].<br />
==Overview==<br />
Pentalogy of Fallot is defined as the occurrence of Tetralogy of Fallot plus an [[atrial septal defect]].[[File:Pentalogy_of_fallot_image_1.png |200p|thumb|center| Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa. paolo.pazzi@up.ac.za.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3984729/]]<br />
<br />
==Historical Perspective==<br />
<br />
*[[Tetrallogy of fallot|Tetralogy of fallot]] was first discovered by Niel Stenson, a Denish physician Anatomist, in 1671. <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
* The association between right ventricular outflow tract obstruction and a large [[ventricular septal defect]] and tetralogy of fallot. was made in 1888 by Etinne-Louise.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref><br />
<br />
* In 1924, Canadian, Maude Abbott was the first to discover the association between ventricular septal defect , pulmonary stenosis, overriding aorta and right ventricular hypertrophy and the development of tetralogy of Fallot.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref<br />
In 1939, the first surgical treatment was developed by Dr Helen Taussig in Johns Hopkins&amp;lt;nowiki&amp;gt;&&amp;lt;/nowiki&amp;gt;lt;nowiki&lt;nowiki&gt;&&lt;/nowiki&gt;gt;<nowiki>&</nowiki>lt;nowiki<nowiki>&</nowiki>gt;<nowiki>&lt;nowiki&gt;<ref name="pmid30020660">&lt;/nowiki&gt;</nowiki>&lt;/nowiki&gt;&lt;/nowiki&gt;{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Classification==<br />
<br />
* There is no established system for the classification of pentalogy of fallot.<br />
<br />
<br /><br />
<br />
==Pathophysiology==<br />
<br />
It is thought that conotruncal Diseases like [[Tetralogy of Fallot|tetralogy of fallot]] and pentalogy of fallot is the result of <br />
<br />
* Neural Crest migration defect. <br />
* Underdevelopment of right ventricular infundibulum.<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
<br />
==Causes==<br />
<br />
<br />
<br />
<br />
The cause of pentalogy of fallot has not been identified. To review risk factors for the development of pentalogy of fallot, click [[tetralogy of fallot causes#Overview|here]].<br />
<br />
==Differentiating pentalogy of fallot from other Diseases==<br />
pentalogy of Fallot must be differentiated from other diseases that cause .<br />
<br />
===right to left shunt=== <br />
*[[Transposition of the great vessels|transposition of great arteries]] with pulmonic stenosis<br />
* double outlet right ventricle including Taussig-Bing anomaly<br />
*[[tricuspid atresia]]<br />
* Ebstein Anomaly<br />
*[[pulmonary atresia]] with intact ventricular septum<br />
*Respiratory diseases<br />
<br />
* Bronchiolitis,<br />
*viral and bacterial [[pneumonia]]<br />
*[[pneumothorax]] because when they are in heart failure they present with signs of respiratory distress, cyanosis and failure to thrive<br />
<br />
=== Bidirectional shunt diseases===<br />
* total anomalous pulmonary venous return,<br />
*[[hypoplastic left heart syndrome]],<br />
* single ventricle <br />
*[[Persistent truncus arteriosus|truncus arteriosus]] <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Epidemiology and Demographics==<br />
The epidemiology of pentalogy of fallot has not been well studied.<br />
<br />
==Risk Factors==<br />
<br />
<br />
<br />
<br />
Common risk factors in the development of pentalogy of fallot includes<ref name="SilvaNeves2019">{{cite journal|last1=Silva|first1=Joana A.|last2=Neves|first2=Ana L.|last3=Flor-de-Lima|first3=Filipa|last4=Soares|first4=Paulo|last5=Guimarães|first5=Hercília|title=Risk Factors and Outcomes of Tetralogy of Fallot: From Fetal to Neonatal Life|journal=Pediatric Cardiology|volume=41|issue=1|year=2019|pages=155–164|issn=0172-0643|doi=10.1007/s00246-019-02239-4}}</ref><br />
<br />
* Alcoholism in mother <br />
* Maternal Diabetes <br />
* Advanced maternal age i.e greater than 40 years <br />
* Malnutrition in pregnancy <br />
* Family history of tetralogy of fallot <br />
* Viral illness during pregnancy like [[Rubella]].<br />
* presence of [[Down syndrome]] or [[22q11.2 deletion syndrome|DiGeorge syndrome]]<br />
<br />
==Screening==<br />
There is insufficient evidence to recommend routine screening for pentalogy of fallot.<br />
<br />
==Natural History, Complications, and Prognosis==<br />
If left untreated, patients with pentalogy of fallot may progress to develop finger clubbing, stunted growth, cardiac arrhythmias, hypoplastic pulmonary artery, paradoxical emboli and [[polycythemia]] .<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
<br />
Prognosis is generally excellent provided the [[Ventricular septal defect|VSD]] has been closed and the right ventricular outflow tract has been relieved.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. 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C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
<br />
<br />
There are no established criteria for the diagnosis of pentalogy fallot.<br />
<br />
===History and Symptoms===<br />
<br />
The hallmark of pentalogy of fallot is cyanosis. A positive history of cyanosis and easy fatigability leading to squatting during exercise is suggestive of cyanotic congenital heart defect.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
. The most common symptoms of pentalogy of fallot include cyanosis, easy fatigabillity , and hypercyanotic spells with crying , feeding and defecating.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
==Physical Examination==<br />
<br />
=== Appearance===<br />
* patients with pentalogy of fallot usually appear small due to failure to thrive. <br />
* patients may be found in squatting position( compensatory mechanism)<br />
<br />
=== Vital Signs===<br />
* Tachycardia with regular pulse <br />
* Tachypnea <br />
* low grade fever in patients with concomitant infective [[endocarditis]]<br />
<br />
=== HEENT===<br />
* Retinal vessel engorgement may be present<br />
<br />
=== Heart===<br />
<br />
A thrill may be present at left sternal border.<br />
*A right ventricular impulse may be prominent.<br />
*Second heart sound (S2) is single as P2 is absent.<br />
*A harsh systolic ejection murmur best heard at the left sternal border is usually present.<br />
*P2 is faint and delayed in mild cyanosis and inaudible in severe cyanosis.<br />
*A diastolic murmur may be heard due to aortic regurgitation.<br />
<br />
=== Extremities===<br />
*Clubbing<br />
*Cyanosis is most prominent at lips and nail beds<br />
<br />
===Laboratory Findings===<br />
<br />
<br />
<br />
Some patients with pentalogy of fallot may have [[polycythemia]] <br />
which is usually suggestive of worsening hypoxia and compensatory production of erythropoetin.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
.<br />
<br />
===Electrocardiogram===<br />
<br />
An ECG may be helpful in the diagnosis of pentalogy of fallot, <br />
Findings on an ECG suggestive of pentalogy of fallot include [[right axis deviation]] and right ventricular hypertrophy.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
[[File: Right_ventrriular_hypertophy.png|200p|thumb|right|Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874376/]]<br />
<br />
===X-ray===<br />
<br />
<br />
<br />
<br />
An x-ray may be helpful in the diagnosis of pentalogy of Fallot. Findings on an x-ray suggestive of pentalogy of fallot include boot shaped heart or coeur en sabot.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref> [[File:Boot_shaped_heart.png|200p|thumb|left| Typical preoperative chest X‐ray of a 16‐month‐old boy with tetralogy of Fallot.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5412831/]]<br />
<br />
<br />
<br />
<br />
.<br />
<br />
===Echocardiography or Ultrasound===<br />
<br />
<br />
<br />
<br />
Echocardiography may be helpful in the diagnosis of pentalogy of fallot. Findings on an echocardiography diagnostic of pentalogy of fallot include.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
* Ventricular septal defect.<br />
* Atrial septal defect.<br />
* Right ventricular outflow tract obstruction.<br />
* overriding aorta [[File:Pentalogy_of_fallot_image_2.png|200p|thumb|left | Department of Biochemistry, University of Allahabad, Allahabad-211002, India.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3299189/]]<br />
<br />
===CT scan===<br />
<br />
<br />
Thoracic CT angiography may be helpful in the diagnosis of pentalogy of fallot. Findings on CT scan diagnostic of pentalogy of fallot include. <ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
*ventricular septal defect.<br />
* right ventricular hypertrophy,<br />
* pulmonary atresia <br />
* aortopulmonary collateral arteries.<br />
<br />
===MRI===<br />
<br />
<br />
cardiac MRI may be helpful in the diagnosis of pentalogy of fallot. Findings on MRI diagnostic of pentalogy of fallot include RVOT stenosis, VSD, ASD,Overriding aorta, right ventricular hypertrophy and hypoplastic pulmonary arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
<br />
<br />
===Other Imaging Findings===<br />
Other imaging findings for pentalogy of fallot include Right ventricular angiopraphy which demonstrates infundibular and pulmonary artery anatomy. left ventricular angiography, which demonstrates. <ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
*VSD<br />
* ASD, <br />
* Overiding aorta<br />
<br />
===Other Diagnostic Studies===<br />
<br />
There are no other diagnostic studies associated with pentalogy of Fallot<br />
<br />
==Treatment==<br />
===Medical Therapy===<br />
The mainstay of treatment for pentalogy of fallot is Surgery.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
Pharmacologic medical therapy is recommended among patients with severe RVOTO and hypercyanotic spells.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
<br />
Pharmacologic medical therapies for pentalogy of fallot include.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
<br />
* prostaglandin E1 in neonates with ductal dependent pulmonary blood flow<br />
*[[Morphine]] and [[ketamine]] for sedation<br />
*vasopressors like [[phenylephrine]]<br />
*[[Propranolol|propanolol]] to decrease the need for palliative surgical intervention.<br />
* iron treatment to decrease frequency of spells. <br />
<br />
Patients with hypercyanotic spells are treated with,<br />
* oxygen <br />
*volume expansion <br />
* morphine sedation.<br />
<br />
===Surgery===<br />
<br />
<br />
<br />
Surgery is the mainstay of treatment for pentalogy of fallot. interventional procedures are used to relieve pulmonary obstructions and embolize colaterals. <br />
different surgical procedures can be done to treat pentalogy of fallot and it includes.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
* pulmonary valvotomy( for stenotic pulmonic valve)<br />
* pulmonary valvectomy( for small and thickened pulmonic valve) <br />
* closure of ASD/VSD<br />
* shunt surgery for severe cyanosis or in patients with frequent spells in the first year of life <br />
* Blalock -Taussig Shunt- communication between the right or left pulmonary artery and the right or left subclavian artery. <br />
* Waterson-Cooley Shunt- communication between the ascending aorta with the right pulmonary artery <br />
* Potts shunt-communication between the descending aorta and left pulmonary artery <br />
* Central shunt- Communication between the main pulmonary artery and ascending aorta.<br />
<br />
===Primary Prevention===<br />
There are no established measures for the primary prevention of pentalogy of fallot .<br />
<br />
===Secondary Prevention===<br />
There are no established measures for the secondary prevention of pentalogy of fallot<br />
===Prevention of Cyanosis===<br />
The following factors may reduce systemic vascular resistance (SVR) and exacerbate shunting which in turn exacerbate cyanosis and should be avoided if at all possible:<br />
<br />
*Acidosis<br />
*Bathing in hot water<br />
*Fever<br />
*Stress<br />
*Infection<br />
*Posture (upright, not squatting)<br />
*Exercise<br />
*[[Beta-adrenergic agonist|Beta-adrenergic agonists]]<br />
*[[Dehydration]]<br />
*Closure of the [[patent ductus arteriosus]]<br />
<br />
===Prevention of Infective Endocarditis===<br />
Antibiotic prophylaxis should be administered before respiratory and oral procedures.<br />
<br />
==References==<br />
{{reflist|2}}<br />
<br />
{{WikiDoc Help Menu}}<br />
{{WikiDoc Sources}}<br />
[[Category:Cardiology]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Abdulkareem Opeoluwalukanhttps://www.wikidoc.org/index.php?title=Pentalogy_of_Fallot&diff=1623927Pentalogy of Fallot2020-07-10T16:22:58Z<p>Abdulkareem Opeoluwalukan: /* Medical Therapy */</p>
<hr />
<div>__NOTOC__<br />
{{SI}}<br />
{{CMG}} {{AE}}[[User:Abdulkareem Opeoluwalukan|Abdulkareem Opeoluwalukan, M.D]].<br />
==Overview==<br />
Pentalogy of Fallot is defined as the occurrence of Tetralogy of Fallot plus an [[atrial septal defect]].[[File:Pentalogy_of_fallot_image_1.png |200p|thumb|center| Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa. paolo.pazzi@up.ac.za.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3984729/]]<br />
<br />
==Historical Perspective==<br />
<br />
*[[Tetrallogy of fallot|Tetralogy of fallot]] was first discovered by Niel Stenson, a Denish physician Anatomist, in 1671. <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
* The association between right ventricular outflow tract obstruction and a large [[ventricular septal defect]] and tetralogy of fallot. was made in 1888 by Etinne-Louise.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref><br />
<br />
* In 1924, Canadian, Maude Abbott was the first to discover the association between ventricular septal defect , pulmonary stenosis, overriding aorta and right ventricular hypertrophy and the development of tetralogy of Fallot.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref<br />
In 1939, the first surgical treatment was developed by Dr Helen Taussig in Johns Hopkins&amp;lt;nowiki&amp;gt;&&amp;lt;/nowiki&amp;gt;lt;nowiki&lt;nowiki&gt;&&lt;/nowiki&gt;gt;<nowiki>&</nowiki>lt;nowiki<nowiki>&</nowiki>gt;<nowiki>&lt;nowiki&gt;<ref name="pmid30020660">&lt;/nowiki&gt;</nowiki>&lt;/nowiki&gt;&lt;/nowiki&gt;{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Classification==<br />
<br />
* There is no established system for the classification of pentalogy of fallot.<br />
<br />
<br /><br />
<br />
==Pathophysiology==<br />
<br />
It is thought that conotruncal Diseases like [[Tetralogy of Fallot|tetralogy of fallot]] and pentalogy of fallot is the result of <br />
<br />
* Neural Crest migration defect. <br />
* Underdevelopment of right ventricular infundibulum.<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
<br />
==Causes==<br />
<br />
<br />
<br />
<br />
The cause of pentalogy of fallot has not been identified. To review risk factors for the development of pentalogy of fallot, click [[tetralogy of fallot causes#Overview|here]].<br />
<br />
==Differentiating pentalogy of fallot from other Diseases==<br />
pentalogy of Fallot must be differentiated from other diseases that cause .<br />
<br />
===right to left shunt=== <br />
*[[Transposition of the great vessels|transposition of great arteries]] with pulmonic stenosis<br />
* double outlet right ventricle including Taussig-Bing anomaly<br />
*[[tricuspid atresia]]<br />
* Ebstein Anomaly<br />
*[[pulmonary atresia]] with intact ventricular septum<br />
*Respiratory diseases<br />
<br />
* Bronchiolitis,<br />
*viral and bacterial [[pneumonia]]<br />
*[[pneumothorax]] because when they are in heart failure they present with signs of respiratory distress, cyanosis and failure to thrive<br />
<br />
=== Bidirectional shunt diseases===<br />
* total anomalous pulmonary venous return,<br />
*[[hypoplastic left heart syndrome]],<br />
* single ventricle <br />
*[[Persistent truncus arteriosus|truncus arteriosus]] <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Epidemiology and Demographics==<br />
The epidemiology of pentalogy of fallot has not been well studied.<br />
<br />
==Risk Factors==<br />
<br />
<br />
<br />
<br />
Common risk factors in the development of pentalogy of fallot includes<ref name="SilvaNeves2019">{{cite journal|last1=Silva|first1=Joana A.|last2=Neves|first2=Ana L.|last3=Flor-de-Lima|first3=Filipa|last4=Soares|first4=Paulo|last5=Guimarães|first5=Hercília|title=Risk Factors and Outcomes of Tetralogy of Fallot: From Fetal to Neonatal Life|journal=Pediatric Cardiology|volume=41|issue=1|year=2019|pages=155–164|issn=0172-0643|doi=10.1007/s00246-019-02239-4}}</ref><br />
<br />
* Alcoholism in mother <br />
* Maternal Diabetes <br />
* Advanced maternal age i.e greater than 40 years <br />
* Malnutrition in pregnancy <br />
* Family history of tetralogy of fallot <br />
* Viral illness during pregnancy like [[Rubella]].<br />
* presence of [[Down syndrome]] or [[22q11.2 deletion syndrome|DiGeorge syndrome]]<br />
<br />
==Screening==<br />
There is insufficient evidence to recommend routine screening for pentalogy of fallot.<br />
<br />
==Natural History, Complications, and Prognosis==<br />
If left untreated, patients with pentalogy of fallot may progress to develop finger clubbing, stunted growth, cardiac arrhythmias, hypoplastic pulmonary artery, paradoxical emboli and [[polycythemia]] .<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
<br />
Prognosis is generally excellent provided the [[Ventricular septal defect|VSD]] has been closed and the right ventricular outflow tract has been relieved.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
<br />
<br />
There are no established criteria for the diagnosis of pentalogy fallot.<br />
<br />
===History and Symptoms===<br />
<br />
The hallmark of pentalogy of fallot is cyanosis. A positive history of cyanosis and easy fatigability leading to squatting during exercise is suggestive of cyanotic congenital heart defect.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
. The most common symptoms of pentalogy of fallot include cyanosis, easy fatigabillity , and hypercyanotic spells with crying , feeding and defecating.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
==Physical Examination==<br />
<br />
=== Appearance===<br />
* patients with pentalogy of fallot usually appear small due to failure to thrive. <br />
* patients may be found in squatting position( compensatory mechanism)<br />
<br />
=== Vital Signs===<br />
* Tachycardia with regular pulse <br />
* Tachypnea <br />
* low grade fever in patients with concomitant infective [[endocarditis]]<br />
<br />
=== HEENT===<br />
* Retinal vessel engorgement may be present<br />
<br />
=== Heart===<br />
<br />
A thrill may be present at left sternal border.<br />
*A right ventricular impulse may be prominent.<br />
*Second heart sound (S2) is single as P2 is absent.<br />
*A harsh systolic ejection murmur best heard at the left sternal border is usually present.<br />
*P2 is faint and delayed in mild cyanosis and inaudible in severe cyanosis.<br />
*A diastolic murmur may be heard due to aortic regurgitation.<br />
<br />
=== Extremities===<br />
*Clubbing<br />
*Cyanosis is most prominent at lips and nail beds<br />
<br />
===Laboratory Findings===<br />
<br />
<br />
<br />
Some patients with pentalogy of fallot may have [[polycythemia]] <br />
which is usually suggestive of worsening hypoxia and compensatory production of erythropoetin.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
.<br />
<br />
===Electrocardiogram===<br />
<br />
An ECG may be helpful in the diagnosis of pentalogy of fallot, <br />
Findings on an ECG suggestive of pentalogy of fallot include [[right axis deviation]] and right ventricular hypertrophy.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
[[File: Right_ventrriular_hypertophy.png|200p|thumb|right|Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874376/]]<br />
<br />
===X-ray===<br />
<br />
<br />
<br />
<br />
An x-ray may be helpful in the diagnosis of pentalogy of Fallot. Findings on an x-ray suggestive of pentalogy of fallot include boot shaped heart or coeur en sabot.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref> [[File:Boot_shaped_heart.png|200p|thumb|left| Typical preoperative chest X‐ray of a 16‐month‐old boy with tetralogy of Fallot.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5412831/]]<br />
<br />
<br />
<br />
<br />
.<br />
<br />
===Echocardiography or Ultrasound===<br />
<br />
<br />
<br />
<br />
Echocardiography may be helpful in the diagnosis of pentalogy of fallot. Findings on an echocardiography diagnostic of pentalogy of fallot include.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
* Ventricular septal defect.<br />
* Atrial septal defect.<br />
* Right ventricular outflow tract obstruction.<br />
* overriding aorta [[File:Pentalogy_of_fallot_image_2.png|200p|thumb|left | Department of Biochemistry, University of Allahabad, Allahabad-211002, India.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3299189/]]<br />
<br />
===CT scan===<br />
<br />
<br />
Thoracic CT angiography may be helpful in the diagnosis of pentalogy of fallot. Findings on CT scan diagnostic of pentalogy of fallot include. <ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
*ventricular septal defect.<br />
* right ventricular hypertrophy,<br />
* pulmonary atresia <br />
* aortopulmonary collateral arteries.<br />
<br />
===MRI===<br />
<br />
<br />
cardiac MRI may be helpful in the diagnosis of pentalogy of fallot. Findings on MRI diagnostic of pentalogy of fallot include RVOT stenosis, VSD, ASD,Overriding aorta, right ventricular hypertrophy and hypoplastic pulmonary arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
<br />
<br />
===Other Imaging Findings===<br />
Other imaging findings for pentalogy of fallot include Right ventricular angiopraphy, which demonstrates infundibular and pulmonary artery anatomy, and left ventricular angiography, which demonstrates VSD, ASD, and Overiding aorta <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
===Other Diagnostic Studies===<br />
<br />
There are no other diagnostic studies associated with pentalogy of Fallot<br />
<br />
==Treatment==<br />
===Medical Therapy===<br />
The mainstay of treatment for pentalogy of fallot is Surgery.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
Pharmacologic medical therapy is recommended among patients with severe RVOTO and hypercyanotic spells.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
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Pharmacologic medical therapies for pentalogy of fallot include.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
<br />
* prostaglandin E1 in neonates with ductal dependent pulmonary blood flow<br />
*[[Morphine]] and [[ketamine]] for sedation<br />
*vasopressors like [[phenylephrine]]<br />
*[[Propranolol|propanolol]] to decrease the need for palliative surgical intervention.<br />
* iron treatment to decrease frequency of spells. <br />
<br />
Patients with hypercyanotic spells are treated with,<br />
* oxygen <br />
*volume expansion <br />
* morphine sedation.<br />
<br />
===Surgery===<br />
<br />
<br />
<br />
Surgery is the mainstay of treatment for pentalogy of fallot. interventional procedures are used to relieve pulmonary obstructions and embolize colaterals. <br />
different surgical procedures can be done to treat pentalogy of fallot and it includes.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
* pulmonary valvotomy( for stenotic pulmonic valve)<br />
* pulmonary valvectomy( for small and thickened pulmonic valve) <br />
* closure of ASD/VSD<br />
* shunt surgery for severe cyanosis or in patients with frequent spells in the first year of life <br />
* Blalock -Taussig Shunt- communication between the right or left pulmonary artery and the right or left subclavian artery. <br />
* Waterson-Cooley Shunt- communication between the ascending aorta with the right pulmonary artery <br />
* Potts shunt-communication between the descending aorta and left pulmonary artery <br />
* Central shunt- Communication between the main pulmonary artery and ascending aorta.<br />
<br />
===Primary Prevention===<br />
There are no established measures for the primary prevention of pentalogy of fallot .<br />
<br />
===Secondary Prevention===<br />
There are no established measures for the secondary prevention of pentalogy of fallot<br />
===Prevention of Cyanosis===<br />
The following factors may reduce systemic vascular resistance (SVR) and exacerbate shunting which in turn exacerbate cyanosis and should be avoided if at all possible:<br />
<br />
*Acidosis<br />
*Bathing in hot water<br />
*Fever<br />
*Stress<br />
*Infection<br />
*Posture (upright, not squatting)<br />
*Exercise<br />
*[[Beta-adrenergic agonist|Beta-adrenergic agonists]]<br />
*[[Dehydration]]<br />
*Closure of the [[patent ductus arteriosus]]<br />
<br />
===Prevention of Infective Endocarditis===<br />
Antibiotic prophylaxis should be administered before respiratory and oral procedures.<br />
<br />
==References==<br />
{{reflist|2}}<br />
<br />
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[[Category:Cardiology]]<br />
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{{WH}}<br />
{{WS}}</div>Abdulkareem Opeoluwalukanhttps://www.wikidoc.org/index.php?title=Pentalogy_of_Fallot&diff=1623925Pentalogy of Fallot2020-07-10T16:19:21Z<p>Abdulkareem Opeoluwalukan: /* Surgery */</p>
<hr />
<div>__NOTOC__<br />
{{SI}}<br />
{{CMG}} {{AE}}[[User:Abdulkareem Opeoluwalukan|Abdulkareem Opeoluwalukan, M.D]].<br />
==Overview==<br />
Pentalogy of Fallot is defined as the occurrence of Tetralogy of Fallot plus an [[atrial septal defect]].[[File:Pentalogy_of_fallot_image_1.png |200p|thumb|center| Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa. paolo.pazzi@up.ac.za.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3984729/]]<br />
<br />
==Historical Perspective==<br />
<br />
*[[Tetrallogy of fallot|Tetralogy of fallot]] was first discovered by Niel Stenson, a Denish physician Anatomist, in 1671. <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
* The association between right ventricular outflow tract obstruction and a large [[ventricular septal defect]] and tetralogy of fallot. was made in 1888 by Etinne-Louise.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref><br />
<br />
* In 1924, Canadian, Maude Abbott was the first to discover the association between ventricular septal defect , pulmonary stenosis, overriding aorta and right ventricular hypertrophy and the development of tetralogy of Fallot.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref<br />
In 1939, the first surgical treatment was developed by Dr Helen Taussig in Johns Hopkins&amp;lt;nowiki&amp;gt;&&amp;lt;/nowiki&amp;gt;lt;nowiki&lt;nowiki&gt;&&lt;/nowiki&gt;gt;<nowiki>&</nowiki>lt;nowiki<nowiki>&</nowiki>gt;<nowiki>&lt;nowiki&gt;<ref name="pmid30020660">&lt;/nowiki&gt;</nowiki>&lt;/nowiki&gt;&lt;/nowiki&gt;{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Classification==<br />
<br />
* There is no established system for the classification of pentalogy of fallot.<br />
<br />
<br /><br />
<br />
==Pathophysiology==<br />
<br />
It is thought that conotruncal Diseases like [[Tetralogy of Fallot|tetralogy of fallot]] and pentalogy of fallot is the result of <br />
<br />
* Neural Crest migration defect. <br />
* Underdevelopment of right ventricular infundibulum.<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
<br />
==Causes==<br />
<br />
<br />
<br />
<br />
The cause of pentalogy of fallot has not been identified. To review risk factors for the development of pentalogy of fallot, click [[tetralogy of fallot causes#Overview|here]].<br />
<br />
==Differentiating pentalogy of fallot from other Diseases==<br />
pentalogy of Fallot must be differentiated from other diseases that cause .<br />
<br />
===right to left shunt=== <br />
*[[Transposition of the great vessels|transposition of great arteries]] with pulmonic stenosis<br />
* double outlet right ventricle including Taussig-Bing anomaly<br />
*[[tricuspid atresia]]<br />
* Ebstein Anomaly<br />
*[[pulmonary atresia]] with intact ventricular septum<br />
*Respiratory diseases<br />
<br />
* Bronchiolitis,<br />
*viral and bacterial [[pneumonia]]<br />
*[[pneumothorax]] because when they are in heart failure they present with signs of respiratory distress, cyanosis and failure to thrive<br />
<br />
=== Bidirectional shunt diseases===<br />
* total anomalous pulmonary venous return,<br />
*[[hypoplastic left heart syndrome]],<br />
* single ventricle <br />
*[[Persistent truncus arteriosus|truncus arteriosus]] <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Epidemiology and Demographics==<br />
The epidemiology of pentalogy of fallot has not been well studied.<br />
<br />
==Risk Factors==<br />
<br />
<br />
<br />
<br />
Common risk factors in the development of pentalogy of fallot includes<ref name="SilvaNeves2019">{{cite journal|last1=Silva|first1=Joana A.|last2=Neves|first2=Ana L.|last3=Flor-de-Lima|first3=Filipa|last4=Soares|first4=Paulo|last5=Guimarães|first5=Hercília|title=Risk Factors and Outcomes of Tetralogy of Fallot: From Fetal to Neonatal Life|journal=Pediatric Cardiology|volume=41|issue=1|year=2019|pages=155–164|issn=0172-0643|doi=10.1007/s00246-019-02239-4}}</ref><br />
<br />
* Alcoholism in mother <br />
* Maternal Diabetes <br />
* Advanced maternal age i.e greater than 40 years <br />
* Malnutrition in pregnancy <br />
* Family history of tetralogy of fallot <br />
* Viral illness during pregnancy like [[Rubella]].<br />
* presence of [[Down syndrome]] or [[22q11.2 deletion syndrome|DiGeorge syndrome]]<br />
<br />
==Screening==<br />
There is insufficient evidence to recommend routine screening for pentalogy of fallot.<br />
<br />
==Natural History, Complications, and Prognosis==<br />
If left untreated, patients with pentalogy of fallot may progress to develop finger clubbing, stunted growth, cardiac arrhythmias, hypoplastic pulmonary artery, paradoxical emboli and [[polycythemia]] .<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
<br />
Prognosis is generally excellent provided the [[Ventricular septal defect|VSD]] has been closed and the right ventricular outflow tract has been relieved.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. 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C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
<br />
<br />
There are no established criteria for the diagnosis of pentalogy fallot.<br />
<br />
===History and Symptoms===<br />
<br />
The hallmark of pentalogy of fallot is cyanosis. A positive history of cyanosis and easy fatigability leading to squatting during exercise is suggestive of cyanotic congenital heart defect.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
. The most common symptoms of pentalogy of fallot include cyanosis, easy fatigabillity , and hypercyanotic spells with crying , feeding and defecating.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
==Physical Examination==<br />
<br />
=== Appearance===<br />
* patients with pentalogy of fallot usually appear small due to failure to thrive. <br />
* patients may be found in squatting position( compensatory mechanism)<br />
<br />
=== Vital Signs===<br />
* Tachycardia with regular pulse <br />
* Tachypnea <br />
* low grade fever in patients with concomitant infective [[endocarditis]]<br />
<br />
=== HEENT===<br />
* Retinal vessel engorgement may be present<br />
<br />
=== Heart===<br />
<br />
A thrill may be present at left sternal border.<br />
*A right ventricular impulse may be prominent.<br />
*Second heart sound (S2) is single as P2 is absent.<br />
*A harsh systolic ejection murmur best heard at the left sternal border is usually present.<br />
*P2 is faint and delayed in mild cyanosis and inaudible in severe cyanosis.<br />
*A diastolic murmur may be heard due to aortic regurgitation.<br />
<br />
=== Extremities===<br />
*Clubbing<br />
*Cyanosis is most prominent at lips and nail beds<br />
<br />
===Laboratory Findings===<br />
<br />
<br />
<br />
Some patients with pentalogy of fallot may have [[polycythemia]] <br />
which is usually suggestive of worsening hypoxia and compensatory production of erythropoetin.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
.<br />
<br />
===Electrocardiogram===<br />
<br />
An ECG may be helpful in the diagnosis of pentalogy of fallot, <br />
Findings on an ECG suggestive of pentalogy of fallot include [[right axis deviation]] and right ventricular hypertrophy.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
[[File: Right_ventrriular_hypertophy.png|200p|thumb|right|Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874376/]]<br />
<br />
===X-ray===<br />
<br />
<br />
<br />
<br />
An x-ray may be helpful in the diagnosis of pentalogy of Fallot. Findings on an x-ray suggestive of pentalogy of fallot include boot shaped heart or coeur en sabot.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref> [[File:Boot_shaped_heart.png|200p|thumb|left| Typical preoperative chest X‐ray of a 16‐month‐old boy with tetralogy of Fallot.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5412831/]]<br />
<br />
<br />
<br />
<br />
.<br />
<br />
===Echocardiography or Ultrasound===<br />
<br />
<br />
<br />
<br />
Echocardiography may be helpful in the diagnosis of pentalogy of fallot. Findings on an echocardiography diagnostic of pentalogy of fallot include.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
* Ventricular septal defect.<br />
* Atrial septal defect.<br />
* Right ventricular outflow tract obstruction.<br />
* overriding aorta [[File:Pentalogy_of_fallot_image_2.png|200p|thumb|left | Department of Biochemistry, University of Allahabad, Allahabad-211002, India.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3299189/]]<br />
<br />
===CT scan===<br />
<br />
<br />
Thoracic CT angiography may be helpful in the diagnosis of pentalogy of fallot. Findings on CT scan diagnostic of pentalogy of fallot include. <ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
*ventricular septal defect.<br />
* right ventricular hypertrophy,<br />
* pulmonary atresia <br />
* aortopulmonary collateral arteries.<br />
<br />
===MRI===<br />
<br />
<br />
cardiac MRI may be helpful in the diagnosis of pentalogy of fallot. Findings on MRI diagnostic of pentalogy of fallot include RVOT stenosis, VSD, ASD,Overriding aorta, right ventricular hypertrophy and hypoplastic pulmonary arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
<br />
<br />
===Other Imaging Findings===<br />
Other imaging findings for pentalogy of fallot include Right ventricular angiopraphy, which demonstrates infundibular and pulmonary artery anatomy, and left ventricular angiography, which demonstrates VSD, ASD, and Overiding aorta <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
===Other Diagnostic Studies===<br />
<br />
There are no other diagnostic studies associated with pentalogy of Fallot<br />
<br />
==Treatment==<br />
===Medical Therapy===<br />
The mainstay of treatment for pentalogy of fallot is Surgery.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
Pharmacologic medical therapy is recommended among patients with severe RVOTO and hypercyanotic spells<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
Pharmacologic medical therapies for pentalogy of fallot include <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
* prostaglandin E1 in neonates with ductal dependent pulmonary blood flow<br />
*[[Morphine]] and [[ketamine]] for sedation<br />
*vasopressors like [[phenylephrine]]<br />
*[[Propranolol|propanolol]] to decrease the need for palliative surgical intervention.<br />
* iron treatment to decrease frequency of spells. <br />
<br />
Patients with hypercyanotic spells are treated with oxygen,volume expansion and morphine sedation.<br />
<br />
===Surgery===<br />
<br />
<br />
<br />
Surgery is the mainstay of treatment for pentalogy of fallot. interventional procedures are used to relieve pulmonary obstructions and embolize colaterals. <br />
different surgical procedures can be done to treat pentalogy of fallot and it includes.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
* pulmonary valvotomy( for stenotic pulmonic valve)<br />
* pulmonary valvectomy( for small and thickened pulmonic valve) <br />
* closure of ASD/VSD<br />
* shunt surgery for severe cyanosis or in patients with frequent spells in the first year of life <br />
* Blalock -Taussig Shunt- communication between the right or left pulmonary artery and the right or left subclavian artery. <br />
* Waterson-Cooley Shunt- communication between the ascending aorta with the right pulmonary artery <br />
* Potts shunt-communication between the descending aorta and left pulmonary artery <br />
* Central shunt- Communication between the main pulmonary artery and ascending aorta.<br />
<br />
===Primary Prevention===<br />
There are no established measures for the primary prevention of pentalogy of fallot .<br />
<br />
===Secondary Prevention===<br />
There are no established measures for the secondary prevention of pentalogy of fallot<br />
===Prevention of Cyanosis===<br />
The following factors may reduce systemic vascular resistance (SVR) and exacerbate shunting which in turn exacerbate cyanosis and should be avoided if at all possible:<br />
<br />
*Acidosis<br />
*Bathing in hot water<br />
*Fever<br />
*Stress<br />
*Infection<br />
*Posture (upright, not squatting)<br />
*Exercise<br />
*[[Beta-adrenergic agonist|Beta-adrenergic agonists]]<br />
*[[Dehydration]]<br />
*Closure of the [[patent ductus arteriosus]]<br />
<br />
===Prevention of Infective Endocarditis===<br />
Antibiotic prophylaxis should be administered before respiratory and oral procedures.<br />
<br />
==References==<br />
{{reflist|2}}<br />
<br />
{{WikiDoc Help Menu}}<br />
{{WikiDoc Sources}}<br />
[[Category:Cardiology]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Abdulkareem Opeoluwalukanhttps://www.wikidoc.org/index.php?title=Pentalogy_of_Fallot&diff=1623923Pentalogy of Fallot2020-07-10T16:17:12Z<p>Abdulkareem Opeoluwalukan: /* CT scan */</p>
<hr />
<div>__NOTOC__<br />
{{SI}}<br />
{{CMG}} {{AE}}[[User:Abdulkareem Opeoluwalukan|Abdulkareem Opeoluwalukan, M.D]].<br />
==Overview==<br />
Pentalogy of Fallot is defined as the occurrence of Tetralogy of Fallot plus an [[atrial septal defect]].[[File:Pentalogy_of_fallot_image_1.png |200p|thumb|center| Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa. paolo.pazzi@up.ac.za.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3984729/]]<br />
<br />
==Historical Perspective==<br />
<br />
*[[Tetrallogy of fallot|Tetralogy of fallot]] was first discovered by Niel Stenson, a Denish physician Anatomist, in 1671. <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
* The association between right ventricular outflow tract obstruction and a large [[ventricular septal defect]] and tetralogy of fallot. was made in 1888 by Etinne-Louise.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref><br />
<br />
* In 1924, Canadian, Maude Abbott was the first to discover the association between ventricular septal defect , pulmonary stenosis, overriding aorta and right ventricular hypertrophy and the development of tetralogy of Fallot.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref<br />
In 1939, the first surgical treatment was developed by Dr Helen Taussig in Johns Hopkins&amp;lt;nowiki&amp;gt;&&amp;lt;/nowiki&amp;gt;lt;nowiki&lt;nowiki&gt;&&lt;/nowiki&gt;gt;<nowiki>&</nowiki>lt;nowiki<nowiki>&</nowiki>gt;<nowiki>&lt;nowiki&gt;<ref name="pmid30020660">&lt;/nowiki&gt;</nowiki>&lt;/nowiki&gt;&lt;/nowiki&gt;{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Classification==<br />
<br />
* There is no established system for the classification of pentalogy of fallot.<br />
<br />
<br /><br />
<br />
==Pathophysiology==<br />
<br />
It is thought that conotruncal Diseases like [[Tetralogy of Fallot|tetralogy of fallot]] and pentalogy of fallot is the result of <br />
<br />
* Neural Crest migration defect. <br />
* Underdevelopment of right ventricular infundibulum.<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
<br />
==Causes==<br />
<br />
<br />
<br />
<br />
The cause of pentalogy of fallot has not been identified. To review risk factors for the development of pentalogy of fallot, click [[tetralogy of fallot causes#Overview|here]].<br />
<br />
==Differentiating pentalogy of fallot from other Diseases==<br />
pentalogy of Fallot must be differentiated from other diseases that cause .<br />
<br />
===right to left shunt=== <br />
*[[Transposition of the great vessels|transposition of great arteries]] with pulmonic stenosis<br />
* double outlet right ventricle including Taussig-Bing anomaly<br />
*[[tricuspid atresia]]<br />
* Ebstein Anomaly<br />
*[[pulmonary atresia]] with intact ventricular septum<br />
*Respiratory diseases<br />
<br />
* Bronchiolitis,<br />
*viral and bacterial [[pneumonia]]<br />
*[[pneumothorax]] because when they are in heart failure they present with signs of respiratory distress, cyanosis and failure to thrive<br />
<br />
=== Bidirectional shunt diseases===<br />
* total anomalous pulmonary venous return,<br />
*[[hypoplastic left heart syndrome]],<br />
* single ventricle <br />
*[[Persistent truncus arteriosus|truncus arteriosus]] <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Epidemiology and Demographics==<br />
The epidemiology of pentalogy of fallot has not been well studied.<br />
<br />
==Risk Factors==<br />
<br />
<br />
<br />
<br />
Common risk factors in the development of pentalogy of fallot includes<ref name="SilvaNeves2019">{{cite journal|last1=Silva|first1=Joana A.|last2=Neves|first2=Ana L.|last3=Flor-de-Lima|first3=Filipa|last4=Soares|first4=Paulo|last5=Guimarães|first5=Hercília|title=Risk Factors and Outcomes of Tetralogy of Fallot: From Fetal to Neonatal Life|journal=Pediatric Cardiology|volume=41|issue=1|year=2019|pages=155–164|issn=0172-0643|doi=10.1007/s00246-019-02239-4}}</ref><br />
<br />
* Alcoholism in mother <br />
* Maternal Diabetes <br />
* Advanced maternal age i.e greater than 40 years <br />
* Malnutrition in pregnancy <br />
* Family history of tetralogy of fallot <br />
* Viral illness during pregnancy like [[Rubella]].<br />
* presence of [[Down syndrome]] or [[22q11.2 deletion syndrome|DiGeorge syndrome]]<br />
<br />
==Screening==<br />
There is insufficient evidence to recommend routine screening for pentalogy of fallot.<br />
<br />
==Natural History, Complications, and Prognosis==<br />
If left untreated, patients with pentalogy of fallot may progress to develop finger clubbing, stunted growth, cardiac arrhythmias, hypoplastic pulmonary artery, paradoxical emboli and [[polycythemia]] .<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
<br />
Prognosis is generally excellent provided the [[Ventricular septal defect|VSD]] has been closed and the right ventricular outflow tract has been relieved.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
<br />
<br />
There are no established criteria for the diagnosis of pentalogy fallot.<br />
<br />
===History and Symptoms===<br />
<br />
The hallmark of pentalogy of fallot is cyanosis. A positive history of cyanosis and easy fatigability leading to squatting during exercise is suggestive of cyanotic congenital heart defect.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
. The most common symptoms of pentalogy of fallot include cyanosis, easy fatigabillity , and hypercyanotic spells with crying , feeding and defecating.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
==Physical Examination==<br />
<br />
=== Appearance===<br />
* patients with pentalogy of fallot usually appear small due to failure to thrive. <br />
* patients may be found in squatting position( compensatory mechanism)<br />
<br />
=== Vital Signs===<br />
* Tachycardia with regular pulse <br />
* Tachypnea <br />
* low grade fever in patients with concomitant infective [[endocarditis]]<br />
<br />
=== HEENT===<br />
* Retinal vessel engorgement may be present<br />
<br />
=== Heart===<br />
<br />
A thrill may be present at left sternal border.<br />
*A right ventricular impulse may be prominent.<br />
*Second heart sound (S2) is single as P2 is absent.<br />
*A harsh systolic ejection murmur best heard at the left sternal border is usually present.<br />
*P2 is faint and delayed in mild cyanosis and inaudible in severe cyanosis.<br />
*A diastolic murmur may be heard due to aortic regurgitation.<br />
<br />
=== Extremities===<br />
*Clubbing<br />
*Cyanosis is most prominent at lips and nail beds<br />
<br />
===Laboratory Findings===<br />
<br />
<br />
<br />
Some patients with pentalogy of fallot may have [[polycythemia]] <br />
which is usually suggestive of worsening hypoxia and compensatory production of erythropoetin.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
.<br />
<br />
===Electrocardiogram===<br />
<br />
An ECG may be helpful in the diagnosis of pentalogy of fallot, <br />
Findings on an ECG suggestive of pentalogy of fallot include [[right axis deviation]] and right ventricular hypertrophy.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
[[File: Right_ventrriular_hypertophy.png|200p|thumb|right|Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874376/]]<br />
<br />
===X-ray===<br />
<br />
<br />
<br />
<br />
An x-ray may be helpful in the diagnosis of pentalogy of Fallot. Findings on an x-ray suggestive of pentalogy of fallot include boot shaped heart or coeur en sabot.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref> [[File:Boot_shaped_heart.png|200p|thumb|left| Typical preoperative chest X‐ray of a 16‐month‐old boy with tetralogy of Fallot.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5412831/]]<br />
<br />
<br />
<br />
<br />
.<br />
<br />
===Echocardiography or Ultrasound===<br />
<br />
<br />
<br />
<br />
Echocardiography may be helpful in the diagnosis of pentalogy of fallot. Findings on an echocardiography diagnostic of pentalogy of fallot include.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
* Ventricular septal defect.<br />
* Atrial septal defect.<br />
* Right ventricular outflow tract obstruction.<br />
* overriding aorta [[File:Pentalogy_of_fallot_image_2.png|200p|thumb|left | Department of Biochemistry, University of Allahabad, Allahabad-211002, India.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3299189/]]<br />
<br />
===CT scan===<br />
<br />
<br />
Thoracic CT angiography may be helpful in the diagnosis of pentalogy of fallot. Findings on CT scan diagnostic of pentalogy of fallot include. <ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
*ventricular septal defect.<br />
* right ventricular hypertrophy,<br />
* pulmonary atresia <br />
* aortopulmonary collateral arteries.<br />
<br />
===MRI===<br />
<br />
<br />
cardiac MRI may be helpful in the diagnosis of pentalogy of fallot. Findings on MRI diagnostic of pentalogy of fallot include RVOT stenosis, VSD, ASD,Overriding aorta, right ventricular hypertrophy and hypoplastic pulmonary arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
<br />
<br />
===Other Imaging Findings===<br />
Other imaging findings for pentalogy of fallot include Right ventricular angiopraphy, which demonstrates infundibular and pulmonary artery anatomy, and left ventricular angiography, which demonstrates VSD, ASD, and Overiding aorta <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
===Other Diagnostic Studies===<br />
<br />
There are no other diagnostic studies associated with pentalogy of Fallot<br />
<br />
==Treatment==<br />
===Medical Therapy===<br />
The mainstay of treatment for pentalogy of fallot is Surgery.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
Pharmacologic medical therapy is recommended among patients with severe RVOTO and hypercyanotic spells<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
Pharmacologic medical therapies for pentalogy of fallot include <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
* prostaglandin E1 in neonates with ductal dependent pulmonary blood flow<br />
*[[Morphine]] and [[ketamine]] for sedation<br />
*vasopressors like [[phenylephrine]]<br />
*[[Propranolol|propanolol]] to decrease the need for palliative surgical intervention.<br />
* iron treatment to decrease frequency of spells. <br />
<br />
Patients with hypercyanotic spells are treated with oxygen,volume expansion and morphine sedation.<br />
<br />
===Surgery===<br />
<br />
<br />
<br />
Surgery is the mainstay of treatment for pentalogy of fallot. interventional procedures are used to relieve pulmonary obstructions and embolize colaterals. <br />
different surgical procedures can be done to treat pentalogy of fallot and it includes <br />
* pulmonary valvotomy( for stenotic pulmonic valve)<br />
* pulmonary valvectomy( for small and thickened pulmonic valve) <br />
* closure of ASD/VSD<br />
* shunt surgery for severe cyanosis or in patients with frequent spells in the first year of life <br />
* Blalock -Taussig Shunt- communication between the right or left pulmonary artery and the right or left subclavian artery. <br />
* Waterson-Cooley Shunt- communication between the ascending aorta with the right pulmonary artery <br />
* Potts shunt-communication between the descending aorta and left pulmonary artery <br />
* Central shunt- Communication between the main pulmonary artery and ascending aorta.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
===Primary Prevention===<br />
There are no established measures for the primary prevention of pentalogy of fallot .<br />
<br />
===Secondary Prevention===<br />
There are no established measures for the secondary prevention of pentalogy of fallot<br />
===Prevention of Cyanosis===<br />
The following factors may reduce systemic vascular resistance (SVR) and exacerbate shunting which in turn exacerbate cyanosis and should be avoided if at all possible:<br />
<br />
*Acidosis<br />
*Bathing in hot water<br />
*Fever<br />
*Stress<br />
*Infection<br />
*Posture (upright, not squatting)<br />
*Exercise<br />
*[[Beta-adrenergic agonist|Beta-adrenergic agonists]]<br />
*[[Dehydration]]<br />
*Closure of the [[patent ductus arteriosus]]<br />
<br />
===Prevention of Infective Endocarditis===<br />
Antibiotic prophylaxis should be administered before respiratory and oral procedures.<br />
<br />
==References==<br />
{{reflist|2}}<br />
<br />
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[[Category:Cardiology]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Abdulkareem Opeoluwalukanhttps://www.wikidoc.org/index.php?title=Pentalogy_of_Fallot&diff=1623919Pentalogy of Fallot2020-07-10T16:09:59Z<p>Abdulkareem Opeoluwalukan: /* Echocardiography or Ultrasound */</p>
<hr />
<div>__NOTOC__<br />
{{SI}}<br />
{{CMG}} {{AE}}[[User:Abdulkareem Opeoluwalukan|Abdulkareem Opeoluwalukan, M.D]].<br />
==Overview==<br />
Pentalogy of Fallot is defined as the occurrence of Tetralogy of Fallot plus an [[atrial septal defect]].[[File:Pentalogy_of_fallot_image_1.png |200p|thumb|center| Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa. paolo.pazzi@up.ac.za.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3984729/]]<br />
<br />
==Historical Perspective==<br />
<br />
*[[Tetrallogy of fallot|Tetralogy of fallot]] was first discovered by Niel Stenson, a Denish physician Anatomist, in 1671. <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
* The association between right ventricular outflow tract obstruction and a large [[ventricular septal defect]] and tetralogy of fallot. was made in 1888 by Etinne-Louise.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref><br />
<br />
* In 1924, Canadian, Maude Abbott was the first to discover the association between ventricular septal defect , pulmonary stenosis, overriding aorta and right ventricular hypertrophy and the development of tetralogy of Fallot.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref<br />
In 1939, the first surgical treatment was developed by Dr Helen Taussig in Johns Hopkins&amp;lt;nowiki&amp;gt;&&amp;lt;/nowiki&amp;gt;lt;nowiki&lt;nowiki&gt;&&lt;/nowiki&gt;gt;<nowiki>&</nowiki>lt;nowiki<nowiki>&</nowiki>gt;<nowiki>&lt;nowiki&gt;<ref name="pmid30020660">&lt;/nowiki&gt;</nowiki>&lt;/nowiki&gt;&lt;/nowiki&gt;{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Classification==<br />
<br />
* There is no established system for the classification of pentalogy of fallot.<br />
<br />
<br /><br />
<br />
==Pathophysiology==<br />
<br />
It is thought that conotruncal Diseases like [[Tetralogy of Fallot|tetralogy of fallot]] and pentalogy of fallot is the result of <br />
<br />
* Neural Crest migration defect. <br />
* Underdevelopment of right ventricular infundibulum.<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
<br />
==Causes==<br />
<br />
<br />
<br />
<br />
The cause of pentalogy of fallot has not been identified. To review risk factors for the development of pentalogy of fallot, click [[tetralogy of fallot causes#Overview|here]].<br />
<br />
==Differentiating pentalogy of fallot from other Diseases==<br />
pentalogy of Fallot must be differentiated from other diseases that cause .<br />
<br />
===right to left shunt=== <br />
*[[Transposition of the great vessels|transposition of great arteries]] with pulmonic stenosis<br />
* double outlet right ventricle including Taussig-Bing anomaly<br />
*[[tricuspid atresia]]<br />
* Ebstein Anomaly<br />
*[[pulmonary atresia]] with intact ventricular septum<br />
*Respiratory diseases<br />
<br />
* Bronchiolitis,<br />
*viral and bacterial [[pneumonia]]<br />
*[[pneumothorax]] because when they are in heart failure they present with signs of respiratory distress, cyanosis and failure to thrive<br />
<br />
=== Bidirectional shunt diseases===<br />
* total anomalous pulmonary venous return,<br />
*[[hypoplastic left heart syndrome]],<br />
* single ventricle <br />
*[[Persistent truncus arteriosus|truncus arteriosus]] <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Epidemiology and Demographics==<br />
The epidemiology of pentalogy of fallot has not been well studied.<br />
<br />
==Risk Factors==<br />
<br />
<br />
<br />
<br />
Common risk factors in the development of pentalogy of fallot includes<ref name="SilvaNeves2019">{{cite journal|last1=Silva|first1=Joana A.|last2=Neves|first2=Ana L.|last3=Flor-de-Lima|first3=Filipa|last4=Soares|first4=Paulo|last5=Guimarães|first5=Hercília|title=Risk Factors and Outcomes of Tetralogy of Fallot: From Fetal to Neonatal Life|journal=Pediatric Cardiology|volume=41|issue=1|year=2019|pages=155–164|issn=0172-0643|doi=10.1007/s00246-019-02239-4}}</ref><br />
<br />
* Alcoholism in mother <br />
* Maternal Diabetes <br />
* Advanced maternal age i.e greater than 40 years <br />
* Malnutrition in pregnancy <br />
* Family history of tetralogy of fallot <br />
* Viral illness during pregnancy like [[Rubella]].<br />
* presence of [[Down syndrome]] or [[22q11.2 deletion syndrome|DiGeorge syndrome]]<br />
<br />
==Screening==<br />
There is insufficient evidence to recommend routine screening for pentalogy of fallot.<br />
<br />
==Natural History, Complications, and Prognosis==<br />
If left untreated, patients with pentalogy of fallot may progress to develop finger clubbing, stunted growth, cardiac arrhythmias, hypoplastic pulmonary artery, paradoxical emboli and [[polycythemia]] .<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
<br />
Prognosis is generally excellent provided the [[Ventricular septal defect|VSD]] has been closed and the right ventricular outflow tract has been relieved.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
<br />
<br />
There are no established criteria for the diagnosis of pentalogy fallot.<br />
<br />
===History and Symptoms===<br />
<br />
The hallmark of pentalogy of fallot is cyanosis. A positive history of cyanosis and easy fatigability leading to squatting during exercise is suggestive of cyanotic congenital heart defect.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
. The most common symptoms of pentalogy of fallot include cyanosis, easy fatigabillity , and hypercyanotic spells with crying , feeding and defecating.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
==Physical Examination==<br />
<br />
=== Appearance===<br />
* patients with pentalogy of fallot usually appear small due to failure to thrive. <br />
* patients may be found in squatting position( compensatory mechanism)<br />
<br />
=== Vital Signs===<br />
* Tachycardia with regular pulse <br />
* Tachypnea <br />
* low grade fever in patients with concomitant infective [[endocarditis]]<br />
<br />
=== HEENT===<br />
* Retinal vessel engorgement may be present<br />
<br />
=== Heart===<br />
<br />
A thrill may be present at left sternal border.<br />
*A right ventricular impulse may be prominent.<br />
*Second heart sound (S2) is single as P2 is absent.<br />
*A harsh systolic ejection murmur best heard at the left sternal border is usually present.<br />
*P2 is faint and delayed in mild cyanosis and inaudible in severe cyanosis.<br />
*A diastolic murmur may be heard due to aortic regurgitation.<br />
<br />
=== Extremities===<br />
*Clubbing<br />
*Cyanosis is most prominent at lips and nail beds<br />
<br />
===Laboratory Findings===<br />
<br />
<br />
<br />
Some patients with pentalogy of fallot may have [[polycythemia]] <br />
which is usually suggestive of worsening hypoxia and compensatory production of erythropoetin.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
.<br />
<br />
===Electrocardiogram===<br />
<br />
An ECG may be helpful in the diagnosis of pentalogy of fallot, <br />
Findings on an ECG suggestive of pentalogy of fallot include [[right axis deviation]] and right ventricular hypertrophy.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
[[File: Right_ventrriular_hypertophy.png|200p|thumb|right|Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874376/]]<br />
<br />
===X-ray===<br />
<br />
<br />
<br />
<br />
An x-ray may be helpful in the diagnosis of pentalogy of Fallot. Findings on an x-ray suggestive of pentalogy of fallot include boot shaped heart or coeur en sabot.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref> [[File:Boot_shaped_heart.png|200p|thumb|left| Typical preoperative chest X‐ray of a 16‐month‐old boy with tetralogy of Fallot.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5412831/]]<br />
<br />
<br />
<br />
<br />
.<br />
<br />
===Echocardiography or Ultrasound===<br />
<br />
<br />
<br />
<br />
Echocardiography may be helpful in the diagnosis of pentalogy of fallot. Findings on an echocardiography diagnostic of pentalogy of fallot include.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. 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C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
* Ventricular septal defect.<br />
* Atrial septal defect.<br />
* Right ventricular outflow tract obstruction.<br />
* overriding aorta [[File:Pentalogy_of_fallot_image_2.png|200p|thumb|left | Department of Biochemistry, University of Allahabad, Allahabad-211002, India.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3299189/]]<br />
<br />
===CT scan===<br />
<br />
<br />
Thoracic CT angiography may be helpful in the diagnosis of pentallogy of fallot. Findings on CT scan diagnostic of pentalogy of fallot include ventricular septal defect, right ventricular hypertrophy, pulmonary atresia and major aortopulmonary collateral arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref> <br />
<br />
<br />
<br />
===MRI===<br />
<br />
<br />
cardiac MRI may be helpful in the diagnosis of pentalogy of fallot. Findings on MRI diagnostic of pentalogy of fallot include RVOT stenosis, VSD, ASD,Overriding aorta, right ventricular hypertrophy and hypoplastic pulmonary arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
<br />
<br />
===Other Imaging Findings===<br />
Other imaging findings for pentalogy of fallot include Right ventricular angiopraphy, which demonstrates infundibular and pulmonary artery anatomy, and left ventricular angiography, which demonstrates VSD, ASD, and Overiding aorta <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
===Other Diagnostic Studies===<br />
<br />
There are no other diagnostic studies associated with pentalogy of Fallot<br />
<br />
==Treatment==<br />
===Medical Therapy===<br />
The mainstay of treatment for pentalogy of fallot is Surgery.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
Pharmacologic medical therapy is recommended among patients with severe RVOTO and hypercyanotic spells<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
Pharmacologic medical therapies for pentalogy of fallot include <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
* prostaglandin E1 in neonates with ductal dependent pulmonary blood flow<br />
*[[Morphine]] and [[ketamine]] for sedation<br />
*vasopressors like [[phenylephrine]]<br />
*[[Propranolol|propanolol]] to decrease the need for palliative surgical intervention.<br />
* iron treatment to decrease frequency of spells. <br />
<br />
Patients with hypercyanotic spells are treated with oxygen,volume expansion and morphine sedation.<br />
<br />
===Surgery===<br />
<br />
<br />
<br />
Surgery is the mainstay of treatment for pentalogy of fallot. interventional procedures are used to relieve pulmonary obstructions and embolize colaterals. <br />
different surgical procedures can be done to treat pentalogy of fallot and it includes <br />
* pulmonary valvotomy( for stenotic pulmonic valve)<br />
* pulmonary valvectomy( for small and thickened pulmonic valve) <br />
* closure of ASD/VSD<br />
* shunt surgery for severe cyanosis or in patients with frequent spells in the first year of life <br />
* Blalock -Taussig Shunt- communication between the right or left pulmonary artery and the right or left subclavian artery. <br />
* Waterson-Cooley Shunt- communication between the ascending aorta with the right pulmonary artery <br />
* Potts shunt-communication between the descending aorta and left pulmonary artery <br />
* Central shunt- Communication between the main pulmonary artery and ascending aorta.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
===Primary Prevention===<br />
There are no established measures for the primary prevention of pentalogy of fallot .<br />
<br />
===Secondary Prevention===<br />
There are no established measures for the secondary prevention of pentalogy of fallot<br />
===Prevention of Cyanosis===<br />
The following factors may reduce systemic vascular resistance (SVR) and exacerbate shunting which in turn exacerbate cyanosis and should be avoided if at all possible:<br />
<br />
*Acidosis<br />
*Bathing in hot water<br />
*Fever<br />
*Stress<br />
*Infection<br />
*Posture (upright, not squatting)<br />
*Exercise<br />
*[[Beta-adrenergic agonist|Beta-adrenergic agonists]]<br />
*[[Dehydration]]<br />
*Closure of the [[patent ductus arteriosus]]<br />
<br />
===Prevention of Infective Endocarditis===<br />
Antibiotic prophylaxis should be administered before respiratory and oral procedures.<br />
<br />
==References==<br />
{{reflist|2}}<br />
<br />
{{WikiDoc Help Menu}}<br />
{{WikiDoc Sources}}<br />
[[Category:Cardiology]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Abdulkareem Opeoluwalukanhttps://www.wikidoc.org/index.php?title=Pentalogy_of_Fallot&diff=1623914Pentalogy of Fallot2020-07-10T16:04:24Z<p>Abdulkareem Opeoluwalukan: /* Electrocardiogram */</p>
<hr />
<div>__NOTOC__<br />
{{SI}}<br />
{{CMG}} {{AE}}[[User:Abdulkareem Opeoluwalukan|Abdulkareem Opeoluwalukan, M.D]].<br />
==Overview==<br />
Pentalogy of Fallot is defined as the occurrence of Tetralogy of Fallot plus an [[atrial septal defect]].[[File:Pentalogy_of_fallot_image_1.png |200p|thumb|center| Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa. paolo.pazzi@up.ac.za.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3984729/]]<br />
<br />
==Historical Perspective==<br />
<br />
*[[Tetrallogy of fallot|Tetralogy of fallot]] was first discovered by Niel Stenson, a Denish physician Anatomist, in 1671. <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
* The association between right ventricular outflow tract obstruction and a large [[ventricular septal defect]] and tetralogy of fallot. was made in 1888 by Etinne-Louise.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref><br />
<br />
* In 1924, Canadian, Maude Abbott was the first to discover the association between ventricular septal defect , pulmonary stenosis, overriding aorta and right ventricular hypertrophy and the development of tetralogy of Fallot.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref<br />
In 1939, the first surgical treatment was developed by Dr Helen Taussig in Johns Hopkins&amp;lt;nowiki&amp;gt;&&amp;lt;/nowiki&amp;gt;lt;nowiki&lt;nowiki&gt;&&lt;/nowiki&gt;gt;<nowiki>&</nowiki>lt;nowiki<nowiki>&</nowiki>gt;<nowiki>&lt;nowiki&gt;<ref name="pmid30020660">&lt;/nowiki&gt;</nowiki>&lt;/nowiki&gt;&lt;/nowiki&gt;{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Classification==<br />
<br />
* There is no established system for the classification of pentalogy of fallot.<br />
<br />
<br /><br />
<br />
==Pathophysiology==<br />
<br />
It is thought that conotruncal Diseases like [[Tetralogy of Fallot|tetralogy of fallot]] and pentalogy of fallot is the result of <br />
<br />
* Neural Crest migration defect. <br />
* Underdevelopment of right ventricular infundibulum.<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
<br />
==Causes==<br />
<br />
<br />
<br />
<br />
The cause of pentalogy of fallot has not been identified. To review risk factors for the development of pentalogy of fallot, click [[tetralogy of fallot causes#Overview|here]].<br />
<br />
==Differentiating pentalogy of fallot from other Diseases==<br />
pentalogy of Fallot must be differentiated from other diseases that cause .<br />
<br />
===right to left shunt=== <br />
*[[Transposition of the great vessels|transposition of great arteries]] with pulmonic stenosis<br />
* double outlet right ventricle including Taussig-Bing anomaly<br />
*[[tricuspid atresia]]<br />
* Ebstein Anomaly<br />
*[[pulmonary atresia]] with intact ventricular septum<br />
*Respiratory diseases<br />
<br />
* Bronchiolitis,<br />
*viral and bacterial [[pneumonia]]<br />
*[[pneumothorax]] because when they are in heart failure they present with signs of respiratory distress, cyanosis and failure to thrive<br />
<br />
=== Bidirectional shunt diseases===<br />
* total anomalous pulmonary venous return,<br />
*[[hypoplastic left heart syndrome]],<br />
* single ventricle <br />
*[[Persistent truncus arteriosus|truncus arteriosus]] <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Epidemiology and Demographics==<br />
The epidemiology of pentalogy of fallot has not been well studied.<br />
<br />
==Risk Factors==<br />
<br />
<br />
<br />
<br />
Common risk factors in the development of pentalogy of fallot includes<ref name="SilvaNeves2019">{{cite journal|last1=Silva|first1=Joana A.|last2=Neves|first2=Ana L.|last3=Flor-de-Lima|first3=Filipa|last4=Soares|first4=Paulo|last5=Guimarães|first5=Hercília|title=Risk Factors and Outcomes of Tetralogy of Fallot: From Fetal to Neonatal Life|journal=Pediatric Cardiology|volume=41|issue=1|year=2019|pages=155–164|issn=0172-0643|doi=10.1007/s00246-019-02239-4}}</ref><br />
<br />
* Alcoholism in mother <br />
* Maternal Diabetes <br />
* Advanced maternal age i.e greater than 40 years <br />
* Malnutrition in pregnancy <br />
* Family history of tetralogy of fallot <br />
* Viral illness during pregnancy like [[Rubella]].<br />
* presence of [[Down syndrome]] or [[22q11.2 deletion syndrome|DiGeorge syndrome]]<br />
<br />
==Screening==<br />
There is insufficient evidence to recommend routine screening for pentalogy of fallot.<br />
<br />
==Natural History, Complications, and Prognosis==<br />
If left untreated, patients with pentalogy of fallot may progress to develop finger clubbing, stunted growth, cardiac arrhythmias, hypoplastic pulmonary artery, paradoxical emboli and [[polycythemia]] .<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
<br />
Prognosis is generally excellent provided the [[Ventricular septal defect|VSD]] has been closed and the right ventricular outflow tract has been relieved.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
<br />
<br />
There are no established criteria for the diagnosis of pentalogy fallot.<br />
<br />
===History and Symptoms===<br />
<br />
The hallmark of pentalogy of fallot is cyanosis. A positive history of cyanosis and easy fatigability leading to squatting during exercise is suggestive of cyanotic congenital heart defect.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
. The most common symptoms of pentalogy of fallot include cyanosis, easy fatigabillity , and hypercyanotic spells with crying , feeding and defecating.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
==Physical Examination==<br />
<br />
=== Appearance===<br />
* patients with pentalogy of fallot usually appear small due to failure to thrive. <br />
* patients may be found in squatting position( compensatory mechanism)<br />
<br />
=== Vital Signs===<br />
* Tachycardia with regular pulse <br />
* Tachypnea <br />
* low grade fever in patients with concomitant infective [[endocarditis]]<br />
<br />
=== HEENT===<br />
* Retinal vessel engorgement may be present<br />
<br />
=== Heart===<br />
<br />
A thrill may be present at left sternal border.<br />
*A right ventricular impulse may be prominent.<br />
*Second heart sound (S2) is single as P2 is absent.<br />
*A harsh systolic ejection murmur best heard at the left sternal border is usually present.<br />
*P2 is faint and delayed in mild cyanosis and inaudible in severe cyanosis.<br />
*A diastolic murmur may be heard due to aortic regurgitation.<br />
<br />
=== Extremities===<br />
*Clubbing<br />
*Cyanosis is most prominent at lips and nail beds<br />
<br />
===Laboratory Findings===<br />
<br />
<br />
<br />
Some patients with pentalogy of fallot may have [[polycythemia]] <br />
which is usually suggestive of worsening hypoxia and compensatory production of erythropoetin.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
.<br />
<br />
===Electrocardiogram===<br />
<br />
An ECG may be helpful in the diagnosis of pentalogy of fallot, <br />
Findings on an ECG suggestive of pentalogy of fallot include [[right axis deviation]] and right ventricular hypertrophy.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. 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C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
[[File: Right_ventrriular_hypertophy.png|200p|thumb|right|Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874376/]]<br />
<br />
===X-ray===<br />
<br />
<br />
<br />
<br />
An x-ray may be helpful in the diagnosis of pentalogy of Fallot. Findings on an x-ray suggestive of pentalogy of fallot include boot shaped heart or coeur en sabot.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref> [[File:Boot_shaped_heart.png|200p|thumb|left| Typical preoperative chest X‐ray of a 16‐month‐old boy with tetralogy of Fallot.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5412831/]]<br />
<br />
<br />
<br />
<br />
.<br />
<br />
===Echocardiography or Ultrasound===<br />
<br />
<br />
<br />
<br />
Echocardiography may be helpful in the diagnosis of pentalogy of fallot. Findings on an echocardiography diagnostic of pentallogy of fallot include Ventricular septal defect, Atrial septal defect , Right ventricular outflow tract obstruction and overriding aorta<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref> [[File:Pentalogy_of_fallot_image_2.png|200p|thumb|left | Department of Biochemistry, University of Allahabad, Allahabad-211002, India.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3299189/]]<br />
<br />
===CT scan===<br />
<br />
<br />
Thoracic CT angiography may be helpful in the diagnosis of pentallogy of fallot. Findings on CT scan diagnostic of pentalogy of fallot include ventricular septal defect, right ventricular hypertrophy, pulmonary atresia and major aortopulmonary collateral arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref> <br />
<br />
<br />
<br />
===MRI===<br />
<br />
<br />
cardiac MRI may be helpful in the diagnosis of pentalogy of fallot. Findings on MRI diagnostic of pentalogy of fallot include RVOT stenosis, VSD, ASD,Overriding aorta, right ventricular hypertrophy and hypoplastic pulmonary arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
<br />
<br />
===Other Imaging Findings===<br />
Other imaging findings for pentalogy of fallot include Right ventricular angiopraphy, which demonstrates infundibular and pulmonary artery anatomy, and left ventricular angiography, which demonstrates VSD, ASD, and Overiding aorta <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
===Other Diagnostic Studies===<br />
<br />
There are no other diagnostic studies associated with pentalogy of Fallot<br />
<br />
==Treatment==<br />
===Medical Therapy===<br />
The mainstay of treatment for pentalogy of fallot is Surgery.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
Pharmacologic medical therapy is recommended among patients with severe RVOTO and hypercyanotic spells<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
Pharmacologic medical therapies for pentalogy of fallot include <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
* prostaglandin E1 in neonates with ductal dependent pulmonary blood flow<br />
*[[Morphine]] and [[ketamine]] for sedation<br />
*vasopressors like [[phenylephrine]]<br />
*[[Propranolol|propanolol]] to decrease the need for palliative surgical intervention.<br />
* iron treatment to decrease frequency of spells. <br />
<br />
Patients with hypercyanotic spells are treated with oxygen,volume expansion and morphine sedation.<br />
<br />
===Surgery===<br />
<br />
<br />
<br />
Surgery is the mainstay of treatment for pentalogy of fallot. interventional procedures are used to relieve pulmonary obstructions and embolize colaterals. <br />
different surgical procedures can be done to treat pentalogy of fallot and it includes <br />
* pulmonary valvotomy( for stenotic pulmonic valve)<br />
* pulmonary valvectomy( for small and thickened pulmonic valve) <br />
* closure of ASD/VSD<br />
* shunt surgery for severe cyanosis or in patients with frequent spells in the first year of life <br />
* Blalock -Taussig Shunt- communication between the right or left pulmonary artery and the right or left subclavian artery. <br />
* Waterson-Cooley Shunt- communication between the ascending aorta with the right pulmonary artery <br />
* Potts shunt-communication between the descending aorta and left pulmonary artery <br />
* Central shunt- Communication between the main pulmonary artery and ascending aorta.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
===Primary Prevention===<br />
There are no established measures for the primary prevention of pentalogy of fallot .<br />
<br />
===Secondary Prevention===<br />
There are no established measures for the secondary prevention of pentalogy of fallot<br />
===Prevention of Cyanosis===<br />
The following factors may reduce systemic vascular resistance (SVR) and exacerbate shunting which in turn exacerbate cyanosis and should be avoided if at all possible:<br />
<br />
*Acidosis<br />
*Bathing in hot water<br />
*Fever<br />
*Stress<br />
*Infection<br />
*Posture (upright, not squatting)<br />
*Exercise<br />
*[[Beta-adrenergic agonist|Beta-adrenergic agonists]]<br />
*[[Dehydration]]<br />
*Closure of the [[patent ductus arteriosus]]<br />
<br />
===Prevention of Infective Endocarditis===<br />
Antibiotic prophylaxis should be administered before respiratory and oral procedures.<br />
<br />
==References==<br />
{{reflist|2}}<br />
<br />
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{{WikiDoc Sources}}<br />
[[Category:Cardiology]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Abdulkareem Opeoluwalukanhttps://www.wikidoc.org/index.php?title=Pentalogy_of_Fallot&diff=1623911Pentalogy of Fallot2020-07-10T16:02:29Z<p>Abdulkareem Opeoluwalukan: /* Laboratory Findings */</p>
<hr />
<div>__NOTOC__<br />
{{SI}}<br />
{{CMG}} {{AE}}[[User:Abdulkareem Opeoluwalukan|Abdulkareem Opeoluwalukan, M.D]].<br />
==Overview==<br />
Pentalogy of Fallot is defined as the occurrence of Tetralogy of Fallot plus an [[atrial septal defect]].[[File:Pentalogy_of_fallot_image_1.png |200p|thumb|center| Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa. paolo.pazzi@up.ac.za.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3984729/]]<br />
<br />
==Historical Perspective==<br />
<br />
*[[Tetrallogy of fallot|Tetralogy of fallot]] was first discovered by Niel Stenson, a Denish physician Anatomist, in 1671. <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
* The association between right ventricular outflow tract obstruction and a large [[ventricular septal defect]] and tetralogy of fallot. was made in 1888 by Etinne-Louise.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref><br />
<br />
* In 1924, Canadian, Maude Abbott was the first to discover the association between ventricular septal defect , pulmonary stenosis, overriding aorta and right ventricular hypertrophy and the development of tetralogy of Fallot.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref<br />
In 1939, the first surgical treatment was developed by Dr Helen Taussig in Johns Hopkins&amp;lt;nowiki&amp;gt;&&amp;lt;/nowiki&amp;gt;lt;nowiki&lt;nowiki&gt;&&lt;/nowiki&gt;gt;<nowiki>&</nowiki>lt;nowiki<nowiki>&</nowiki>gt;<nowiki>&lt;nowiki&gt;<ref name="pmid30020660">&lt;/nowiki&gt;</nowiki>&lt;/nowiki&gt;&lt;/nowiki&gt;{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Classification==<br />
<br />
* There is no established system for the classification of pentalogy of fallot.<br />
<br />
<br /><br />
<br />
==Pathophysiology==<br />
<br />
It is thought that conotruncal Diseases like [[Tetralogy of Fallot|tetralogy of fallot]] and pentalogy of fallot is the result of <br />
<br />
* Neural Crest migration defect. <br />
* Underdevelopment of right ventricular infundibulum.<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
<br />
==Causes==<br />
<br />
<br />
<br />
<br />
The cause of pentalogy of fallot has not been identified. To review risk factors for the development of pentalogy of fallot, click [[tetralogy of fallot causes#Overview|here]].<br />
<br />
==Differentiating pentalogy of fallot from other Diseases==<br />
pentalogy of Fallot must be differentiated from other diseases that cause .<br />
<br />
===right to left shunt=== <br />
*[[Transposition of the great vessels|transposition of great arteries]] with pulmonic stenosis<br />
* double outlet right ventricle including Taussig-Bing anomaly<br />
*[[tricuspid atresia]]<br />
* Ebstein Anomaly<br />
*[[pulmonary atresia]] with intact ventricular septum<br />
*Respiratory diseases<br />
<br />
* Bronchiolitis,<br />
*viral and bacterial [[pneumonia]]<br />
*[[pneumothorax]] because when they are in heart failure they present with signs of respiratory distress, cyanosis and failure to thrive<br />
<br />
=== Bidirectional shunt diseases===<br />
* total anomalous pulmonary venous return,<br />
*[[hypoplastic left heart syndrome]],<br />
* single ventricle <br />
*[[Persistent truncus arteriosus|truncus arteriosus]] <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Epidemiology and Demographics==<br />
The epidemiology of pentalogy of fallot has not been well studied.<br />
<br />
==Risk Factors==<br />
<br />
<br />
<br />
<br />
Common risk factors in the development of pentalogy of fallot includes<ref name="SilvaNeves2019">{{cite journal|last1=Silva|first1=Joana A.|last2=Neves|first2=Ana L.|last3=Flor-de-Lima|first3=Filipa|last4=Soares|first4=Paulo|last5=Guimarães|first5=Hercília|title=Risk Factors and Outcomes of Tetralogy of Fallot: From Fetal to Neonatal Life|journal=Pediatric Cardiology|volume=41|issue=1|year=2019|pages=155–164|issn=0172-0643|doi=10.1007/s00246-019-02239-4}}</ref><br />
<br />
* Alcoholism in mother <br />
* Maternal Diabetes <br />
* Advanced maternal age i.e greater than 40 years <br />
* Malnutrition in pregnancy <br />
* Family history of tetralogy of fallot <br />
* Viral illness during pregnancy like [[Rubella]].<br />
* presence of [[Down syndrome]] or [[22q11.2 deletion syndrome|DiGeorge syndrome]]<br />
<br />
==Screening==<br />
There is insufficient evidence to recommend routine screening for pentalogy of fallot.<br />
<br />
==Natural History, Complications, and Prognosis==<br />
If left untreated, patients with pentalogy of fallot may progress to develop finger clubbing, stunted growth, cardiac arrhythmias, hypoplastic pulmonary artery, paradoxical emboli and [[polycythemia]] .<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
<br />
Prognosis is generally excellent provided the [[Ventricular septal defect|VSD]] has been closed and the right ventricular outflow tract has been relieved.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
<br />
<br />
There are no established criteria for the diagnosis of pentalogy fallot.<br />
<br />
===History and Symptoms===<br />
<br />
The hallmark of pentalogy of fallot is cyanosis. A positive history of cyanosis and easy fatigability leading to squatting during exercise is suggestive of cyanotic congenital heart defect.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
. The most common symptoms of pentalogy of fallot include cyanosis, easy fatigabillity , and hypercyanotic spells with crying , feeding and defecating.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
==Physical Examination==<br />
<br />
=== Appearance===<br />
* patients with pentalogy of fallot usually appear small due to failure to thrive. <br />
* patients may be found in squatting position( compensatory mechanism)<br />
<br />
=== Vital Signs===<br />
* Tachycardia with regular pulse <br />
* Tachypnea <br />
* low grade fever in patients with concomitant infective [[endocarditis]]<br />
<br />
=== HEENT===<br />
* Retinal vessel engorgement may be present<br />
<br />
=== Heart===<br />
<br />
A thrill may be present at left sternal border.<br />
*A right ventricular impulse may be prominent.<br />
*Second heart sound (S2) is single as P2 is absent.<br />
*A harsh systolic ejection murmur best heard at the left sternal border is usually present.<br />
*P2 is faint and delayed in mild cyanosis and inaudible in severe cyanosis.<br />
*A diastolic murmur may be heard due to aortic regurgitation.<br />
<br />
=== Extremities===<br />
*Clubbing<br />
*Cyanosis is most prominent at lips and nail beds<br />
<br />
===Laboratory Findings===<br />
<br />
<br />
<br />
Some patients with pentalogy of fallot may have [[polycythemia]] <br />
which is usually suggestive of worsening hypoxia and compensatory production of erythropoetin.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
.<br />
<br />
===Electrocardiogram===<br />
<br />
An ECG may be helpful in the diagnosis of pentalogy of fallot <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
Findings on an ECG suggestive of pentalogy of fallot include [[right axis deviation]] and right ventricular hypertrophy.<br />
[[File: Right_ventrriular_hypertophy.png|200p|thumb|right|Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874376/]]<br />
<br />
===X-ray===<br />
<br />
<br />
<br />
<br />
An x-ray may be helpful in the diagnosis of pentalogy of Fallot. Findings on an x-ray suggestive of pentalogy of fallot include boot shaped heart or coeur en sabot.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref> [[File:Boot_shaped_heart.png|200p|thumb|left| Typical preoperative chest X‐ray of a 16‐month‐old boy with tetralogy of Fallot.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5412831/]]<br />
<br />
<br />
<br />
<br />
.<br />
<br />
===Echocardiography or Ultrasound===<br />
<br />
<br />
<br />
<br />
Echocardiography may be helpful in the diagnosis of pentalogy of fallot. Findings on an echocardiography diagnostic of pentallogy of fallot include Ventricular septal defect, Atrial septal defect , Right ventricular outflow tract obstruction and overriding aorta<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref> [[File:Pentalogy_of_fallot_image_2.png|200p|thumb|left | Department of Biochemistry, University of Allahabad, Allahabad-211002, India.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3299189/]]<br />
<br />
===CT scan===<br />
<br />
<br />
Thoracic CT angiography may be helpful in the diagnosis of pentallogy of fallot. Findings on CT scan diagnostic of pentalogy of fallot include ventricular septal defect, right ventricular hypertrophy, pulmonary atresia and major aortopulmonary collateral arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref> <br />
<br />
<br />
<br />
===MRI===<br />
<br />
<br />
cardiac MRI may be helpful in the diagnosis of pentalogy of fallot. Findings on MRI diagnostic of pentalogy of fallot include RVOT stenosis, VSD, ASD,Overriding aorta, right ventricular hypertrophy and hypoplastic pulmonary arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
<br />
<br />
===Other Imaging Findings===<br />
Other imaging findings for pentalogy of fallot include Right ventricular angiopraphy, which demonstrates infundibular and pulmonary artery anatomy, and left ventricular angiography, which demonstrates VSD, ASD, and Overiding aorta <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
===Other Diagnostic Studies===<br />
<br />
There are no other diagnostic studies associated with pentalogy of Fallot<br />
<br />
==Treatment==<br />
===Medical Therapy===<br />
The mainstay of treatment for pentalogy of fallot is Surgery.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
Pharmacologic medical therapy is recommended among patients with severe RVOTO and hypercyanotic spells<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
Pharmacologic medical therapies for pentalogy of fallot include <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
* prostaglandin E1 in neonates with ductal dependent pulmonary blood flow<br />
*[[Morphine]] and [[ketamine]] for sedation<br />
*vasopressors like [[phenylephrine]]<br />
*[[Propranolol|propanolol]] to decrease the need for palliative surgical intervention.<br />
* iron treatment to decrease frequency of spells. <br />
<br />
Patients with hypercyanotic spells are treated with oxygen,volume expansion and morphine sedation.<br />
<br />
===Surgery===<br />
<br />
<br />
<br />
Surgery is the mainstay of treatment for pentalogy of fallot. interventional procedures are used to relieve pulmonary obstructions and embolize colaterals. <br />
different surgical procedures can be done to treat pentalogy of fallot and it includes <br />
* pulmonary valvotomy( for stenotic pulmonic valve)<br />
* pulmonary valvectomy( for small and thickened pulmonic valve) <br />
* closure of ASD/VSD<br />
* shunt surgery for severe cyanosis or in patients with frequent spells in the first year of life <br />
* Blalock -Taussig Shunt- communication between the right or left pulmonary artery and the right or left subclavian artery. <br />
* Waterson-Cooley Shunt- communication between the ascending aorta with the right pulmonary artery <br />
* Potts shunt-communication between the descending aorta and left pulmonary artery <br />
* Central shunt- Communication between the main pulmonary artery and ascending aorta.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
===Primary Prevention===<br />
There are no established measures for the primary prevention of pentalogy of fallot .<br />
<br />
===Secondary Prevention===<br />
There are no established measures for the secondary prevention of pentalogy of fallot<br />
===Prevention of Cyanosis===<br />
The following factors may reduce systemic vascular resistance (SVR) and exacerbate shunting which in turn exacerbate cyanosis and should be avoided if at all possible:<br />
<br />
*Acidosis<br />
*Bathing in hot water<br />
*Fever<br />
*Stress<br />
*Infection<br />
*Posture (upright, not squatting)<br />
*Exercise<br />
*[[Beta-adrenergic agonist|Beta-adrenergic agonists]]<br />
*[[Dehydration]]<br />
*Closure of the [[patent ductus arteriosus]]<br />
<br />
===Prevention of Infective Endocarditis===<br />
Antibiotic prophylaxis should be administered before respiratory and oral procedures.<br />
<br />
==References==<br />
{{reflist|2}}<br />
<br />
{{WikiDoc Help Menu}}<br />
{{WikiDoc Sources}}<br />
[[Category:Cardiology]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Abdulkareem Opeoluwalukanhttps://www.wikidoc.org/index.php?title=Pentalogy_of_Fallot&diff=1623902Pentalogy of Fallot2020-07-10T15:53:18Z<p>Abdulkareem Opeoluwalukan: /* History and Symptoms */</p>
<hr />
<div>__NOTOC__<br />
{{SI}}<br />
{{CMG}} {{AE}}[[User:Abdulkareem Opeoluwalukan|Abdulkareem Opeoluwalukan, M.D]].<br />
==Overview==<br />
Pentalogy of Fallot is defined as the occurrence of Tetralogy of Fallot plus an [[atrial septal defect]].[[File:Pentalogy_of_fallot_image_1.png |200p|thumb|center| Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa. paolo.pazzi@up.ac.za.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3984729/]]<br />
<br />
==Historical Perspective==<br />
<br />
*[[Tetrallogy of fallot|Tetralogy of fallot]] was first discovered by Niel Stenson, a Denish physician Anatomist, in 1671. <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
* The association between right ventricular outflow tract obstruction and a large [[ventricular septal defect]] and tetralogy of fallot. was made in 1888 by Etinne-Louise.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref><br />
<br />
* In 1924, Canadian, Maude Abbott was the first to discover the association between ventricular septal defect , pulmonary stenosis, overriding aorta and right ventricular hypertrophy and the development of tetralogy of Fallot.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref<br />
In 1939, the first surgical treatment was developed by Dr Helen Taussig in Johns Hopkins&amp;lt;nowiki&amp;gt;&&amp;lt;/nowiki&amp;gt;lt;nowiki&lt;nowiki&gt;&&lt;/nowiki&gt;gt;<nowiki>&</nowiki>lt;nowiki<nowiki>&</nowiki>gt;<nowiki>&lt;nowiki&gt;<ref name="pmid30020660">&lt;/nowiki&gt;</nowiki>&lt;/nowiki&gt;&lt;/nowiki&gt;{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Classification==<br />
<br />
* There is no established system for the classification of pentalogy of fallot.<br />
<br />
<br /><br />
<br />
==Pathophysiology==<br />
<br />
It is thought that conotruncal Diseases like [[Tetralogy of Fallot|tetralogy of fallot]] and pentalogy of fallot is the result of <br />
<br />
* Neural Crest migration defect. <br />
* Underdevelopment of right ventricular infundibulum.<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
<br />
==Causes==<br />
<br />
<br />
<br />
<br />
The cause of pentalogy of fallot has not been identified. To review risk factors for the development of pentalogy of fallot, click [[tetralogy of fallot causes#Overview|here]].<br />
<br />
==Differentiating pentalogy of fallot from other Diseases==<br />
pentalogy of Fallot must be differentiated from other diseases that cause .<br />
<br />
===right to left shunt=== <br />
*[[Transposition of the great vessels|transposition of great arteries]] with pulmonic stenosis<br />
* double outlet right ventricle including Taussig-Bing anomaly<br />
*[[tricuspid atresia]]<br />
* Ebstein Anomaly<br />
*[[pulmonary atresia]] with intact ventricular septum<br />
*Respiratory diseases<br />
<br />
* Bronchiolitis,<br />
*viral and bacterial [[pneumonia]]<br />
*[[pneumothorax]] because when they are in heart failure they present with signs of respiratory distress, cyanosis and failure to thrive<br />
<br />
=== Bidirectional shunt diseases===<br />
* total anomalous pulmonary venous return,<br />
*[[hypoplastic left heart syndrome]],<br />
* single ventricle <br />
*[[Persistent truncus arteriosus|truncus arteriosus]] <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Epidemiology and Demographics==<br />
The epidemiology of pentalogy of fallot has not been well studied.<br />
<br />
==Risk Factors==<br />
<br />
<br />
<br />
<br />
Common risk factors in the development of pentalogy of fallot includes<ref name="SilvaNeves2019">{{cite journal|last1=Silva|first1=Joana A.|last2=Neves|first2=Ana L.|last3=Flor-de-Lima|first3=Filipa|last4=Soares|first4=Paulo|last5=Guimarães|first5=Hercília|title=Risk Factors and Outcomes of Tetralogy of Fallot: From Fetal to Neonatal Life|journal=Pediatric Cardiology|volume=41|issue=1|year=2019|pages=155–164|issn=0172-0643|doi=10.1007/s00246-019-02239-4}}</ref><br />
<br />
* Alcoholism in mother <br />
* Maternal Diabetes <br />
* Advanced maternal age i.e greater than 40 years <br />
* Malnutrition in pregnancy <br />
* Family history of tetralogy of fallot <br />
* Viral illness during pregnancy like [[Rubella]].<br />
* presence of [[Down syndrome]] or [[22q11.2 deletion syndrome|DiGeorge syndrome]]<br />
<br />
==Screening==<br />
There is insufficient evidence to recommend routine screening for pentalogy of fallot.<br />
<br />
==Natural History, Complications, and Prognosis==<br />
If left untreated, patients with pentalogy of fallot may progress to develop finger clubbing, stunted growth, cardiac arrhythmias, hypoplastic pulmonary artery, paradoxical emboli and [[polycythemia]] .<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
<br />
Prognosis is generally excellent provided the [[Ventricular septal defect|VSD]] has been closed and the right ventricular outflow tract has been relieved.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. 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A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. 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C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
<br />
<br />
There are no established criteria for the diagnosis of pentalogy fallot.<br />
<br />
===History and Symptoms===<br />
<br />
The hallmark of pentalogy of fallot is cyanosis. A positive history of cyanosis and easy fatigability leading to squatting during exercise is suggestive of cyanotic congenital heart defect.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. 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A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. 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C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
. The most common symptoms of pentalogy of fallot include cyanosis, easy fatigabillity , and hypercyanotic spells with crying , feeding and defecating.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. A.|last129=Musco|first129=Giovanna|last130=Stoll|first130=Guido|last131=Toyka|first131=Klaus V.|last132=Leung|first132=Alexander K. C.|last133=Leung|first133=Alexander K. C.|last134=Robson|first134=William Lane M.|last135=Böhm|first135=Markus|last136=Luger|first136=Thomas A.|last137=Pischik|first137=Elena|last138=Kauppinen|first138=Raili|last139=Frank|first139=Jorge|last140=Schwarz|first140=Thomas|last141=Thapar|first141=Manish|last142=Bonkovsky|first142=Herbert. L.|last143=Wagner|first143=Jeffrey C.|last144=Smith|first144=A. Gordon|last145=Mela|first145=Maria|last146=Thalheimer|first146=Ulrich|last147=Samonakis|first147=Dimitrios|last148=Burroughs|first148=Andrew K.|last149=Mela|first149=Maria|last150=Thalheimer|first150=Ulrich|last151=Samonakis|first151=Dimitrios|last152=Burroughs|first152=Andrew K.|last153=Shastri|first153=Yogesh M.|last154=Stein|first154=Jürgen M.|last155=Segman|first155=Ronnen H.|last156=Shalev|first156=Arieh Y.|last157=Jacob|first157=Giris|last158=Robertson|first158=David|last159=Leung|first159=Alexander K. C.|last160=Robson|first160=William Lane M.|last161=Leung|first161=Alexander K. C.|last162=Lampinen|first162=Katja|last163=Kublickiene|first163=Karolina|last164=Kaaja|first164=Risto|last165=Lenarczyk|first165=Radosław|last166=Kowalski|first166=Oskar|last167=Kalarus|first167=Zbigniew|last168=Wichterle|first168=Dan|last169=Leung|first169=Alexander K. C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
==Physical Examination==<br />
<br />
=== Appearance===<br />
* patients with pentalogy of fallot usually appear small due to failure to thrive. <br />
* patients may be found in squatting position( compensatory mechanism)<br />
<br />
=== Vital Signs===<br />
* Tachycardia with regular pulse <br />
* Tachypnea <br />
* low grade fever in patients with concomitant infective [[endocarditis]]<br />
<br />
=== HEENT===<br />
* Retinal vessel engorgement may be present<br />
<br />
=== Heart===<br />
<br />
A thrill may be present at left sternal border.<br />
*A right ventricular impulse may be prominent.<br />
*Second heart sound (S2) is single as P2 is absent.<br />
*A harsh systolic ejection murmur best heard at the left sternal border is usually present.<br />
*P2 is faint and delayed in mild cyanosis and inaudible in severe cyanosis.<br />
*A diastolic murmur may be heard due to aortic regurgitation.<br />
<br />
=== Extremities===<br />
*Clubbing<br />
*Cyanosis is most prominent at lips and nail beds<br />
<br />
===Laboratory Findings===<br />
<br />
<br />
<br />
Some patients with pentalogy of fallot may have [[polycythemia]] <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
which is usually suggestive of worsening hypoxia and compensatory production of erythropoetin.<br />
<br />
.<br />
<br />
===Electrocardiogram===<br />
<br />
An ECG may be helpful in the diagnosis of pentalogy of fallot <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
Findings on an ECG suggestive of pentalogy of fallot include [[right axis deviation]] and right ventricular hypertrophy.<br />
[[File: Right_ventrriular_hypertophy.png|200p|thumb|right|Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874376/]]<br />
<br />
===X-ray===<br />
<br />
<br />
<br />
<br />
An x-ray may be helpful in the diagnosis of pentalogy of Fallot. Findings on an x-ray suggestive of pentalogy of fallot include boot shaped heart or coeur en sabot.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref> [[File:Boot_shaped_heart.png|200p|thumb|left| Typical preoperative chest X‐ray of a 16‐month‐old boy with tetralogy of Fallot.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5412831/]]<br />
<br />
<br />
<br />
<br />
.<br />
<br />
===Echocardiography or Ultrasound===<br />
<br />
<br />
<br />
<br />
Echocardiography may be helpful in the diagnosis of pentalogy of fallot. Findings on an echocardiography diagnostic of pentallogy of fallot include Ventricular septal defect, Atrial septal defect , Right ventricular outflow tract obstruction and overriding aorta<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref> [[File:Pentalogy_of_fallot_image_2.png|200p|thumb|left | Department of Biochemistry, University of Allahabad, Allahabad-211002, India.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3299189/]]<br />
<br />
===CT scan===<br />
<br />
<br />
Thoracic CT angiography may be helpful in the diagnosis of pentallogy of fallot. Findings on CT scan diagnostic of pentalogy of fallot include ventricular septal defect, right ventricular hypertrophy, pulmonary atresia and major aortopulmonary collateral arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref> <br />
<br />
<br />
<br />
===MRI===<br />
<br />
<br />
cardiac MRI may be helpful in the diagnosis of pentalogy of fallot. Findings on MRI diagnostic of pentalogy of fallot include RVOT stenosis, VSD, ASD,Overriding aorta, right ventricular hypertrophy and hypoplastic pulmonary arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
<br />
<br />
===Other Imaging Findings===<br />
Other imaging findings for pentalogy of fallot include Right ventricular angiopraphy, which demonstrates infundibular and pulmonary artery anatomy, and left ventricular angiography, which demonstrates VSD, ASD, and Overiding aorta <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
===Other Diagnostic Studies===<br />
<br />
There are no other diagnostic studies associated with pentalogy of Fallot<br />
<br />
==Treatment==<br />
===Medical Therapy===<br />
The mainstay of treatment for pentalogy of fallot is Surgery.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
Pharmacologic medical therapy is recommended among patients with severe RVOTO and hypercyanotic spells<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
Pharmacologic medical therapies for pentalogy of fallot include <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
* prostaglandin E1 in neonates with ductal dependent pulmonary blood flow<br />
*[[Morphine]] and [[ketamine]] for sedation<br />
*vasopressors like [[phenylephrine]]<br />
*[[Propranolol|propanolol]] to decrease the need for palliative surgical intervention.<br />
* iron treatment to decrease frequency of spells. <br />
<br />
Patients with hypercyanotic spells are treated with oxygen,volume expansion and morphine sedation.<br />
<br />
===Surgery===<br />
<br />
<br />
<br />
Surgery is the mainstay of treatment for pentalogy of fallot. interventional procedures are used to relieve pulmonary obstructions and embolize colaterals. <br />
different surgical procedures can be done to treat pentalogy of fallot and it includes <br />
* pulmonary valvotomy( for stenotic pulmonic valve)<br />
* pulmonary valvectomy( for small and thickened pulmonic valve) <br />
* closure of ASD/VSD<br />
* shunt surgery for severe cyanosis or in patients with frequent spells in the first year of life <br />
* Blalock -Taussig Shunt- communication between the right or left pulmonary artery and the right or left subclavian artery. <br />
* Waterson-Cooley Shunt- communication between the ascending aorta with the right pulmonary artery <br />
* Potts shunt-communication between the descending aorta and left pulmonary artery <br />
* Central shunt- Communication between the main pulmonary artery and ascending aorta.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
===Primary Prevention===<br />
There are no established measures for the primary prevention of pentalogy of fallot .<br />
<br />
===Secondary Prevention===<br />
There are no established measures for the secondary prevention of pentalogy of fallot<br />
===Prevention of Cyanosis===<br />
The following factors may reduce systemic vascular resistance (SVR) and exacerbate shunting which in turn exacerbate cyanosis and should be avoided if at all possible:<br />
<br />
*Acidosis<br />
*Bathing in hot water<br />
*Fever<br />
*Stress<br />
*Infection<br />
*Posture (upright, not squatting)<br />
*Exercise<br />
*[[Beta-adrenergic agonist|Beta-adrenergic agonists]]<br />
*[[Dehydration]]<br />
*Closure of the [[patent ductus arteriosus]]<br />
<br />
===Prevention of Infective Endocarditis===<br />
Antibiotic prophylaxis should be administered before respiratory and oral procedures.<br />
<br />
==References==<br />
{{reflist|2}}<br />
<br />
{{WikiDoc Help Menu}}<br />
{{WikiDoc Sources}}<br />
[[Category:Cardiology]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Abdulkareem Opeoluwalukanhttps://www.wikidoc.org/index.php?title=Pentalogy_of_Fallot&diff=1623900Pentalogy of Fallot2020-07-10T15:49:51Z<p>Abdulkareem Opeoluwalukan: /* Natural History, Complications, and Prognosis */</p>
<hr />
<div>__NOTOC__<br />
{{SI}}<br />
{{CMG}} {{AE}}[[User:Abdulkareem Opeoluwalukan|Abdulkareem Opeoluwalukan, M.D]].<br />
==Overview==<br />
Pentalogy of Fallot is defined as the occurrence of Tetralogy of Fallot plus an [[atrial septal defect]].[[File:Pentalogy_of_fallot_image_1.png |200p|thumb|center| Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa. paolo.pazzi@up.ac.za.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3984729/]]<br />
<br />
==Historical Perspective==<br />
<br />
*[[Tetrallogy of fallot|Tetralogy of fallot]] was first discovered by Niel Stenson, a Denish physician Anatomist, in 1671. <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
* The association between right ventricular outflow tract obstruction and a large [[ventricular septal defect]] and tetralogy of fallot. was made in 1888 by Etinne-Louise.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref><br />
<br />
* In 1924, Canadian, Maude Abbott was the first to discover the association between ventricular septal defect , pulmonary stenosis, overriding aorta and right ventricular hypertrophy and the development of tetralogy of Fallot.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref<br />
In 1939, the first surgical treatment was developed by Dr Helen Taussig in Johns Hopkins&amp;lt;nowiki&amp;gt;&&amp;lt;/nowiki&amp;gt;lt;nowiki&lt;nowiki&gt;&&lt;/nowiki&gt;gt;<nowiki>&</nowiki>lt;nowiki<nowiki>&</nowiki>gt;<nowiki>&lt;nowiki&gt;<ref name="pmid30020660">&lt;/nowiki&gt;</nowiki>&lt;/nowiki&gt;&lt;/nowiki&gt;{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Classification==<br />
<br />
* There is no established system for the classification of pentalogy of fallot.<br />
<br />
<br /><br />
<br />
==Pathophysiology==<br />
<br />
It is thought that conotruncal Diseases like [[Tetralogy of Fallot|tetralogy of fallot]] and pentalogy of fallot is the result of <br />
<br />
* Neural Crest migration defect. <br />
* Underdevelopment of right ventricular infundibulum.<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
<br />
==Causes==<br />
<br />
<br />
<br />
<br />
The cause of pentalogy of fallot has not been identified. To review risk factors for the development of pentalogy of fallot, click [[tetralogy of fallot causes#Overview|here]].<br />
<br />
==Differentiating pentalogy of fallot from other Diseases==<br />
pentalogy of Fallot must be differentiated from other diseases that cause .<br />
<br />
===right to left shunt=== <br />
*[[Transposition of the great vessels|transposition of great arteries]] with pulmonic stenosis<br />
* double outlet right ventricle including Taussig-Bing anomaly<br />
*[[tricuspid atresia]]<br />
* Ebstein Anomaly<br />
*[[pulmonary atresia]] with intact ventricular septum<br />
*Respiratory diseases<br />
<br />
* Bronchiolitis,<br />
*viral and bacterial [[pneumonia]]<br />
*[[pneumothorax]] because when they are in heart failure they present with signs of respiratory distress, cyanosis and failure to thrive<br />
<br />
=== Bidirectional shunt diseases===<br />
* total anomalous pulmonary venous return,<br />
*[[hypoplastic left heart syndrome]],<br />
* single ventricle <br />
*[[Persistent truncus arteriosus|truncus arteriosus]] <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Epidemiology and Demographics==<br />
The epidemiology of pentalogy of fallot has not been well studied.<br />
<br />
==Risk Factors==<br />
<br />
<br />
<br />
<br />
Common risk factors in the development of pentalogy of fallot includes<ref name="SilvaNeves2019">{{cite journal|last1=Silva|first1=Joana A.|last2=Neves|first2=Ana L.|last3=Flor-de-Lima|first3=Filipa|last4=Soares|first4=Paulo|last5=Guimarães|first5=Hercília|title=Risk Factors and Outcomes of Tetralogy of Fallot: From Fetal to Neonatal Life|journal=Pediatric Cardiology|volume=41|issue=1|year=2019|pages=155–164|issn=0172-0643|doi=10.1007/s00246-019-02239-4}}</ref><br />
<br />
* Alcoholism in mother <br />
* Maternal Diabetes <br />
* Advanced maternal age i.e greater than 40 years <br />
* Malnutrition in pregnancy <br />
* Family history of tetralogy of fallot <br />
* Viral illness during pregnancy like [[Rubella]].<br />
* presence of [[Down syndrome]] or [[22q11.2 deletion syndrome|DiGeorge syndrome]]<br />
<br />
==Screening==<br />
There is insufficient evidence to recommend routine screening for pentalogy of fallot.<br />
<br />
==Natural History, Complications, and Prognosis==<br />
If left untreated, patients with pentalogy of fallot may progress to develop finger clubbing, stunted growth, cardiac arrhythmias, hypoplastic pulmonary artery, paradoxical emboli and [[polycythemia]] .<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
<br />
Prognosis is generally excellent provided the [[Ventricular septal defect|VSD]] has been closed and the right ventricular outflow tract has been relieved.<ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. 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<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
<br />
<br />
There are no established criteria for the diagnosis of pentalogy fallot.<br />
<br />
===History and Symptoms===<br />
<br />
The hallmark of pentalogy of fallot is cyanosis. A positive history of cyanosis and easy fatigability leading to squatting during exercise is suggestive of cyanotic congenital heart defct <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
. The most common symptoms of pentalogy of fallot include cyanosis, easy fatigabillity , and hypercyanotic spells with crying , feeding and defecating<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
==Physical Examination==<br />
<br />
=== Appearance===<br />
* patients with pentalogy of fallot usually appear small due to failure to thrive. <br />
* patients may be found in squatting position( compensatory mechanism)<br />
<br />
=== Vital Signs===<br />
* Tachycardia with regular pulse <br />
* Tachypnea <br />
* low grade fever in patients with concomitant infective [[endocarditis]]<br />
<br />
=== HEENT===<br />
* Retinal vessel engorgement may be present<br />
<br />
=== Heart===<br />
<br />
A thrill may be present at left sternal border.<br />
*A right ventricular impulse may be prominent.<br />
*Second heart sound (S2) is single as P2 is absent.<br />
*A harsh systolic ejection murmur best heard at the left sternal border is usually present.<br />
*P2 is faint and delayed in mild cyanosis and inaudible in severe cyanosis.<br />
*A diastolic murmur may be heard due to aortic regurgitation.<br />
<br />
=== Extremities===<br />
*Clubbing<br />
*Cyanosis is most prominent at lips and nail beds<br />
<br />
===Laboratory Findings===<br />
<br />
<br />
<br />
Some patients with pentalogy of fallot may have [[polycythemia]] <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
which is usually suggestive of worsening hypoxia and compensatory production of erythropoetin.<br />
<br />
.<br />
<br />
===Electrocardiogram===<br />
<br />
An ECG may be helpful in the diagnosis of pentalogy of fallot <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
Findings on an ECG suggestive of pentalogy of fallot include [[right axis deviation]] and right ventricular hypertrophy.<br />
[[File: Right_ventrriular_hypertophy.png|200p|thumb|right|Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874376/]]<br />
<br />
===X-ray===<br />
<br />
<br />
<br />
<br />
An x-ray may be helpful in the diagnosis of pentalogy of Fallot. Findings on an x-ray suggestive of pentalogy of fallot include boot shaped heart or coeur en sabot.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref> [[File:Boot_shaped_heart.png|200p|thumb|left| Typical preoperative chest X‐ray of a 16‐month‐old boy with tetralogy of Fallot.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5412831/]]<br />
<br />
<br />
<br />
<br />
.<br />
<br />
===Echocardiography or Ultrasound===<br />
<br />
<br />
<br />
<br />
Echocardiography may be helpful in the diagnosis of pentalogy of fallot. Findings on an echocardiography diagnostic of pentallogy of fallot include Ventricular septal defect, Atrial septal defect , Right ventricular outflow tract obstruction and overriding aorta<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref> [[File:Pentalogy_of_fallot_image_2.png|200p|thumb|left | Department of Biochemistry, University of Allahabad, Allahabad-211002, India.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3299189/]]<br />
<br />
===CT scan===<br />
<br />
<br />
Thoracic CT angiography may be helpful in the diagnosis of pentallogy of fallot. Findings on CT scan diagnostic of pentalogy of fallot include ventricular septal defect, right ventricular hypertrophy, pulmonary atresia and major aortopulmonary collateral arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref> <br />
<br />
<br />
<br />
===MRI===<br />
<br />
<br />
cardiac MRI may be helpful in the diagnosis of pentalogy of fallot. Findings on MRI diagnostic of pentalogy of fallot include RVOT stenosis, VSD, ASD,Overriding aorta, right ventricular hypertrophy and hypoplastic pulmonary arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
<br />
<br />
===Other Imaging Findings===<br />
Other imaging findings for pentalogy of fallot include Right ventricular angiopraphy, which demonstrates infundibular and pulmonary artery anatomy, and left ventricular angiography, which demonstrates VSD, ASD, and Overiding aorta <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
===Other Diagnostic Studies===<br />
<br />
There are no other diagnostic studies associated with pentalogy of Fallot<br />
<br />
==Treatment==<br />
===Medical Therapy===<br />
The mainstay of treatment for pentalogy of fallot is Surgery.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
Pharmacologic medical therapy is recommended among patients with severe RVOTO and hypercyanotic spells<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
Pharmacologic medical therapies for pentalogy of fallot include <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
* prostaglandin E1 in neonates with ductal dependent pulmonary blood flow<br />
*[[Morphine]] and [[ketamine]] for sedation<br />
*vasopressors like [[phenylephrine]]<br />
*[[Propranolol|propanolol]] to decrease the need for palliative surgical intervention.<br />
* iron treatment to decrease frequency of spells. <br />
<br />
Patients with hypercyanotic spells are treated with oxygen,volume expansion and morphine sedation.<br />
<br />
===Surgery===<br />
<br />
<br />
<br />
Surgery is the mainstay of treatment for pentalogy of fallot. interventional procedures are used to relieve pulmonary obstructions and embolize colaterals. <br />
different surgical procedures can be done to treat pentalogy of fallot and it includes <br />
* pulmonary valvotomy( for stenotic pulmonic valve)<br />
* pulmonary valvectomy( for small and thickened pulmonic valve) <br />
* closure of ASD/VSD<br />
* shunt surgery for severe cyanosis or in patients with frequent spells in the first year of life <br />
* Blalock -Taussig Shunt- communication between the right or left pulmonary artery and the right or left subclavian artery. <br />
* Waterson-Cooley Shunt- communication between the ascending aorta with the right pulmonary artery <br />
* Potts shunt-communication between the descending aorta and left pulmonary artery <br />
* Central shunt- Communication between the main pulmonary artery and ascending aorta.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
===Primary Prevention===<br />
There are no established measures for the primary prevention of pentalogy of fallot .<br />
<br />
===Secondary Prevention===<br />
There are no established measures for the secondary prevention of pentalogy of fallot<br />
===Prevention of Cyanosis===<br />
The following factors may reduce systemic vascular resistance (SVR) and exacerbate shunting which in turn exacerbate cyanosis and should be avoided if at all possible:<br />
<br />
*Acidosis<br />
*Bathing in hot water<br />
*Fever<br />
*Stress<br />
*Infection<br />
*Posture (upright, not squatting)<br />
*Exercise<br />
*[[Beta-adrenergic agonist|Beta-adrenergic agonists]]<br />
*[[Dehydration]]<br />
*Closure of the [[patent ductus arteriosus]]<br />
<br />
===Prevention of Infective Endocarditis===<br />
Antibiotic prophylaxis should be administered before respiratory and oral procedures.<br />
<br />
==References==<br />
{{reflist|2}}<br />
<br />
{{WikiDoc Help Menu}}<br />
{{WikiDoc Sources}}<br />
[[Category:Cardiology]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Abdulkareem Opeoluwalukanhttps://www.wikidoc.org/index.php?title=Pentalogy_of_Fallot&diff=1623151Pentalogy of Fallot2020-07-08T23:32:45Z<p>Abdulkareem Opeoluwalukan: /* Natural History, Complications, and Prognosis */</p>
<hr />
<div>__NOTOC__<br />
{{SI}}<br />
{{CMG}} {{AE}}[[User:Abdulkareem Opeoluwalukan|Abdulkareem Opeoluwalukan, M.D]].<br />
==Overview==<br />
Pentalogy of Fallot is defined as the occurrence of Tetralogy of Fallot plus an [[atrial septal defect]].[[File:Pentalogy_of_fallot_image_1.png |200p|thumb|center| Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa. paolo.pazzi@up.ac.za.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3984729/]]<br />
<br />
==Historical Perspective==<br />
<br />
*[[Tetrallogy of fallot|Tetralogy of fallot]] was first discovered by Niel Stenson, a Denish physician Anatomist, in 1671. <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
* The association between right ventricular outflow tract obstruction and a large [[ventricular septal defect]] and tetralogy of fallot. was made in 1888 by Etinne-Louise.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref><br />
<br />
* In 1924, Canadian, Maude Abbott was the first to discover the association between ventricular septal defect , pulmonary stenosis, overriding aorta and right ventricular hypertrophy and the development of tetralogy of Fallot.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref<br />
In 1939, the first surgical treatment was developed by Dr Helen Taussig in Johns Hopkins&amp;lt;nowiki&amp;gt;&&amp;lt;/nowiki&amp;gt;lt;nowiki&lt;nowiki&gt;&&lt;/nowiki&gt;gt;<nowiki>&</nowiki>lt;nowiki<nowiki>&</nowiki>gt;<nowiki>&lt;nowiki&gt;<ref name="pmid30020660">&lt;/nowiki&gt;</nowiki>&lt;/nowiki&gt;&lt;/nowiki&gt;{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Classification==<br />
<br />
* There is no established system for the classification of pentalogy of fallot.<br />
<br />
<br /><br />
<br />
==Pathophysiology==<br />
<br />
It is thought that conotruncal Diseases like [[Tetralogy of Fallot|tetralogy of fallot]] and pentalogy of fallot is the result of <br />
<br />
* Neural Crest migration defect. <br />
* Underdevelopment of right ventricular infundibulum.<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
<br />
==Causes==<br />
<br />
<br />
<br />
<br />
The cause of pentalogy of fallot has not been identified. To review risk factors for the development of pentalogy of fallot, click [[tetralogy of fallot causes#Overview|here]].<br />
<br />
==Differentiating pentalogy of fallot from other Diseases==<br />
pentalogy of Fallot must be differentiated from other diseases that cause .<br />
<br />
===right to left shunt=== <br />
*[[Transposition of the great vessels|transposition of great arteries]] with pulmonic stenosis<br />
* double outlet right ventricle including Taussig-Bing anomaly<br />
*[[tricuspid atresia]]<br />
* Ebstein Anomaly<br />
*[[pulmonary atresia]] with intact ventricular septum<br />
*Respiratory diseases<br />
<br />
* Bronchiolitis,<br />
*viral and bacterial [[pneumonia]]<br />
*[[pneumothorax]] because when they are in heart failure they present with signs of respiratory distress, cyanosis and failure to thrive<br />
<br />
=== Bidirectional shunt diseases===<br />
* total anomalous pulmonary venous return,<br />
*[[hypoplastic left heart syndrome]],<br />
* single ventricle <br />
*[[Persistent truncus arteriosus|truncus arteriosus]] <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Epidemiology and Demographics==<br />
The epidemiology of pentalogy of fallot has not been well studied.<br />
<br />
==Risk Factors==<br />
<br />
<br />
<br />
<br />
Common risk factors in the development of pentalogy of fallot includes<ref name="SilvaNeves2019">{{cite journal|last1=Silva|first1=Joana A.|last2=Neves|first2=Ana L.|last3=Flor-de-Lima|first3=Filipa|last4=Soares|first4=Paulo|last5=Guimarães|first5=Hercília|title=Risk Factors and Outcomes of Tetralogy of Fallot: From Fetal to Neonatal Life|journal=Pediatric Cardiology|volume=41|issue=1|year=2019|pages=155–164|issn=0172-0643|doi=10.1007/s00246-019-02239-4}}</ref><br />
<br />
* Alcoholism in mother <br />
* Maternal Diabetes <br />
* Advanced maternal age i.e greater than 40 years <br />
* Malnutrition in pregnancy <br />
* Family history of tetralogy of fallot <br />
* Viral illness during pregnancy like [[Rubella]].<br />
* presence of [[Down syndrome]] or [[22q11.2 deletion syndrome|DiGeorge syndrome]]<br />
<br />
==Screening==<br />
There is insufficient evidence to recommend routine screening for pentalogy of fallot.<br />
<br />
==Natural History, Complications, and Prognosis==<br />
If left untreated, patients with pentalogy of fallot may progress to develop finger clubbing, stunted growth, cardiac arrhythmias, hypoplastic pulmonary artery, paradoxical emboli and [[polycythemia]] .<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
<br />
Prognosis is generally excellent provided the [[Ventricular septal defect|VSD]] has been closed and the right ventricular outflow tract has been relieved,<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
<br />
<br />
There are no established criteria for the diagnosis of pentalogy fallot.<br />
<br />
===History and Symptoms===<br />
<br />
The hallmark of pentalogy of fallot is cyanosis. A positive history of cyanosis and easy fatigability leading to squatting during exercise is suggestive of cyanotic congenital heart defct <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
. The most common symptoms of pentalogy of fallot include cyanosis, easy fatigabillity , and hypercyanotic spells with crying , feeding and defecating<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
==Physical Examination==<br />
<br />
=== Appearance===<br />
* patients with pentalogy of fallot usually appear small due to failure to thrive. <br />
* patients may be found in squatting position( compensatory mechanism)<br />
<br />
=== Vital Signs===<br />
* Tachycardia with regular pulse <br />
* Tachypnea <br />
* low grade fever in patients with concomitant infective [[endocarditis]]<br />
<br />
=== HEENT===<br />
* Retinal vessel engorgement may be present<br />
<br />
=== Heart===<br />
<br />
A thrill may be present at left sternal border.<br />
*A right ventricular impulse may be prominent.<br />
*Second heart sound (S2) is single as P2 is absent.<br />
*A harsh systolic ejection murmur best heard at the left sternal border is usually present.<br />
*P2 is faint and delayed in mild cyanosis and inaudible in severe cyanosis.<br />
*A diastolic murmur may be heard due to aortic regurgitation.<br />
<br />
=== Extremities===<br />
*Clubbing<br />
*Cyanosis is most prominent at lips and nail beds<br />
<br />
===Laboratory Findings===<br />
<br />
<br />
<br />
Some patients with pentalogy of fallot may have [[polycythemia]] <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
which is usually suggestive of worsening hypoxia and compensatory production of erythropoetin.<br />
<br />
.<br />
<br />
===Electrocardiogram===<br />
<br />
An ECG may be helpful in the diagnosis of pentalogy of fallot <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
Findings on an ECG suggestive of pentalogy of fallot include [[right axis deviation]] and right ventricular hypertrophy.<br />
[[File: Right_ventrriular_hypertophy.png|200p|thumb|right|Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874376/]]<br />
<br />
===X-ray===<br />
<br />
<br />
<br />
<br />
An x-ray may be helpful in the diagnosis of pentalogy of Fallot. Findings on an x-ray suggestive of pentalogy of fallot include boot shaped heart or coeur en sabot.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref> [[File:Boot_shaped_heart.png|200p|thumb|left| Typical preoperative chest X‐ray of a 16‐month‐old boy with tetralogy of Fallot.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5412831/]]<br />
<br />
<br />
<br />
<br />
.<br />
<br />
===Echocardiography or Ultrasound===<br />
<br />
<br />
<br />
<br />
Echocardiography may be helpful in the diagnosis of pentalogy of fallot. Findings on an echocardiography diagnostic of pentallogy of fallot include Ventricular septal defect, Atrial septal defect , Right ventricular outflow tract obstruction and overriding aorta<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref> [[File:Pentalogy_of_fallot_image_2.png|200p|thumb|left | Department of Biochemistry, University of Allahabad, Allahabad-211002, India.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3299189/]]<br />
<br />
===CT scan===<br />
<br />
<br />
Thoracic CT angiography may be helpful in the diagnosis of pentallogy of fallot. Findings on CT scan diagnostic of pentalogy of fallot include ventricular septal defect, right ventricular hypertrophy, pulmonary atresia and major aortopulmonary collateral arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref> <br />
<br />
<br />
<br />
===MRI===<br />
<br />
<br />
cardiac MRI may be helpful in the diagnosis of pentalogy of fallot. Findings on MRI diagnostic of pentalogy of fallot include RVOT stenosis, VSD, ASD,Overriding aorta, right ventricular hypertrophy and hypoplastic pulmonary arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
<br />
<br />
===Other Imaging Findings===<br />
Other imaging findings for pentalogy of fallot include Right ventricular angiopraphy, which demonstrates infundibular and pulmonary artery anatomy, and left ventricular angiography, which demonstrates VSD, ASD, and Overiding aorta <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
===Other Diagnostic Studies===<br />
<br />
There are no other diagnostic studies associated with pentalogy of Fallot<br />
<br />
==Treatment==<br />
===Medical Therapy===<br />
The mainstay of treatment for pentalogy of fallot is Surgery.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
Pharmacologic medical therapy is recommended among patients with severe RVOTO and hypercyanotic spells<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
Pharmacologic medical therapies for pentalogy of fallot include <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
* prostaglandin E1 in neonates with ductal dependent pulmonary blood flow<br />
*[[Morphine]] and [[ketamine]] for sedation<br />
*vasopressors like [[phenylephrine]]<br />
*[[Propranolol|propanolol]] to decrease the need for palliative surgical intervention.<br />
* iron treatment to decrease frequency of spells. <br />
<br />
Patients with hypercyanotic spells are treated with oxygen,volume expansion and morphine sedation.<br />
<br />
===Surgery===<br />
<br />
<br />
<br />
Surgery is the mainstay of treatment for pentalogy of fallot. interventional procedures are used to relieve pulmonary obstructions and embolize colaterals. <br />
different surgical procedures can be done to treat pentalogy of fallot and it includes <br />
* pulmonary valvotomy( for stenotic pulmonic valve)<br />
* pulmonary valvectomy( for small and thickened pulmonic valve) <br />
* closure of ASD/VSD<br />
* shunt surgery for severe cyanosis or in patients with frequent spells in the first year of life <br />
* Blalock -Taussig Shunt- communication between the right or left pulmonary artery and the right or left subclavian artery. <br />
* Waterson-Cooley Shunt- communication between the ascending aorta with the right pulmonary artery <br />
* Potts shunt-communication between the descending aorta and left pulmonary artery <br />
* Central shunt- Communication between the main pulmonary artery and ascending aorta.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
===Primary Prevention===<br />
There are no established measures for the primary prevention of pentalogy of fallot .<br />
<br />
===Secondary Prevention===<br />
There are no established measures for the secondary prevention of pentalogy of fallot<br />
===Prevention of Cyanosis===<br />
The following factors may reduce systemic vascular resistance (SVR) and exacerbate shunting which in turn exacerbate cyanosis and should be avoided if at all possible:<br />
<br />
*Acidosis<br />
*Bathing in hot water<br />
*Fever<br />
*Stress<br />
*Infection<br />
*Posture (upright, not squatting)<br />
*Exercise<br />
*[[Beta-adrenergic agonist|Beta-adrenergic agonists]]<br />
*[[Dehydration]]<br />
*Closure of the [[patent ductus arteriosus]]<br />
<br />
===Prevention of Infective Endocarditis===<br />
Antibiotic prophylaxis should be administered before respiratory and oral procedures.<br />
<br />
==References==<br />
{{reflist|2}}<br />
<br />
{{WikiDoc Help Menu}}<br />
{{WikiDoc Sources}}<br />
[[Category:Cardiology]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Abdulkareem Opeoluwalukanhttps://www.wikidoc.org/index.php?title=Pentalogy_of_Fallot&diff=1623150Pentalogy of Fallot2020-07-08T23:28:24Z<p>Abdulkareem Opeoluwalukan: /* Pathophysiology */</p>
<hr />
<div>__NOTOC__<br />
{{SI}}<br />
{{CMG}} {{AE}}[[User:Abdulkareem Opeoluwalukan|Abdulkareem Opeoluwalukan, M.D]].<br />
==Overview==<br />
Pentalogy of Fallot is defined as the occurrence of Tetralogy of Fallot plus an [[atrial septal defect]].[[File:Pentalogy_of_fallot_image_1.png |200p|thumb|center| Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa. paolo.pazzi@up.ac.za.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3984729/]]<br />
<br />
==Historical Perspective==<br />
<br />
*[[Tetrallogy of fallot|Tetralogy of fallot]] was first discovered by Niel Stenson, a Denish physician Anatomist, in 1671. <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
* The association between right ventricular outflow tract obstruction and a large [[ventricular septal defect]] and tetralogy of fallot. was made in 1888 by Etinne-Louise.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref><br />
<br />
* In 1924, Canadian, Maude Abbott was the first to discover the association between ventricular septal defect , pulmonary stenosis, overriding aorta and right ventricular hypertrophy and the development of tetralogy of Fallot.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref<br />
In 1939, the first surgical treatment was developed by Dr Helen Taussig in Johns Hopkins&amp;lt;nowiki&amp;gt;&&amp;lt;/nowiki&amp;gt;lt;nowiki&lt;nowiki&gt;&&lt;/nowiki&gt;gt;<nowiki>&</nowiki>lt;nowiki<nowiki>&</nowiki>gt;<nowiki>&lt;nowiki&gt;<ref name="pmid30020660">&lt;/nowiki&gt;</nowiki>&lt;/nowiki&gt;&lt;/nowiki&gt;{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Classification==<br />
<br />
* There is no established system for the classification of pentalogy of fallot.<br />
<br />
<br /><br />
<br />
==Pathophysiology==<br />
<br />
It is thought that conotruncal Diseases like [[Tetralogy of Fallot|tetralogy of fallot]] and pentalogy of fallot is the result of <br />
<br />
* Neural Crest migration defect. <br />
* Underdevelopment of right ventricular infundibulum.<ref name="OMJA2020">{{cite journal|last1=OM|first1=Akinlade|last2=JA|first2=Ogunmodede|last3=OA|first3=Adeyemi|last4=WO|first4=Yusuf|last5=RO|first5=Awodun|last6=YA|first6=Ayoola|last7=IA|first7=Yusuf|last8=PM|first8=Kolo|title=Adult Nigerian with Untreated Pentalogy of Fallot: A Case Report|journal=Asploro Journal of Biomedical and Clinical Case Reports|volume=3|issue=1|year=2020|pages=62–66|issn=2582-0370|doi=10.36502/2020/ASJBCCR.6187}}</ref><br />
<br />
==Causes==<br />
<br />
<br />
<br />
<br />
The cause of pentalogy of fallot has not been identified. To review risk factors for the development of pentalogy of fallot, click [[tetralogy of fallot causes#Overview|here]].<br />
<br />
==Differentiating pentalogy of fallot from other Diseases==<br />
pentalogy of Fallot must be differentiated from other diseases that cause .<br />
<br />
===right to left shunt=== <br />
*[[Transposition of the great vessels|transposition of great arteries]] with pulmonic stenosis<br />
* double outlet right ventricle including Taussig-Bing anomaly<br />
*[[tricuspid atresia]]<br />
* Ebstein Anomaly<br />
*[[pulmonary atresia]] with intact ventricular septum<br />
*Respiratory diseases<br />
<br />
* Bronchiolitis,<br />
*viral and bacterial [[pneumonia]]<br />
*[[pneumothorax]] because when they are in heart failure they present with signs of respiratory distress, cyanosis and failure to thrive<br />
<br />
=== Bidirectional shunt diseases===<br />
* total anomalous pulmonary venous return,<br />
*[[hypoplastic left heart syndrome]],<br />
* single ventricle <br />
*[[Persistent truncus arteriosus|truncus arteriosus]] <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Epidemiology and Demographics==<br />
The epidemiology of pentalogy of fallot has not been well studied.<br />
<br />
==Risk Factors==<br />
<br />
<br />
<br />
<br />
Common risk factors in the development of pentalogy of fallot includes<ref name="SilvaNeves2019">{{cite journal|last1=Silva|first1=Joana A.|last2=Neves|first2=Ana L.|last3=Flor-de-Lima|first3=Filipa|last4=Soares|first4=Paulo|last5=Guimarães|first5=Hercília|title=Risk Factors and Outcomes of Tetralogy of Fallot: From Fetal to Neonatal Life|journal=Pediatric Cardiology|volume=41|issue=1|year=2019|pages=155–164|issn=0172-0643|doi=10.1007/s00246-019-02239-4}}</ref><br />
<br />
* Alcoholism in mother <br />
* Maternal Diabetes <br />
* Advanced maternal age i.e greater than 40 years <br />
* Malnutrition in pregnancy <br />
* Family history of tetralogy of fallot <br />
* Viral illness during pregnancy like [[Rubella]].<br />
* presence of [[Down syndrome]] or [[22q11.2 deletion syndrome|DiGeorge syndrome]]<br />
<br />
==Screening==<br />
There is insufficient evidence to recommend routine screening for pentalogy of fallot.<br />
<br />
==Natural History, Complications, and Prognosis==<br />
If left untreated, patients with pentalogy of fallot may progress to develop finger clubbing, stunted growth, cardiac arrhythmias, hypoplastic pulmonary artery and [[polycythemia]] with relative [[Iron deficiency anemia|iron deficiency]].<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
Prognosis is generally excellent provided the [[Ventricular septal defect|VSD]] has been closed and the right ventricular outflow tract has been relieved,<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
<br />
<br />
There are no established criteria for the diagnosis of pentalogy fallot.<br />
<br />
===History and Symptoms===<br />
<br />
The hallmark of pentalogy of fallot is cyanosis. A positive history of cyanosis and easy fatigability leading to squatting during exercise is suggestive of cyanotic congenital heart defct <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
. The most common symptoms of pentalogy of fallot include cyanosis, easy fatigabillity , and hypercyanotic spells with crying , feeding and defecating<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
==Physical Examination==<br />
<br />
=== Appearance===<br />
* patients with pentalogy of fallot usually appear small due to failure to thrive. <br />
* patients may be found in squatting position( compensatory mechanism)<br />
<br />
=== Vital Signs===<br />
* Tachycardia with regular pulse <br />
* Tachypnea <br />
* low grade fever in patients with concomitant infective [[endocarditis]]<br />
<br />
=== HEENT===<br />
* Retinal vessel engorgement may be present<br />
<br />
=== Heart===<br />
<br />
A thrill may be present at left sternal border.<br />
*A right ventricular impulse may be prominent.<br />
*Second heart sound (S2) is single as P2 is absent.<br />
*A harsh systolic ejection murmur best heard at the left sternal border is usually present.<br />
*P2 is faint and delayed in mild cyanosis and inaudible in severe cyanosis.<br />
*A diastolic murmur may be heard due to aortic regurgitation.<br />
<br />
=== Extremities===<br />
*Clubbing<br />
*Cyanosis is most prominent at lips and nail beds<br />
<br />
===Laboratory Findings===<br />
<br />
<br />
<br />
Some patients with pentalogy of fallot may have [[polycythemia]] <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
which is usually suggestive of worsening hypoxia and compensatory production of erythropoetin.<br />
<br />
.<br />
<br />
===Electrocardiogram===<br />
<br />
An ECG may be helpful in the diagnosis of pentalogy of fallot <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
Findings on an ECG suggestive of pentalogy of fallot include [[right axis deviation]] and right ventricular hypertrophy.<br />
[[File: Right_ventrriular_hypertophy.png|200p|thumb|right|Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874376/]]<br />
<br />
===X-ray===<br />
<br />
<br />
<br />
<br />
An x-ray may be helpful in the diagnosis of pentalogy of Fallot. Findings on an x-ray suggestive of pentalogy of fallot include boot shaped heart or coeur en sabot.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref> [[File:Boot_shaped_heart.png|200p|thumb|left| Typical preoperative chest X‐ray of a 16‐month‐old boy with tetralogy of Fallot.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5412831/]]<br />
<br />
<br />
<br />
<br />
.<br />
<br />
===Echocardiography or Ultrasound===<br />
<br />
<br />
<br />
<br />
Echocardiography may be helpful in the diagnosis of pentalogy of fallot. Findings on an echocardiography diagnostic of pentallogy of fallot include Ventricular septal defect, Atrial septal defect , Right ventricular outflow tract obstruction and overriding aorta<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref> [[File:Pentalogy_of_fallot_image_2.png|200p|thumb|left | Department of Biochemistry, University of Allahabad, Allahabad-211002, India.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3299189/]]<br />
<br />
===CT scan===<br />
<br />
<br />
Thoracic CT angiography may be helpful in the diagnosis of pentallogy of fallot. Findings on CT scan diagnostic of pentalogy of fallot include ventricular septal defect, right ventricular hypertrophy, pulmonary atresia and major aortopulmonary collateral arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref> <br />
<br />
<br />
<br />
===MRI===<br />
<br />
<br />
cardiac MRI may be helpful in the diagnosis of pentalogy of fallot. Findings on MRI diagnostic of pentalogy of fallot include RVOT stenosis, VSD, ASD,Overriding aorta, right ventricular hypertrophy and hypoplastic pulmonary arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
<br />
<br />
===Other Imaging Findings===<br />
Other imaging findings for pentalogy of fallot include Right ventricular angiopraphy, which demonstrates infundibular and pulmonary artery anatomy, and left ventricular angiography, which demonstrates VSD, ASD, and Overiding aorta <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
===Other Diagnostic Studies===<br />
<br />
There are no other diagnostic studies associated with pentalogy of Fallot<br />
<br />
==Treatment==<br />
===Medical Therapy===<br />
The mainstay of treatment for pentalogy of fallot is Surgery.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
Pharmacologic medical therapy is recommended among patients with severe RVOTO and hypercyanotic spells<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
Pharmacologic medical therapies for pentalogy of fallot include <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
* prostaglandin E1 in neonates with ductal dependent pulmonary blood flow<br />
*[[Morphine]] and [[ketamine]] for sedation<br />
*vasopressors like [[phenylephrine]]<br />
*[[Propranolol|propanolol]] to decrease the need for palliative surgical intervention.<br />
* iron treatment to decrease frequency of spells. <br />
<br />
Patients with hypercyanotic spells are treated with oxygen,volume expansion and morphine sedation.<br />
<br />
===Surgery===<br />
<br />
<br />
<br />
Surgery is the mainstay of treatment for pentalogy of fallot. interventional procedures are used to relieve pulmonary obstructions and embolize colaterals. <br />
different surgical procedures can be done to treat pentalogy of fallot and it includes <br />
* pulmonary valvotomy( for stenotic pulmonic valve)<br />
* pulmonary valvectomy( for small and thickened pulmonic valve) <br />
* closure of ASD/VSD<br />
* shunt surgery for severe cyanosis or in patients with frequent spells in the first year of life <br />
* Blalock -Taussig Shunt- communication between the right or left pulmonary artery and the right or left subclavian artery. <br />
* Waterson-Cooley Shunt- communication between the ascending aorta with the right pulmonary artery <br />
* Potts shunt-communication between the descending aorta and left pulmonary artery <br />
* Central shunt- Communication between the main pulmonary artery and ascending aorta.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
===Primary Prevention===<br />
There are no established measures for the primary prevention of pentalogy of fallot .<br />
<br />
===Secondary Prevention===<br />
There are no established measures for the secondary prevention of pentalogy of fallot<br />
===Prevention of Cyanosis===<br />
The following factors may reduce systemic vascular resistance (SVR) and exacerbate shunting which in turn exacerbate cyanosis and should be avoided if at all possible:<br />
<br />
*Acidosis<br />
*Bathing in hot water<br />
*Fever<br />
*Stress<br />
*Infection<br />
*Posture (upright, not squatting)<br />
*Exercise<br />
*[[Beta-adrenergic agonist|Beta-adrenergic agonists]]<br />
*[[Dehydration]]<br />
*Closure of the [[patent ductus arteriosus]]<br />
<br />
===Prevention of Infective Endocarditis===<br />
Antibiotic prophylaxis should be administered before respiratory and oral procedures.<br />
<br />
==References==<br />
{{reflist|2}}<br />
<br />
{{WikiDoc Help Menu}}<br />
{{WikiDoc Sources}}<br />
[[Category:Cardiology]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Abdulkareem Opeoluwalukanhttps://www.wikidoc.org/index.php?title=Pentalogy_of_Fallot&diff=1622717Pentalogy of Fallot2020-07-08T13:00:40Z<p>Abdulkareem Opeoluwalukan: /* Pathophysiology */</p>
<hr />
<div>__NOTOC__<br />
{{SI}}<br />
{{CMG}} {{AE}}[[User:Abdulkareem Opeoluwalukan|Abdulkareem Opeoluwalukan, M.D]].<br />
==Overview==<br />
Pentalogy of Fallot is defined as the occurrence of Tetralogy of Fallot plus an [[atrial septal defect]].[[File:Pentalogy_of_fallot_image_1.png |200p|thumb|center| Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa. paolo.pazzi@up.ac.za.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3984729/]]<br />
<br />
==Historical Perspective==<br />
<br />
*[[Tetrallogy of fallot|Tetralogy of fallot]] was first discovered by Niel Stenson, a Denish physician Anatomist, in 1671. <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
* The association between right ventricular outflow tract obstruction and a large [[ventricular septal defect]] and tetralogy of fallot. was made in 1888 by Etinne-Louise.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref><br />
<br />
* In 1924, Canadian, Maude Abbott was the first to discover the association between ventricular septal defect , pulmonary stenosis, overriding aorta and right ventricular hypertrophy and the development of tetralogy of Fallot.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref<br />
In 1939, the first surgical treatment was developed by Dr Helen Taussig in Johns Hopkins&amp;lt;nowiki&amp;gt;&&amp;lt;/nowiki&amp;gt;lt;nowiki&lt;nowiki&gt;&&lt;/nowiki&gt;gt;<nowiki>&</nowiki>lt;nowiki<nowiki>&</nowiki>gt;<nowiki>&lt;nowiki&gt;<ref name="pmid30020660">&lt;/nowiki&gt;</nowiki>&lt;/nowiki&gt;&lt;/nowiki&gt;{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Classification==<br />
<br />
* There is no established system for the classification of pentalogy of fallot.<br />
<br />
<br /><br />
<br />
==Pathophysiology==<br />
<br />
It is thought that conotruncal Diseases like [[Tetralogy of Fallot|tetralogy of fallot]] and pentalogy of fallot is the result of <br />
<br />
* Neural Crest migration defect. <br />
* Right ventricular outflow tract obstruction.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393. .}}</ref><br />
<br />
==Causes==<br />
<br />
<br />
<br />
<br />
The cause of pentalogy of fallot has not been identified. To review risk factors for the development of pentalogy of fallot, click [[tetralogy of fallot causes#Overview|here]].<br />
<br />
==Differentiating pentalogy of fallot from other Diseases==<br />
pentalogy of Fallot must be differentiated from other diseases that cause .<br />
<br />
===right to left shunt=== <br />
*[[Transposition of the great vessels|transposition of great arteries]] with pulmonic stenosis<br />
* double outlet right ventricle including Taussig-Bing anomaly<br />
*[[tricuspid atresia]]<br />
* Ebstein Anomaly<br />
*[[pulmonary atresia]] with intact ventricular septum<br />
*Respiratory diseases<br />
<br />
* Bronchiolitis,<br />
*viral and bacterial [[pneumonia]]<br />
*[[pneumothorax]] because when they are in heart failure they present with signs of respiratory distress, cyanosis and failure to thrive<br />
<br />
=== Bidirectional shunt diseases===<br />
* total anomalous pulmonary venous return,<br />
*[[hypoplastic left heart syndrome]],<br />
* single ventricle <br />
*[[Persistent truncus arteriosus|truncus arteriosus]] <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Epidemiology and Demographics==<br />
The epidemiology of pentalogy of fallot has not been well studied.<br />
<br />
==Risk Factors==<br />
<br />
<br />
<br />
<br />
Common risk factors in the development of pentalogy of fallot includes<ref name="SilvaNeves2019">{{cite journal|last1=Silva|first1=Joana A.|last2=Neves|first2=Ana L.|last3=Flor-de-Lima|first3=Filipa|last4=Soares|first4=Paulo|last5=Guimarães|first5=Hercília|title=Risk Factors and Outcomes of Tetralogy of Fallot: From Fetal to Neonatal Life|journal=Pediatric Cardiology|volume=41|issue=1|year=2019|pages=155–164|issn=0172-0643|doi=10.1007/s00246-019-02239-4}}</ref><br />
<br />
* Alcoholism in mother <br />
* Maternal Diabetes <br />
* Advanced maternal age i.e greater than 40 years <br />
* Malnutrition in pregnancy <br />
* Family history of tetralogy of fallot <br />
* Viral illness during pregnancy like [[Rubella]].<br />
* presence of [[Down syndrome]] or [[22q11.2 deletion syndrome|DiGeorge syndrome]]<br />
<br />
==Screening==<br />
There is insufficient evidence to recommend routine screening for pentalogy of fallot.<br />
<br />
==Natural History, Complications, and Prognosis==<br />
If left untreated, patients with pentalogy of fallot may progress to develop finger clubbing, stunted growth, cardiac arrhythmias, hypoplastic pulmonary artery and [[polycythemia]] with relative [[Iron deficiency anemia|iron deficiency]].<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
Prognosis is generally excellent provided the [[Ventricular septal defect|VSD]] has been closed and the right ventricular outflow tract has been relieved,<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
<br />
<br />
There are no established criteria for the diagnosis of pentalogy fallot.<br />
<br />
===History and Symptoms===<br />
<br />
The hallmark of pentalogy of fallot is cyanosis. A positive history of cyanosis and easy fatigability leading to squatting during exercise is suggestive of cyanotic congenital heart defct <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
. The most common symptoms of pentalogy of fallot include cyanosis, easy fatigabillity , and hypercyanotic spells with crying , feeding and defecating<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
==Physical Examination==<br />
<br />
=== Appearance===<br />
* patients with pentalogy of fallot usually appear small due to failure to thrive. <br />
* patients may be found in squatting position( compensatory mechanism)<br />
<br />
=== Vital Signs===<br />
* Tachycardia with regular pulse <br />
* Tachypnea <br />
* low grade fever in patients with concomitant infective [[endocarditis]]<br />
<br />
=== HEENT===<br />
* Retinal vessel engorgement may be present<br />
<br />
=== Heart===<br />
<br />
A thrill may be present at left sternal border.<br />
*A right ventricular impulse may be prominent.<br />
*Second heart sound (S2) is single as P2 is absent.<br />
*A harsh systolic ejection murmur best heard at the left sternal border is usually present.<br />
*P2 is faint and delayed in mild cyanosis and inaudible in severe cyanosis.<br />
*A diastolic murmur may be heard due to aortic regurgitation.<br />
<br />
=== Extremities===<br />
*Clubbing<br />
*Cyanosis is most prominent at lips and nail beds<br />
<br />
===Laboratory Findings===<br />
<br />
<br />
<br />
Some patients with pentalogy of fallot may have [[polycythemia]] <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
which is usually suggestive of worsening hypoxia and compensatory production of erythropoetin.<br />
<br />
.<br />
<br />
===Electrocardiogram===<br />
<br />
An ECG may be helpful in the diagnosis of pentalogy of fallot <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
Findings on an ECG suggestive of pentalogy of fallot include [[right axis deviation]] and right ventricular hypertrophy.<br />
[[File: Right_ventrriular_hypertophy.png|200p|thumb|right|Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874376/]]<br />
<br />
===X-ray===<br />
<br />
<br />
<br />
<br />
An x-ray may be helpful in the diagnosis of pentalogy of Fallot. Findings on an x-ray suggestive of pentalogy of fallot include boot shaped heart or coeur en sabot.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref> [[File:Boot_shaped_heart.png|200p|thumb|left| Typical preoperative chest X‐ray of a 16‐month‐old boy with tetralogy of Fallot.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5412831/]]<br />
<br />
<br />
<br />
<br />
.<br />
<br />
===Echocardiography or Ultrasound===<br />
<br />
<br />
<br />
<br />
Echocardiography may be helpful in the diagnosis of pentalogy of fallot. Findings on an echocardiography diagnostic of pentallogy of fallot include Ventricular septal defect, Atrial septal defect , Right ventricular outflow tract obstruction and overriding aorta<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref> [[File:Pentalogy_of_fallot_image_2.png|200p|thumb|left | Department of Biochemistry, University of Allahabad, Allahabad-211002, India.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3299189/]]<br />
<br />
===CT scan===<br />
<br />
<br />
Thoracic CT angiography may be helpful in the diagnosis of pentallogy of fallot. Findings on CT scan diagnostic of pentalogy of fallot include ventricular septal defect, right ventricular hypertrophy, pulmonary atresia and major aortopulmonary collateral arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref> <br />
<br />
<br />
<br />
===MRI===<br />
<br />
<br />
cardiac MRI may be helpful in the diagnosis of pentalogy of fallot. Findings on MRI diagnostic of pentalogy of fallot include RVOT stenosis, VSD, ASD,Overriding aorta, right ventricular hypertrophy and hypoplastic pulmonary arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
<br />
<br />
===Other Imaging Findings===<br />
Other imaging findings for pentalogy of fallot include Right ventricular angiopraphy, which demonstrates infundibular and pulmonary artery anatomy, and left ventricular angiography, which demonstrates VSD, ASD, and Overiding aorta <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
===Other Diagnostic Studies===<br />
<br />
There are no other diagnostic studies associated with pentalogy of Fallot<br />
<br />
==Treatment==<br />
===Medical Therapy===<br />
The mainstay of treatment for pentalogy of fallot is Surgery.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
Pharmacologic medical therapy is recommended among patients with severe RVOTO and hypercyanotic spells<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
Pharmacologic medical therapies for pentalogy of fallot include <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
* prostaglandin E1 in neonates with ductal dependent pulmonary blood flow<br />
*[[Morphine]] and [[ketamine]] for sedation<br />
*vasopressors like [[phenylephrine]]<br />
*[[Propranolol|propanolol]] to decrease the need for palliative surgical intervention.<br />
* iron treatment to decrease frequency of spells. <br />
<br />
Patients with hypercyanotic spells are treated with oxygen,volume expansion and morphine sedation.<br />
<br />
===Surgery===<br />
<br />
<br />
<br />
Surgery is the mainstay of treatment for pentalogy of fallot. interventional procedures are used to relieve pulmonary obstructions and embolize colaterals. <br />
different surgical procedures can be done to treat pentalogy of fallot and it includes <br />
* pulmonary valvotomy( for stenotic pulmonic valve)<br />
* pulmonary valvectomy( for small and thickened pulmonic valve) <br />
* closure of ASD/VSD<br />
* shunt surgery for severe cyanosis or in patients with frequent spells in the first year of life <br />
* Blalock -Taussig Shunt- communication between the right or left pulmonary artery and the right or left subclavian artery. <br />
* Waterson-Cooley Shunt- communication between the ascending aorta with the right pulmonary artery <br />
* Potts shunt-communication between the descending aorta and left pulmonary artery <br />
* Central shunt- Communication between the main pulmonary artery and ascending aorta.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
===Primary Prevention===<br />
There are no established measures for the primary prevention of pentalogy of fallot .<br />
<br />
===Secondary Prevention===<br />
There are no established measures for the secondary prevention of pentalogy of fallot<br />
===Prevention of Cyanosis===<br />
The following factors may reduce systemic vascular resistance (SVR) and exacerbate shunting which in turn exacerbate cyanosis and should be avoided if at all possible:<br />
<br />
*Acidosis<br />
*Bathing in hot water<br />
*Fever<br />
*Stress<br />
*Infection<br />
*Posture (upright, not squatting)<br />
*Exercise<br />
*[[Beta-adrenergic agonist|Beta-adrenergic agonists]]<br />
*[[Dehydration]]<br />
*Closure of the [[patent ductus arteriosus]]<br />
<br />
===Prevention of Infective Endocarditis===<br />
Antibiotic prophylaxis should be administered before respiratory and oral procedures.<br />
<br />
==References==<br />
{{reflist|2}}<br />
<br />
{{WikiDoc Help Menu}}<br />
{{WikiDoc Sources}}<br />
[[Category:Cardiology]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Abdulkareem Opeoluwalukanhttps://www.wikidoc.org/index.php?title=Pentalogy_of_Fallot&diff=1622716Pentalogy of Fallot2020-07-08T12:58:17Z<p>Abdulkareem Opeoluwalukan: /* Pathophysiology */</p>
<hr />
<div>__NOTOC__<br />
{{SI}}<br />
{{CMG}} {{AE}}[[User:Abdulkareem Opeoluwalukan|Abdulkareem Opeoluwalukan, M.D]].<br />
==Overview==<br />
Pentalogy of Fallot is defined as the occurrence of Tetralogy of Fallot plus an [[atrial septal defect]].[[File:Pentalogy_of_fallot_image_1.png |200p|thumb|center| Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa. paolo.pazzi@up.ac.za.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3984729/]]<br />
<br />
==Historical Perspective==<br />
<br />
*[[Tetrallogy of fallot|Tetralogy of fallot]] was first discovered by Niel Stenson, a Denish physician Anatomist, in 1671. <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
* The association between right ventricular outflow tract obstruction and a large [[ventricular septal defect]] and tetralogy of fallot. was made in 1888 by Etinne-Louise.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref><br />
<br />
* In 1924, Canadian, Maude Abbott was the first to discover the association between ventricular septal defect , pulmonary stenosis, overriding aorta and right ventricular hypertrophy and the development of tetralogy of Fallot.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref<br />
In 1939, the first surgical treatment was developed by Dr Helen Taussig in Johns Hopkins&amp;lt;nowiki&amp;gt;&&amp;lt;/nowiki&amp;gt;lt;nowiki&lt;nowiki&gt;&&lt;/nowiki&gt;gt;<nowiki>&</nowiki>lt;nowiki<nowiki>&</nowiki>gt;<nowiki>&lt;nowiki&gt;<ref name="pmid30020660">&lt;/nowiki&gt;</nowiki>&lt;/nowiki&gt;&lt;/nowiki&gt;{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Classification==<br />
<br />
* There is no established system for the classification of pentalogy of fallot.<br />
<br />
<br /><br />
<br />
==Pathophysiology==<br />
<br />
It is thought that conotruncal Diseases like [[Tetralogy of Fallot|tetralogy of fallot]] and pentalogy of fallot is the result of <br />
<br />
* Neural Crest migration defect. <br />
* Right ventricular outflow tract obstruction.<br /><br />
<br />
==Causes==<br />
<br />
<br />
<br />
<br />
The cause of pentalogy of fallot has not been identified. To review risk factors for the development of pentalogy of fallot, click [[tetralogy of fallot causes#Overview|here]].<br />
<br />
==Differentiating pentalogy of fallot from other Diseases==<br />
pentalogy of Fallot must be differentiated from other diseases that cause .<br />
<br />
===right to left shunt=== <br />
*[[Transposition of the great vessels|transposition of great arteries]] with pulmonic stenosis<br />
* double outlet right ventricle including Taussig-Bing anomaly<br />
*[[tricuspid atresia]]<br />
* Ebstein Anomaly<br />
*[[pulmonary atresia]] with intact ventricular septum<br />
*Respiratory diseases<br />
<br />
* Bronchiolitis,<br />
*viral and bacterial [[pneumonia]]<br />
*[[pneumothorax]] because when they are in heart failure they present with signs of respiratory distress, cyanosis and failure to thrive<br />
<br />
=== Bidirectional shunt diseases===<br />
* total anomalous pulmonary venous return,<br />
*[[hypoplastic left heart syndrome]],<br />
* single ventricle <br />
*[[Persistent truncus arteriosus|truncus arteriosus]] <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Epidemiology and Demographics==<br />
The epidemiology of pentalogy of fallot has not been well studied.<br />
<br />
==Risk Factors==<br />
<br />
<br />
<br />
<br />
Common risk factors in the development of pentalogy of fallot includes<ref name="SilvaNeves2019">{{cite journal|last1=Silva|first1=Joana A.|last2=Neves|first2=Ana L.|last3=Flor-de-Lima|first3=Filipa|last4=Soares|first4=Paulo|last5=Guimarães|first5=Hercília|title=Risk Factors and Outcomes of Tetralogy of Fallot: From Fetal to Neonatal Life|journal=Pediatric Cardiology|volume=41|issue=1|year=2019|pages=155–164|issn=0172-0643|doi=10.1007/s00246-019-02239-4}}</ref><br />
<br />
* Alcoholism in mother <br />
* Maternal Diabetes <br />
* Advanced maternal age i.e greater than 40 years <br />
* Malnutrition in pregnancy <br />
* Family history of tetralogy of fallot <br />
* Viral illness during pregnancy like [[Rubella]].<br />
* presence of [[Down syndrome]] or [[22q11.2 deletion syndrome|DiGeorge syndrome]]<br />
<br />
==Screening==<br />
There is insufficient evidence to recommend routine screening for pentalogy of fallot.<br />
<br />
==Natural History, Complications, and Prognosis==<br />
If left untreated, patients with pentalogy of fallot may progress to develop finger clubbing, stunted growth, cardiac arrhythmias, hypoplastic pulmonary artery and [[polycythemia]] with relative [[Iron deficiency anemia|iron deficiency]].<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
Prognosis is generally excellent provided the [[Ventricular septal defect|VSD]] has been closed and the right ventricular outflow tract has been relieved,<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
<br />
<br />
There are no established criteria for the diagnosis of pentalogy fallot.<br />
<br />
===History and Symptoms===<br />
<br />
The hallmark of pentalogy of fallot is cyanosis. A positive history of cyanosis and easy fatigability leading to squatting during exercise is suggestive of cyanotic congenital heart defct <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
. The most common symptoms of pentalogy of fallot include cyanosis, easy fatigabillity , and hypercyanotic spells with crying , feeding and defecating<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
==Physical Examination==<br />
<br />
=== Appearance===<br />
* patients with pentalogy of fallot usually appear small due to failure to thrive. <br />
* patients may be found in squatting position( compensatory mechanism)<br />
<br />
=== Vital Signs===<br />
* Tachycardia with regular pulse <br />
* Tachypnea <br />
* low grade fever in patients with concomitant infective [[endocarditis]]<br />
<br />
=== HEENT===<br />
* Retinal vessel engorgement may be present<br />
<br />
=== Heart===<br />
<br />
A thrill may be present at left sternal border.<br />
*A right ventricular impulse may be prominent.<br />
*Second heart sound (S2) is single as P2 is absent.<br />
*A harsh systolic ejection murmur best heard at the left sternal border is usually present.<br />
*P2 is faint and delayed in mild cyanosis and inaudible in severe cyanosis.<br />
*A diastolic murmur may be heard due to aortic regurgitation.<br />
<br />
=== Extremities===<br />
*Clubbing<br />
*Cyanosis is most prominent at lips and nail beds<br />
<br />
===Laboratory Findings===<br />
<br />
<br />
<br />
Some patients with pentalogy of fallot may have [[polycythemia]] <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
which is usually suggestive of worsening hypoxia and compensatory production of erythropoetin.<br />
<br />
.<br />
<br />
===Electrocardiogram===<br />
<br />
An ECG may be helpful in the diagnosis of pentalogy of fallot <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
Findings on an ECG suggestive of pentalogy of fallot include [[right axis deviation]] and right ventricular hypertrophy.<br />
[[File: Right_ventrriular_hypertophy.png|200p|thumb|right|Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874376/]]<br />
<br />
===X-ray===<br />
<br />
<br />
<br />
<br />
An x-ray may be helpful in the diagnosis of pentalogy of Fallot. Findings on an x-ray suggestive of pentalogy of fallot include boot shaped heart or coeur en sabot.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref> [[File:Boot_shaped_heart.png|200p|thumb|left| Typical preoperative chest X‐ray of a 16‐month‐old boy with tetralogy of Fallot.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5412831/]]<br />
<br />
<br />
<br />
<br />
.<br />
<br />
===Echocardiography or Ultrasound===<br />
<br />
<br />
<br />
<br />
Echocardiography may be helpful in the diagnosis of pentalogy of fallot. Findings on an echocardiography diagnostic of pentallogy of fallot include Ventricular septal defect, Atrial septal defect , Right ventricular outflow tract obstruction and overriding aorta<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref> [[File:Pentalogy_of_fallot_image_2.png|200p|thumb|left | Department of Biochemistry, University of Allahabad, Allahabad-211002, India.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3299189/]]<br />
<br />
===CT scan===<br />
<br />
<br />
Thoracic CT angiography may be helpful in the diagnosis of pentallogy of fallot. Findings on CT scan diagnostic of pentalogy of fallot include ventricular septal defect, right ventricular hypertrophy, pulmonary atresia and major aortopulmonary collateral arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref> <br />
<br />
<br />
<br />
===MRI===<br />
<br />
<br />
cardiac MRI may be helpful in the diagnosis of pentalogy of fallot. Findings on MRI diagnostic of pentalogy of fallot include RVOT stenosis, VSD, ASD,Overriding aorta, right ventricular hypertrophy and hypoplastic pulmonary arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
<br />
<br />
===Other Imaging Findings===<br />
Other imaging findings for pentalogy of fallot include Right ventricular angiopraphy, which demonstrates infundibular and pulmonary artery anatomy, and left ventricular angiography, which demonstrates VSD, ASD, and Overiding aorta <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
===Other Diagnostic Studies===<br />
<br />
There are no other diagnostic studies associated with pentalogy of Fallot<br />
<br />
==Treatment==<br />
===Medical Therapy===<br />
The mainstay of treatment for pentalogy of fallot is Surgery.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
Pharmacologic medical therapy is recommended among patients with severe RVOTO and hypercyanotic spells<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
Pharmacologic medical therapies for pentalogy of fallot include <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
* prostaglandin E1 in neonates with ductal dependent pulmonary blood flow<br />
*[[Morphine]] and [[ketamine]] for sedation<br />
*vasopressors like [[phenylephrine]]<br />
*[[Propranolol|propanolol]] to decrease the need for palliative surgical intervention.<br />
* iron treatment to decrease frequency of spells. <br />
<br />
Patients with hypercyanotic spells are treated with oxygen,volume expansion and morphine sedation.<br />
<br />
===Surgery===<br />
<br />
<br />
<br />
Surgery is the mainstay of treatment for pentalogy of fallot. interventional procedures are used to relieve pulmonary obstructions and embolize colaterals. <br />
different surgical procedures can be done to treat pentalogy of fallot and it includes <br />
* pulmonary valvotomy( for stenotic pulmonic valve)<br />
* pulmonary valvectomy( for small and thickened pulmonic valve) <br />
* closure of ASD/VSD<br />
* shunt surgery for severe cyanosis or in patients with frequent spells in the first year of life <br />
* Blalock -Taussig Shunt- communication between the right or left pulmonary artery and the right or left subclavian artery. <br />
* Waterson-Cooley Shunt- communication between the ascending aorta with the right pulmonary artery <br />
* Potts shunt-communication between the descending aorta and left pulmonary artery <br />
* Central shunt- Communication between the main pulmonary artery and ascending aorta.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
===Primary Prevention===<br />
There are no established measures for the primary prevention of pentalogy of fallot .<br />
<br />
===Secondary Prevention===<br />
There are no established measures for the secondary prevention of pentalogy of fallot<br />
===Prevention of Cyanosis===<br />
The following factors may reduce systemic vascular resistance (SVR) and exacerbate shunting which in turn exacerbate cyanosis and should be avoided if at all possible:<br />
<br />
*Acidosis<br />
*Bathing in hot water<br />
*Fever<br />
*Stress<br />
*Infection<br />
*Posture (upright, not squatting)<br />
*Exercise<br />
*[[Beta-adrenergic agonist|Beta-adrenergic agonists]]<br />
*[[Dehydration]]<br />
*Closure of the [[patent ductus arteriosus]]<br />
<br />
===Prevention of Infective Endocarditis===<br />
Antibiotic prophylaxis should be administered before respiratory and oral procedures.<br />
<br />
==References==<br />
{{reflist|2}}<br />
<br />
{{WikiDoc Help Menu}}<br />
{{WikiDoc Sources}}<br />
[[Category:Cardiology]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Abdulkareem Opeoluwalukanhttps://www.wikidoc.org/index.php?title=Pentalogy_of_Fallot&diff=1622714Pentalogy of Fallot2020-07-08T12:57:13Z<p>Abdulkareem Opeoluwalukan: /* Historical Perspective */</p>
<hr />
<div>__NOTOC__<br />
{{SI}}<br />
{{CMG}} {{AE}}[[User:Abdulkareem Opeoluwalukan|Abdulkareem Opeoluwalukan, M.D]].<br />
==Overview==<br />
Pentalogy of Fallot is defined as the occurrence of Tetralogy of Fallot plus an [[atrial septal defect]].[[File:Pentalogy_of_fallot_image_1.png |200p|thumb|center| Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa. paolo.pazzi@up.ac.za.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3984729/]]<br />
<br />
==Historical Perspective==<br />
<br />
*[[Tetrallogy of fallot|Tetralogy of fallot]] was first discovered by Niel Stenson, a Denish physician Anatomist, in 1671. <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
* The association between right ventricular outflow tract obstruction and a large [[ventricular septal defect]] and tetralogy of fallot. was made in 1888 by Etinne-Louise.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref><br />
<br />
* In 1924, Canadian, Maude Abbott was the first to discover the association between ventricular septal defect , pulmonary stenosis, overriding aorta and right ventricular hypertrophy and the development of tetralogy of Fallot.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref<br />
In 1939, the first surgical treatment was developed by Dr Helen Taussig in Johns Hopkins&amp;lt;nowiki&amp;gt;&&amp;lt;/nowiki&amp;gt;lt;nowiki&lt;nowiki&gt;&&lt;/nowiki&gt;gt;<nowiki>&</nowiki>lt;nowiki<nowiki>&</nowiki>gt;<nowiki>&lt;nowiki&gt;<ref name="pmid30020660">&lt;/nowiki&gt;</nowiki>&lt;/nowiki&gt;&lt;/nowiki&gt;{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Classification==<br />
<br />
* There is no established system for the classification of pentalogy of fallot.<br />
<br />
<br /><br />
<br />
==Pathophysiology==<br />
<br />
It is thought that conotruncal like [[Tetralogy of Fallot|tetralogy of fallot]] and pentalogy of fallot is the result of <br />
<br />
* Neural Crest migration defect. <br />
* Right ventricular outflow tract obstruction.<br /><br />
<br />
<br />
==Causes==<br />
<br />
<br />
<br />
<br />
The cause of pentalogy of fallot has not been identified. To review risk factors for the development of pentalogy of fallot, click [[tetralogy of fallot causes#Overview|here]].<br />
<br />
==Differentiating pentalogy of fallot from other Diseases==<br />
pentalogy of Fallot must be differentiated from other diseases that cause .<br />
<br />
===right to left shunt=== <br />
*[[Transposition of the great vessels|transposition of great arteries]] with pulmonic stenosis<br />
* double outlet right ventricle including Taussig-Bing anomaly<br />
*[[tricuspid atresia]]<br />
* Ebstein Anomaly<br />
*[[pulmonary atresia]] with intact ventricular septum<br />
*Respiratory diseases<br />
<br />
* Bronchiolitis,<br />
*viral and bacterial [[pneumonia]]<br />
*[[pneumothorax]] because when they are in heart failure they present with signs of respiratory distress, cyanosis and failure to thrive<br />
<br />
=== Bidirectional shunt diseases===<br />
* total anomalous pulmonary venous return,<br />
*[[hypoplastic left heart syndrome]],<br />
* single ventricle <br />
*[[Persistent truncus arteriosus|truncus arteriosus]] <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Epidemiology and Demographics==<br />
The epidemiology of pentalogy of fallot has not been well studied.<br />
<br />
==Risk Factors==<br />
<br />
<br />
<br />
<br />
Common risk factors in the development of pentalogy of fallot includes<ref name="SilvaNeves2019">{{cite journal|last1=Silva|first1=Joana A.|last2=Neves|first2=Ana L.|last3=Flor-de-Lima|first3=Filipa|last4=Soares|first4=Paulo|last5=Guimarães|first5=Hercília|title=Risk Factors and Outcomes of Tetralogy of Fallot: From Fetal to Neonatal Life|journal=Pediatric Cardiology|volume=41|issue=1|year=2019|pages=155–164|issn=0172-0643|doi=10.1007/s00246-019-02239-4}}</ref><br />
<br />
* Alcoholism in mother <br />
* Maternal Diabetes <br />
* Advanced maternal age i.e greater than 40 years <br />
* Malnutrition in pregnancy <br />
* Family history of tetralogy of fallot <br />
* Viral illness during pregnancy like [[Rubella]].<br />
* presence of [[Down syndrome]] or [[22q11.2 deletion syndrome|DiGeorge syndrome]]<br />
<br />
==Screening==<br />
There is insufficient evidence to recommend routine screening for pentalogy of fallot.<br />
<br />
==Natural History, Complications, and Prognosis==<br />
If left untreated, patients with pentalogy of fallot may progress to develop finger clubbing, stunted growth, cardiac arrhythmias, hypoplastic pulmonary artery and [[polycythemia]] with relative [[Iron deficiency anemia|iron deficiency]].<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
Prognosis is generally excellent provided the [[Ventricular septal defect|VSD]] has been closed and the right ventricular outflow tract has been relieved,<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
<br />
<br />
There are no established criteria for the diagnosis of pentalogy fallot.<br />
<br />
===History and Symptoms===<br />
<br />
The hallmark of pentalogy of fallot is cyanosis. A positive history of cyanosis and easy fatigability leading to squatting during exercise is suggestive of cyanotic congenital heart defct <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
. The most common symptoms of pentalogy of fallot include cyanosis, easy fatigabillity , and hypercyanotic spells with crying , feeding and defecating<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
==Physical Examination==<br />
<br />
=== Appearance===<br />
* patients with pentalogy of fallot usually appear small due to failure to thrive. <br />
* patients may be found in squatting position( compensatory mechanism)<br />
<br />
=== Vital Signs===<br />
* Tachycardia with regular pulse <br />
* Tachypnea <br />
* low grade fever in patients with concomitant infective [[endocarditis]]<br />
<br />
=== HEENT===<br />
* Retinal vessel engorgement may be present<br />
<br />
=== Heart===<br />
<br />
A thrill may be present at left sternal border.<br />
*A right ventricular impulse may be prominent.<br />
*Second heart sound (S2) is single as P2 is absent.<br />
*A harsh systolic ejection murmur best heard at the left sternal border is usually present.<br />
*P2 is faint and delayed in mild cyanosis and inaudible in severe cyanosis.<br />
*A diastolic murmur may be heard due to aortic regurgitation.<br />
<br />
=== Extremities===<br />
*Clubbing<br />
*Cyanosis is most prominent at lips and nail beds<br />
<br />
===Laboratory Findings===<br />
<br />
<br />
<br />
Some patients with pentalogy of fallot may have [[polycythemia]] <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
which is usually suggestive of worsening hypoxia and compensatory production of erythropoetin.<br />
<br />
.<br />
<br />
===Electrocardiogram===<br />
<br />
An ECG may be helpful in the diagnosis of pentalogy of fallot <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
Findings on an ECG suggestive of pentalogy of fallot include [[right axis deviation]] and right ventricular hypertrophy.<br />
[[File: Right_ventrriular_hypertophy.png|200p|thumb|right|Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874376/]]<br />
<br />
===X-ray===<br />
<br />
<br />
<br />
<br />
An x-ray may be helpful in the diagnosis of pentalogy of Fallot. Findings on an x-ray suggestive of pentalogy of fallot include boot shaped heart or coeur en sabot.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref> [[File:Boot_shaped_heart.png|200p|thumb|left| Typical preoperative chest X‐ray of a 16‐month‐old boy with tetralogy of Fallot.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5412831/]]<br />
<br />
<br />
<br />
<br />
.<br />
<br />
===Echocardiography or Ultrasound===<br />
<br />
<br />
<br />
<br />
Echocardiography may be helpful in the diagnosis of pentalogy of fallot. Findings on an echocardiography diagnostic of pentallogy of fallot include Ventricular septal defect, Atrial septal defect , Right ventricular outflow tract obstruction and overriding aorta<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref> [[File:Pentalogy_of_fallot_image_2.png|200p|thumb|left | Department of Biochemistry, University of Allahabad, Allahabad-211002, India.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3299189/]]<br />
<br />
===CT scan===<br />
<br />
<br />
Thoracic CT angiography may be helpful in the diagnosis of pentallogy of fallot. Findings on CT scan diagnostic of pentalogy of fallot include ventricular septal defect, right ventricular hypertrophy, pulmonary atresia and major aortopulmonary collateral arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref> <br />
<br />
<br />
<br />
===MRI===<br />
<br />
<br />
cardiac MRI may be helpful in the diagnosis of pentalogy of fallot. Findings on MRI diagnostic of pentalogy of fallot include RVOT stenosis, VSD, ASD,Overriding aorta, right ventricular hypertrophy and hypoplastic pulmonary arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
<br />
<br />
===Other Imaging Findings===<br />
Other imaging findings for pentalogy of fallot include Right ventricular angiopraphy, which demonstrates infundibular and pulmonary artery anatomy, and left ventricular angiography, which demonstrates VSD, ASD, and Overiding aorta <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
===Other Diagnostic Studies===<br />
<br />
There are no other diagnostic studies associated with pentalogy of Fallot<br />
<br />
==Treatment==<br />
===Medical Therapy===<br />
The mainstay of treatment for pentalogy of fallot is Surgery.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
Pharmacologic medical therapy is recommended among patients with severe RVOTO and hypercyanotic spells<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
Pharmacologic medical therapies for pentalogy of fallot include <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
* prostaglandin E1 in neonates with ductal dependent pulmonary blood flow<br />
*[[Morphine]] and [[ketamine]] for sedation<br />
*vasopressors like [[phenylephrine]]<br />
*[[Propranolol|propanolol]] to decrease the need for palliative surgical intervention.<br />
* iron treatment to decrease frequency of spells. <br />
<br />
Patients with hypercyanotic spells are treated with oxygen,volume expansion and morphine sedation.<br />
<br />
===Surgery===<br />
<br />
<br />
<br />
Surgery is the mainstay of treatment for pentalogy of fallot. interventional procedures are used to relieve pulmonary obstructions and embolize colaterals. <br />
different surgical procedures can be done to treat pentalogy of fallot and it includes <br />
* pulmonary valvotomy( for stenotic pulmonic valve)<br />
* pulmonary valvectomy( for small and thickened pulmonic valve) <br />
* closure of ASD/VSD<br />
* shunt surgery for severe cyanosis or in patients with frequent spells in the first year of life <br />
* Blalock -Taussig Shunt- communication between the right or left pulmonary artery and the right or left subclavian artery. <br />
* Waterson-Cooley Shunt- communication between the ascending aorta with the right pulmonary artery <br />
* Potts shunt-communication between the descending aorta and left pulmonary artery <br />
* Central shunt- Communication between the main pulmonary artery and ascending aorta.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
===Primary Prevention===<br />
There are no established measures for the primary prevention of pentalogy of fallot .<br />
<br />
===Secondary Prevention===<br />
There are no established measures for the secondary prevention of pentalogy of fallot<br />
===Prevention of Cyanosis===<br />
The following factors may reduce systemic vascular resistance (SVR) and exacerbate shunting which in turn exacerbate cyanosis and should be avoided if at all possible:<br />
<br />
*Acidosis<br />
*Bathing in hot water<br />
*Fever<br />
*Stress<br />
*Infection<br />
*Posture (upright, not squatting)<br />
*Exercise<br />
*[[Beta-adrenergic agonist|Beta-adrenergic agonists]]<br />
*[[Dehydration]]<br />
*Closure of the [[patent ductus arteriosus]]<br />
<br />
===Prevention of Infective Endocarditis===<br />
Antibiotic prophylaxis should be administered before respiratory and oral procedures.<br />
<br />
==References==<br />
{{reflist|2}}<br />
<br />
{{WikiDoc Help Menu}}<br />
{{WikiDoc Sources}}<br />
[[Category:Cardiology]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Abdulkareem Opeoluwalukanhttps://www.wikidoc.org/index.php?title=Pentalogy_of_Fallot&diff=1619843Pentalogy of Fallot2020-06-30T16:55:42Z<p>Abdulkareem Opeoluwalukan: /* Echocardiography or Ultrasound */</p>
<hr />
<div>__NOTOC__<br />
{{SI}}<br />
{{CMG}} {{AE}}[[User:Abdulkareem Opeoluwalukan|Abdulkareem Opeoluwalukan, M.D]].<br />
==Overview==<br />
Pentalogy of Fallot is defined as the occurrence of Tetralogy of Fallot plus an [[atrial septal defect]].[[File:Pentalogy_of_fallot_image_1.png |200p|thumb|center| Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa. paolo.pazzi@up.ac.za.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3984729/]]<br />
<br />
==Historical Perspective==<br />
tetrallogy of fallot was first discovered by Niel Stenson, a Denish physician Anatomist, in 1671<ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref>.<br />
<br />
The association between Rigt ventriular outflow tract obstruction and a large ventricular septal defect and tetrallogy of fallot. was made in 1888 by Etinne-Louise]<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref>.<br />
<br />
In 1924, Canadian, Maude Abbott was the first to discover the association between ventricular septal defect , pulmonary stenosis, overriding aorta and right ventricular hypertrophy and the development of tetrallogy of Fallot.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref<br />
In 1939, the first surgical treatment was developed by Dr Helen Taussig in Johns Hopkins&lt;nowiki&gt;&lt;nowiki&gt;<nowiki><ref name="pmid30020660"></nowiki>&lt;/nowiki&gt;&lt;/nowiki&gt;{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Classification==<br />
There is no established system for the classification of [pentallogy of fallot ].<br />
<br />
<br /><br />
<br />
==Pathophysiology==<br />
<br />
<br />
<br />
<br />
It is thought that tetrallogy of fallot is the result of anterocephalad deviation of the aortico pulmonary septum<ref name="pmid25870631">{{cite journal |vauthors=Beig JR, Ahmed W, Hafeez I, Gupta A, Tramboo NA, Rather HA |title=Pentalogy of fallot with a single coronary artery: a rare case report |journal=J Tehran Heart Cent |volume=9 |issue=3 |pages=132–4 |date=2014 |pmid=25870631 |pmc=4393836 |doi= |url=}}</ref> thus leading to <br />
* ventricular septal defect<br />
* right ventricular outflow tract obstruction <br />
*overriding aorta <br />
* right ventricular hypertrophy with an additional ASD( atrial septal defect) with ostium secundum type being the most common followed by ostium primum <ref name="pmid25870631">{{cite journal |vauthors=Beig JR, Ahmed W, Hafeez I, Gupta A, Tramboo NA, Rather HA |title=Pentalogy of fallot with a single coronary artery: a rare case report |journal=J Tehran Heart Cent |volume=9 |issue=3 |pages=132–4 |date=2014 |pmid=25870631 |pmc=4393836 |doi= |url=}}</ref>. thus making it a pentallogy of fallot. even though there are no reports on the molecular pathophysiology of pentallogy of fallot, conotruncal heart defects like tetrallogy of fallot are associated with neural crest migration defect. systemic pathophysiology of tetrallogy of fallot depends on the extent of right ventricular outflow tract obstruction. severe pulmonic stenosis leads to a significant decrease in pulmonary circulation and worsening right to left shunt leading to cyanosis. A collateral PDA makes Tetralogy of fallot compatible with life as it preserves pulmonic circulation <ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. 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C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. 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<br />
==Causes==<br />
<br />
<br />
<br />
<br />
The cause of pentalogy of fallot has not been identified. To review risk factors for the development of pentalogy of fallot, click [[tetralogy of fallot causes#Overview|here]].<br />
<br />
==Differentiating pentalogy of fallot from other Diseases==<br />
pentalogy of Fallot must be differentiated from other diseases that cause .<br />
<br />
===right to left shunt=== <br />
* transposition of great arteries with pulmonic stenosis,<br />
* double outlet right ventricle including Taussig-Bing anomaly, <br />
*tricuspid atresia,<br />
* Ebstein Anomaly,<br />
* pulmonary atresia with intact ventricular septum ,<br />
<br />
=== Respiratory diseases===<br />
* Bronchiolitis,<br />
*viral and bacterial pneumonia <br />
* pneumothorax because when they are in heart failure they present with signs of respiratory distress, cyanosis and failure to thrive<br />
<br />
=== Bidirectional shunt diseases===<br />
* total anomalous pulmonary venous return,<br />
* hypoplastic left heart syndrome,<br />
* single ventricle <br />
* truncus arteriosus <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Epidemiology and Demographics==<br />
The epidemiology of pentalogy of fallot has not been well studied.<br />
<br />
==Risk Factors==<br />
<br />
<br />
<br />
<br />
Common risk factors in the development of pentalogy of fallot includes<ref name="SilvaNeves2019">{{cite journal|last1=Silva|first1=Joana A.|last2=Neves|first2=Ana L.|last3=Flor-de-Lima|first3=Filipa|last4=Soares|first4=Paulo|last5=Guimarães|first5=Hercília|title=Risk Factors and Outcomes of Tetralogy of Fallot: From Fetal to Neonatal Life|journal=Pediatric Cardiology|volume=41|issue=1|year=2019|pages=155–164|issn=0172-0643|doi=10.1007/s00246-019-02239-4}}</ref><br />
<br />
* Alcoholism in mother <br />
* Maternal Diabetes <br />
* Advanced maternal age i.e greater than 40 years <br />
* Malnutrition in pregnancy <br />
* Family history of tetralogy of fallot <br />
* Viral illness during pregnancy like Rubella. <br />
* presence of Down syndrome or DiGeorge syndrome<br />
<br />
==Screening==<br />
There is insufficient evidence to recommend routine screening for pentalogy of fallot.<br />
<br />
==Natural History, Complications, and Prognosis==<br />
If left untreated, patients with pentalogy of fallot may progress to develop finger clubbing, stunted growth, cardiac arrhythmias, hypoplastic pulmonary artery and polycythemia with relative iron deficiency.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
Prognosis is generally excellent provided the VSD has been closed and the right ventricular outflow tract has been relieved,<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
<br />
<br />
There are no established criteria for the diagnosis of pentalogy fallot.<br />
<br />
===History and Symptoms===<br />
<br />
The hallmark of pentalogy of fallot is cyanosis. A positive history of cyanosis and easy fatigability leading to squatting during exercise is suggestive of cyanotic congenital heart defct <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
. The most common symptoms of pentalogy of fallot include cyanosis, easy fatigabillity , and hypercyanotic spells with crying , feeding and defecating<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
==Physical Examination==<br />
<br />
=== Appearance===<br />
* patients with pentalogy of fallot usually appear small due to failure to thrive. <br />
* patients may be found in squatting position( compensatory mechanism)<br />
<br />
=== Vital Signs===<br />
* Tachycardia with regular pulse <br />
* Tachypnea <br />
* low grade fever in patients with concomitant infective endocarditis<br />
<br />
=== HEENT===<br />
* Retinal vessel engorgement may be present<br />
<br />
=== Heart===<br />
<br />
A thrill may be present at left sternal border.<br />
*A right ventricular impulse may be prominent.<br />
*Second heart sound (S2) is single as P2 is absent.<br />
*A harsh systolic ejection murmur best heard at the left sternal border is usually present.<br />
*P2 is faint and delayed in mild cyanosis and inaudible in severe cyanosis.<br />
*A diastolic murmur may be heard due to aortic regurgitation.<br />
<br />
=== Extremities===<br />
*Clubbing<br />
*Cyanosis is most prominent at lips and nail beds<br />
<br />
===Laboratory Findings===<br />
<br />
<br />
Some patients with pentalogy of fallot may have polycythemia <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
which is usually suggestive of worsening hypoxia and compensatory production of erythropoetin.<br />
<br />
.<br />
<br />
===Electrocardiogram===<br />
<br />
An ECG may be helpful in the diagnosis of pentalogy of fallot <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
Findings on an ECG suggestive of pentalogy of fallot include right axis deviation and right ventricular hypertrophy.<br />
[[File: Right_ventrriular_hypertophy.png|200p|thumb|right|Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874376/]]<br />
<br />
===X-ray===<br />
<br />
<br />
<br />
<br />
An x-ray may be helpful in the diagnosis of pentalogy of Fallot. Findings on an x-ray suggestive of pentalogy of fallot include boot shaped heart or coeur en sabot.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref> [[File:Boot_shaped_heart.png|200p|thumb|left| Typical preoperative chest X‐ray of a 16‐month‐old boy with tetralogy of Fallot.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5412831/]]<br />
<br />
<br />
<br />
<br />
.<br />
<br />
===Echocardiography or Ultrasound===<br />
<br />
<br />
<br />
<br />
Echocardiography may be helpful in the diagnosis of pentalogy of fallot. Findings on an echocardiography diagnostic of pentallogy of fallot include Ventricular septal defect, Atrial septal defect , Right ventricular outflow tract obstruction and overriding aorta<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref> [[File:Pentalogy_of_fallot_image_2.png|200p|thumb|left | Department of Biochemistry, University of Allahabad, Allahabad-211002, India.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3299189/]]<br />
<br />
===CT scan===<br />
<br />
<br />
Thoracic CT angiography may be helpful in the diagnosis of pentallogy of fallot. Findings on CT scan diagnostic of pentalogy of fallot include ventricular septal defect, right ventricular hypertrophy, pulmonary atresia and major aortopulmonary collateral arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref> <br />
<br />
<br />
<br />
===MRI===<br />
<br />
<br />
cardiac MRI may be helpful in the diagnosis of pentalogy of fallot. Findings on MRI diagnostic of pentalogy of fallot include RVOT stenosis, VSD, ASD,Overriding aorta, right ventricular hypertrophy and hypoplastic pulmonary arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
<br />
<br />
===Other Imaging Findings===<br />
Other imaging findings for pentalogy of fallot include Right ventricular angiopraphy, which demonstrates infundibular and pulmonary artery anatomy, and left ventricular angiography, which demonstrates VSD, ASD, and Overiding aorta <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
===Other Diagnostic Studies===<br />
<br />
There are no other diagnostic studies associated with pentalogy of Fallot<br />
<br />
==Treatment==<br />
===Medical Therapy===<br />
The mainstay of treatment for pentalogy of fallot is Surgery.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
Pharmacologic medical therapy is recommended among patients with severe RVOTO and hypercyanotic spells<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
Pharmacologic medical therapies for pentalogy of fallot include <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
* prostaglandin E1 in neonates with ductal dependent pulmonary blood flow<br />
* Morphine and ketamine for sedation<br />
*vasopressors like phenylephrine<br />
*propanolol to decrease the need for palliative surgical intervention.<br />
* iron treatment to decrease frequency of spells. <br />
<br />
Patients with hypercyanotic spells are treated with oxygen,volume expansion and morphine sedation.<br />
<br />
===Surgery===<br />
<br />
<br />
<br />
Surgery is the mainstay of treatment for pentalogy of fallot. interventional procedures are used to relieve pulmonary obstructions and embolize colaterals. <br />
different surgical procedures can be done to treat pentalogy of fallot and it includes <br />
* pulmonary valvotomy( for stenotic pulmonic valve)<br />
* pulmonary valvectomy( for small and thickened pulmonic valve) <br />
* closure of ASD/VSD<br />
* shunt surgery for severe cyanosis or in patients with frequent spells in the first year of life <br />
* Blalock -Taussig Shunt- communication between the right or left pulmonary artery and the right or left subclavian artery. <br />
* Waterson-Cooley Shunt- communication between the ascending aorta with the right pulmonary artery <br />
* Potts shunt-communication between the descending aorta and left pulmonary artery <br />
* Central shunt- Communication between the main pulmonary artery and ascending aorta.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
===Primary Prevention===<br />
There are no established measures for the primary prevention of [pentalogy of fallot ].<br />
<br />
===Secondary Prevention===<br />
There are no established measures for the secondary prevention of [pentalogy of fallot].<br />
===Prevention of Cyanosis===<br />
The following factors may reduce systemic vascular resistance (SVR) and exacerbate shunting which in turn exacerbate cyanosis and should be avoided if at all possible:<br />
<br />
*Acidosis<br />
*Bathing in hot water<br />
*Fever<br />
*Stress<br />
*Infection<br />
*Posture (upright, not squatting)<br />
*Exercise<br />
*Beta-adrenergic agonists<br />
*Dehydration<br />
*Closure of the patent ductus arteriosus<br />
===Prevention of Infective Endocarditis===<br />
Antibiotic prophylaxis should be administered before respiratory and oral procedures.<br />
<br />
==References==<br />
{{reflist|2}}<br />
<br />
{{WikiDoc Help Menu}}<br />
{{WikiDoc Sources}}<br />
[[Category:Cardiology]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Abdulkareem Opeoluwalukanhttps://www.wikidoc.org/index.php?title=Pentalogy_of_Fallot&diff=1619829Pentalogy of Fallot2020-06-30T16:19:20Z<p>Abdulkareem Opeoluwalukan: /* X-ray */</p>
<hr />
<div>__NOTOC__<br />
{{SI}}<br />
{{CMG}} {{AE}}[[User:Abdulkareem Opeoluwalukan|Abdulkareem Opeoluwalukan, M.D]].<br />
==Overview==<br />
Pentalogy of Fallot is defined as the occurrence of Tetralogy of Fallot plus an [[atrial septal defect]].[[File:Pentalogy_of_fallot_image_1.png |200p|thumb|center| Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa. paolo.pazzi@up.ac.za.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3984729/]]<br />
<br />
==Historical Perspective==<br />
tetrallogy of fallot was first discovered by Niel Stenson, a Denish physician Anatomist, in 1671<ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref>.<br />
<br />
The association between Rigt ventriular outflow tract obstruction and a large ventricular septal defect and tetrallogy of fallot. was made in 1888 by Etinne-Louise]<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref>.<br />
<br />
In 1924, Canadian, Maude Abbott was the first to discover the association between ventricular septal defect , pulmonary stenosis, overriding aorta and right ventricular hypertrophy and the development of tetrallogy of Fallot.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref<br />
In 1939, the first surgical treatment was developed by Dr Helen Taussig in Johns Hopkins&lt;nowiki&gt;&lt;nowiki&gt;<nowiki><ref name="pmid30020660"></nowiki>&lt;/nowiki&gt;&lt;/nowiki&gt;{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Classification==<br />
There is no established system for the classification of [pentallogy of fallot ].<br />
<br />
<br /><br />
<br />
==Pathophysiology==<br />
<br />
<br />
<br />
<br />
It is thought that tetrallogy of fallot is the result of anterocephalad deviation of the aortico pulmonary septum<ref name="pmid25870631">{{cite journal |vauthors=Beig JR, Ahmed W, Hafeez I, Gupta A, Tramboo NA, Rather HA |title=Pentalogy of fallot with a single coronary artery: a rare case report |journal=J Tehran Heart Cent |volume=9 |issue=3 |pages=132–4 |date=2014 |pmid=25870631 |pmc=4393836 |doi= |url=}}</ref> thus leading to <br />
* ventricular septal defect<br />
* right ventricular outflow tract obstruction <br />
*overriding aorta <br />
* right ventricular hypertrophy with an additional ASD( atrial septal defect) with ostium secundum type being the most common followed by ostium primum <ref name="pmid25870631">{{cite journal |vauthors=Beig JR, Ahmed W, Hafeez I, Gupta A, Tramboo NA, Rather HA |title=Pentalogy of fallot with a single coronary artery: a rare case report |journal=J Tehran Heart Cent |volume=9 |issue=3 |pages=132–4 |date=2014 |pmid=25870631 |pmc=4393836 |doi= |url=}}</ref>. thus making it a pentallogy of fallot. even though there are no reports on the molecular pathophysiology of pentallogy of fallot, conotruncal heart defects like tetrallogy of fallot are associated with neural crest migration defect. systemic pathophysiology of tetrallogy of fallot depends on the extent of right ventricular outflow tract obstruction. severe pulmonic stenosis leads to a significant decrease in pulmonary circulation and worsening right to left shunt leading to cyanosis. A collateral PDA makes Tetralogy of fallot compatible with life as it preserves pulmonic circulation <ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. 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<br />
==Causes==<br />
<br />
<br />
<br />
<br />
The cause of pentalogy of fallot has not been identified. To review risk factors for the development of pentalogy of fallot, click [[tetralogy of fallot causes#Overview|here]].<br />
<br />
==Differentiating pentalogy of fallot from other Diseases==<br />
pentalogy of Fallot must be differentiated from other diseases that cause .<br />
<br />
===right to left shunt=== <br />
* transposition of great arteries with pulmonic stenosis,<br />
* double outlet right ventricle including Taussig-Bing anomaly, <br />
*tricuspid atresia,<br />
* Ebstein Anomaly,<br />
* pulmonary atresia with intact ventricular septum ,<br />
<br />
=== Respiratory diseases===<br />
* Bronchiolitis,<br />
*viral and bacterial pneumonia <br />
* pneumothorax because when they are in heart failure they present with signs of respiratory distress, cyanosis and failure to thrive<br />
<br />
=== Bidirectional shunt diseases===<br />
* total anomalous pulmonary venous return,<br />
* hypoplastic left heart syndrome,<br />
* single ventricle <br />
* truncus arteriosus <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Epidemiology and Demographics==<br />
The epidemiology of pentalogy of fallot has not been well studied.<br />
<br />
==Risk Factors==<br />
<br />
<br />
<br />
<br />
Common risk factors in the development of pentalogy of fallot includes<ref name="SilvaNeves2019">{{cite journal|last1=Silva|first1=Joana A.|last2=Neves|first2=Ana L.|last3=Flor-de-Lima|first3=Filipa|last4=Soares|first4=Paulo|last5=Guimarães|first5=Hercília|title=Risk Factors and Outcomes of Tetralogy of Fallot: From Fetal to Neonatal Life|journal=Pediatric Cardiology|volume=41|issue=1|year=2019|pages=155–164|issn=0172-0643|doi=10.1007/s00246-019-02239-4}}</ref><br />
<br />
* Alcoholism in mother <br />
* Maternal Diabetes <br />
* Advanced maternal age i.e greater than 40 years <br />
* Malnutrition in pregnancy <br />
* Family history of tetralogy of fallot <br />
* Viral illness during pregnancy like Rubella. <br />
* presence of Down syndrome or DiGeorge syndrome<br />
<br />
==Screening==<br />
There is insufficient evidence to recommend routine screening for pentalogy of fallot.<br />
<br />
==Natural History, Complications, and Prognosis==<br />
If left untreated, patients with pentalogy of fallot may progress to develop finger clubbing, stunted growth, cardiac arrhythmias, hypoplastic pulmonary artery and polycythemia with relative iron deficiency.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
Prognosis is generally excellent provided the VSD has been closed and the right ventricular outflow tract has been relieved,<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
<br />
<br />
There are no established criteria for the diagnosis of pentalogy fallot.<br />
<br />
===History and Symptoms===<br />
<br />
The hallmark of pentalogy of fallot is cyanosis. A positive history of cyanosis and easy fatigability leading to squatting during exercise is suggestive of cyanotic congenital heart defct <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
. The most common symptoms of pentalogy of fallot include cyanosis, easy fatigabillity , and hypercyanotic spells with crying , feeding and defecating<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
==Physical Examination==<br />
<br />
=== Appearance===<br />
* patients with pentalogy of fallot usually appear small due to failure to thrive. <br />
* patients may be found in squatting position( compensatory mechanism)<br />
<br />
=== Vital Signs===<br />
* Tachycardia with regular pulse <br />
* Tachypnea <br />
* low grade fever in patients with concomitant infective endocarditis<br />
<br />
=== HEENT===<br />
* Retinal vessel engorgement may be present<br />
<br />
=== Heart===<br />
<br />
A thrill may be present at left sternal border.<br />
*A right ventricular impulse may be prominent.<br />
*Second heart sound (S2) is single as P2 is absent.<br />
*A harsh systolic ejection murmur best heard at the left sternal border is usually present.<br />
*P2 is faint and delayed in mild cyanosis and inaudible in severe cyanosis.<br />
*A diastolic murmur may be heard due to aortic regurgitation.<br />
<br />
=== Extremities===<br />
*Clubbing<br />
*Cyanosis is most prominent at lips and nail beds<br />
<br />
===Laboratory Findings===<br />
<br />
<br />
Some patients with pentalogy of fallot may have polycythemia <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
which is usually suggestive of worsening hypoxia and compensatory production of erythropoetin.<br />
<br />
.<br />
<br />
===Electrocardiogram===<br />
<br />
An ECG may be helpful in the diagnosis of pentalogy of fallot <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
Findings on an ECG suggestive of pentalogy of fallot include right axis deviation and right ventricular hypertrophy.<br />
[[File: Right_ventrriular_hypertophy.png|200p|thumb|right|Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874376/]]<br />
<br />
===X-ray===<br />
<br />
<br />
<br />
<br />
An x-ray may be helpful in the diagnosis of pentalogy of Fallot. Findings on an x-ray suggestive of pentalogy of fallot include boot shaped heart or coeur en sabot.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref> [[File:Boot_shaped_heart.png|200p|thumb|left| Typical preoperative chest X‐ray of a 16‐month‐old boy with tetralogy of Fallot.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5412831/]]<br />
<br />
<br />
<br />
<br />
.<br />
<br />
===Echocardiography or Ultrasound===<br />
<br />
<br />
<br />
<br />
Echocardiography may be helpful in the diagnosis of pentalogy of fallot. Findings on an echocardiography diagnostic of pentallogy of fallot include Ventricular septal defect, Atrial septal defect , Right ventricular outflow tract obstruction and overriding aorta<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref> [[File:Pentalogy_of_fallot_image_2.png|200p|thumb|left | Department of Biochemistry, University of Allahabad, Allahabad-211002, India.]]<br />
<br />
===CT scan===<br />
<br />
<br />
Thoracic CT angiography may be helpful in the diagnosis of pentallogy of fallot. Findings on CT scan diagnostic of pentalogy of fallot include ventricular septal defect, right ventricular hypertrophy, pulmonary atresia and major aortopulmonary collateral arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref> <br />
<br />
<br />
<br />
===MRI===<br />
<br />
<br />
cardiac MRI may be helpful in the diagnosis of pentalogy of fallot. Findings on MRI diagnostic of pentalogy of fallot include RVOT stenosis, VSD, ASD,Overriding aorta, right ventricular hypertrophy and hypoplastic pulmonary arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
<br />
<br />
===Other Imaging Findings===<br />
Other imaging findings for pentalogy of fallot include Right ventricular angiopraphy, which demonstrates infundibular and pulmonary artery anatomy, and left ventricular angiography, which demonstrates VSD, ASD, and Overiding aorta <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
===Other Diagnostic Studies===<br />
<br />
There are no other diagnostic studies associated with pentalogy of Fallot<br />
<br />
==Treatment==<br />
===Medical Therapy===<br />
The mainstay of treatment for pentalogy of fallot is Surgery.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
Pharmacologic medical therapy is recommended among patients with severe RVOTO and hypercyanotic spells<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
Pharmacologic medical therapies for pentalogy of fallot include <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
* prostaglandin E1 in neonates with ductal dependent pulmonary blood flow<br />
* Morphine and ketamine for sedation<br />
*vasopressors like phenylephrine<br />
*propanolol to decrease the need for palliative surgical intervention.<br />
* iron treatment to decrease frequency of spells. <br />
<br />
Patients with hypercyanotic spells are treated with oxygen,volume expansion and morphine sedation.<br />
<br />
===Surgery===<br />
<br />
<br />
<br />
Surgery is the mainstay of treatment for pentalogy of fallot. interventional procedures are used to relieve pulmonary obstructions and embolize colaterals. <br />
different surgical procedures can be done to treat pentalogy of fallot and it includes <br />
* pulmonary valvotomy( for stenotic pulmonic valve)<br />
* pulmonary valvectomy( for small and thickened pulmonic valve) <br />
* closure of ASD/VSD<br />
* shunt surgery for severe cyanosis or in patients with frequent spells in the first year of life <br />
* Blalock -Taussig Shunt- communication between the right or left pulmonary artery and the right or left subclavian artery. <br />
* Waterson-Cooley Shunt- communication between the ascending aorta with the right pulmonary artery <br />
* Potts shunt-communication between the descending aorta and left pulmonary artery <br />
* Central shunt- Communication between the main pulmonary artery and ascending aorta.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
===Primary Prevention===<br />
There are no established measures for the primary prevention of [pentalogy of fallot ].<br />
<br />
===Secondary Prevention===<br />
There are no established measures for the secondary prevention of [pentalogy of fallot].<br />
===Prevention of Cyanosis===<br />
The following factors may reduce systemic vascular resistance (SVR) and exacerbate shunting which in turn exacerbate cyanosis and should be avoided if at all possible:<br />
<br />
*Acidosis<br />
*Bathing in hot water<br />
*Fever<br />
*Stress<br />
*Infection<br />
*Posture (upright, not squatting)<br />
*Exercise<br />
*Beta-adrenergic agonists<br />
*Dehydration<br />
*Closure of the patent ductus arteriosus<br />
===Prevention of Infective Endocarditis===<br />
Antibiotic prophylaxis should be administered before respiratory and oral procedures.<br />
<br />
==References==<br />
{{reflist|2}}<br />
<br />
{{WikiDoc Help Menu}}<br />
{{WikiDoc Sources}}<br />
[[Category:Cardiology]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Abdulkareem Opeoluwalukanhttps://www.wikidoc.org/index.php?title=Pentalogy_of_Fallot&diff=1619815Pentalogy of Fallot2020-06-30T15:55:55Z<p>Abdulkareem Opeoluwalukan: /* Electrocardiogram */</p>
<hr />
<div>__NOTOC__<br />
{{SI}}<br />
{{CMG}} {{AE}}[[User:Abdulkareem Opeoluwalukan|Abdulkareem Opeoluwalukan, M.D]].<br />
==Overview==<br />
Pentalogy of Fallot is defined as the occurrence of Tetralogy of Fallot plus an [[atrial septal defect]].[[File:Pentalogy_of_fallot_image_1.png |200p|thumb|center| Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa. paolo.pazzi@up.ac.za.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3984729/]]<br />
<br />
==Historical Perspective==<br />
tetrallogy of fallot was first discovered by Niel Stenson, a Denish physician Anatomist, in 1671<ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref>.<br />
<br />
The association between Rigt ventriular outflow tract obstruction and a large ventricular septal defect and tetrallogy of fallot. was made in 1888 by Etinne-Louise]<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref>.<br />
<br />
In 1924, Canadian, Maude Abbott was the first to discover the association between ventricular septal defect , pulmonary stenosis, overriding aorta and right ventricular hypertrophy and the development of tetrallogy of Fallot.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref<br />
In 1939, the first surgical treatment was developed by Dr Helen Taussig in Johns Hopkins&lt;nowiki&gt;&lt;nowiki&gt;<nowiki><ref name="pmid30020660"></nowiki>&lt;/nowiki&gt;&lt;/nowiki&gt;{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Classification==<br />
There is no established system for the classification of [pentallogy of fallot ].<br />
<br />
<br /><br />
<br />
==Pathophysiology==<br />
<br />
<br />
<br />
<br />
It is thought that tetrallogy of fallot is the result of anterocephalad deviation of the aortico pulmonary septum<ref name="pmid25870631">{{cite journal |vauthors=Beig JR, Ahmed W, Hafeez I, Gupta A, Tramboo NA, Rather HA |title=Pentalogy of fallot with a single coronary artery: a rare case report |journal=J Tehran Heart Cent |volume=9 |issue=3 |pages=132–4 |date=2014 |pmid=25870631 |pmc=4393836 |doi= |url=}}</ref> thus leading to <br />
* ventricular septal defect<br />
* right ventricular outflow tract obstruction <br />
*overriding aorta <br />
* right ventricular hypertrophy with an additional ASD( atrial septal defect) with ostium secundum type being the most common followed by ostium primum <ref name="pmid25870631">{{cite journal |vauthors=Beig JR, Ahmed W, Hafeez I, Gupta A, Tramboo NA, Rather HA |title=Pentalogy of fallot with a single coronary artery: a rare case report |journal=J Tehran Heart Cent |volume=9 |issue=3 |pages=132–4 |date=2014 |pmid=25870631 |pmc=4393836 |doi= |url=}}</ref>. thus making it a pentallogy of fallot. even though there are no reports on the molecular pathophysiology of pentallogy of fallot, conotruncal heart defects like tetrallogy of fallot are associated with neural crest migration defect. systemic pathophysiology of tetrallogy of fallot depends on the extent of right ventricular outflow tract obstruction. severe pulmonic stenosis leads to a significant decrease in pulmonary circulation and worsening right to left shunt leading to cyanosis. A collateral PDA makes Tetralogy of fallot compatible with life as it preserves pulmonic circulation <ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. 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<br />
==Causes==<br />
<br />
<br />
<br />
<br />
The cause of pentalogy of fallot has not been identified. To review risk factors for the development of pentalogy of fallot, click [[tetralogy of fallot causes#Overview|here]].<br />
<br />
==Differentiating pentalogy of fallot from other Diseases==<br />
pentalogy of Fallot must be differentiated from other diseases that cause .<br />
<br />
===right to left shunt=== <br />
* transposition of great arteries with pulmonic stenosis,<br />
* double outlet right ventricle including Taussig-Bing anomaly, <br />
*tricuspid atresia,<br />
* Ebstein Anomaly,<br />
* pulmonary atresia with intact ventricular septum ,<br />
<br />
=== Respiratory diseases===<br />
* Bronchiolitis,<br />
*viral and bacterial pneumonia <br />
* pneumothorax because when they are in heart failure they present with signs of respiratory distress, cyanosis and failure to thrive<br />
<br />
=== Bidirectional shunt diseases===<br />
* total anomalous pulmonary venous return,<br />
* hypoplastic left heart syndrome,<br />
* single ventricle <br />
* truncus arteriosus <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Epidemiology and Demographics==<br />
The epidemiology of pentalogy of fallot has not been well studied.<br />
<br />
==Risk Factors==<br />
<br />
<br />
<br />
<br />
Common risk factors in the development of pentalogy of fallot includes<ref name="SilvaNeves2019">{{cite journal|last1=Silva|first1=Joana A.|last2=Neves|first2=Ana L.|last3=Flor-de-Lima|first3=Filipa|last4=Soares|first4=Paulo|last5=Guimarães|first5=Hercília|title=Risk Factors and Outcomes of Tetralogy of Fallot: From Fetal to Neonatal Life|journal=Pediatric Cardiology|volume=41|issue=1|year=2019|pages=155–164|issn=0172-0643|doi=10.1007/s00246-019-02239-4}}</ref><br />
<br />
* Alcoholism in mother <br />
* Maternal Diabetes <br />
* Advanced maternal age i.e greater than 40 years <br />
* Malnutrition in pregnancy <br />
* Family history of tetralogy of fallot <br />
* Viral illness during pregnancy like Rubella. <br />
* presence of Down syndrome or DiGeorge syndrome<br />
<br />
==Screening==<br />
There is insufficient evidence to recommend routine screening for pentalogy of fallot.<br />
<br />
==Natural History, Complications, and Prognosis==<br />
If left untreated, patients with pentalogy of fallot may progress to develop finger clubbing, stunted growth, cardiac arrhythmias, hypoplastic pulmonary artery and polycythemia with relative iron deficiency.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
Prognosis is generally excellent provided the VSD has been closed and the right ventricular outflow tract has been relieved,<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
<br />
<br />
There are no established criteria for the diagnosis of pentalogy fallot.<br />
<br />
===History and Symptoms===<br />
<br />
The hallmark of pentalogy of fallot is cyanosis. A positive history of cyanosis and easy fatigability leading to squatting during exercise is suggestive of cyanotic congenital heart defct <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
. The most common symptoms of pentalogy of fallot include cyanosis, easy fatigabillity , and hypercyanotic spells with crying , feeding and defecating<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
==Physical Examination==<br />
<br />
=== Appearance===<br />
* patients with pentalogy of fallot usually appear small due to failure to thrive. <br />
* patients may be found in squatting position( compensatory mechanism)<br />
<br />
=== Vital Signs===<br />
* Tachycardia with regular pulse <br />
* Tachypnea <br />
* low grade fever in patients with concomitant infective endocarditis<br />
<br />
=== HEENT===<br />
* Retinal vessel engorgement may be present<br />
<br />
=== Heart===<br />
<br />
A thrill may be present at left sternal border.<br />
*A right ventricular impulse may be prominent.<br />
*Second heart sound (S2) is single as P2 is absent.<br />
*A harsh systolic ejection murmur best heard at the left sternal border is usually present.<br />
*P2 is faint and delayed in mild cyanosis and inaudible in severe cyanosis.<br />
*A diastolic murmur may be heard due to aortic regurgitation.<br />
<br />
=== Extremities===<br />
*Clubbing<br />
*Cyanosis is most prominent at lips and nail beds<br />
<br />
===Laboratory Findings===<br />
<br />
<br />
Some patients with pentalogy of fallot may have polycythemia <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
which is usually suggestive of worsening hypoxia and compensatory production of erythropoetin.<br />
<br />
.<br />
<br />
===Electrocardiogram===<br />
<br />
An ECG may be helpful in the diagnosis of pentalogy of fallot <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
Findings on an ECG suggestive of pentalogy of fallot include right axis deviation and right ventricular hypertrophy.<br />
[[File: Right_ventrriular_hypertophy.png|200p|thumb|right|Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874376/]]<br />
<br />
===X-ray===<br />
<br />
<br />
<br />
<br />
An x-ray may be helpful in the diagnosis of pentalogy of Fallot. Findings on an x-ray suggestive of pentalogy of fallot include boot shaped heart or coeur en sabot.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref> [[File:Boot_shaped_heart.png|200p|thumb|left| Typical preoperative chest X‐ray of a 16‐month‐old boy with tetralogy of Fallot.]]<br />
<br />
<br />
<br />
<br />
.<br />
<br />
===Echocardiography or Ultrasound===<br />
<br />
<br />
<br />
<br />
Echocardiography may be helpful in the diagnosis of pentalogy of fallot. Findings on an echocardiography diagnostic of pentallogy of fallot include Ventricular septal defect, Atrial septal defect , Right ventricular outflow tract obstruction and overriding aorta<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref> [[File:Pentalogy_of_fallot_image_2.png|200p|thumb|left | Department of Biochemistry, University of Allahabad, Allahabad-211002, India.]]<br />
<br />
===CT scan===<br />
<br />
<br />
Thoracic CT angiography may be helpful in the diagnosis of pentallogy of fallot. Findings on CT scan diagnostic of pentalogy of fallot include ventricular septal defect, right ventricular hypertrophy, pulmonary atresia and major aortopulmonary collateral arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref> <br />
<br />
<br />
<br />
===MRI===<br />
<br />
<br />
cardiac MRI may be helpful in the diagnosis of pentalogy of fallot. Findings on MRI diagnostic of pentalogy of fallot include RVOT stenosis, VSD, ASD,Overriding aorta, right ventricular hypertrophy and hypoplastic pulmonary arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
<br />
<br />
===Other Imaging Findings===<br />
Other imaging findings for pentalogy of fallot include Right ventricular angiopraphy, which demonstrates infundibular and pulmonary artery anatomy, and left ventricular angiography, which demonstrates VSD, ASD, and Overiding aorta <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
===Other Diagnostic Studies===<br />
<br />
There are no other diagnostic studies associated with pentalogy of Fallot<br />
<br />
==Treatment==<br />
===Medical Therapy===<br />
The mainstay of treatment for pentalogy of fallot is Surgery.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
Pharmacologic medical therapy is recommended among patients with severe RVOTO and hypercyanotic spells<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
Pharmacologic medical therapies for pentalogy of fallot include <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
* prostaglandin E1 in neonates with ductal dependent pulmonary blood flow<br />
* Morphine and ketamine for sedation<br />
*vasopressors like phenylephrine<br />
*propanolol to decrease the need for palliative surgical intervention.<br />
* iron treatment to decrease frequency of spells. <br />
<br />
Patients with hypercyanotic spells are treated with oxygen,volume expansion and morphine sedation.<br />
<br />
===Surgery===<br />
<br />
<br />
<br />
Surgery is the mainstay of treatment for pentalogy of fallot. interventional procedures are used to relieve pulmonary obstructions and embolize colaterals. <br />
different surgical procedures can be done to treat pentalogy of fallot and it includes <br />
* pulmonary valvotomy( for stenotic pulmonic valve)<br />
* pulmonary valvectomy( for small and thickened pulmonic valve) <br />
* closure of ASD/VSD<br />
* shunt surgery for severe cyanosis or in patients with frequent spells in the first year of life <br />
* Blalock -Taussig Shunt- communication between the right or left pulmonary artery and the right or left subclavian artery. <br />
* Waterson-Cooley Shunt- communication between the ascending aorta with the right pulmonary artery <br />
* Potts shunt-communication between the descending aorta and left pulmonary artery <br />
* Central shunt- Communication between the main pulmonary artery and ascending aorta.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
===Primary Prevention===<br />
There are no established measures for the primary prevention of [pentalogy of fallot ].<br />
<br />
===Secondary Prevention===<br />
There are no established measures for the secondary prevention of [pentalogy of fallot].<br />
===Prevention of Cyanosis===<br />
The following factors may reduce systemic vascular resistance (SVR) and exacerbate shunting which in turn exacerbate cyanosis and should be avoided if at all possible:<br />
<br />
*Acidosis<br />
*Bathing in hot water<br />
*Fever<br />
*Stress<br />
*Infection<br />
*Posture (upright, not squatting)<br />
*Exercise<br />
*Beta-adrenergic agonists<br />
*Dehydration<br />
*Closure of the patent ductus arteriosus<br />
===Prevention of Infective Endocarditis===<br />
Antibiotic prophylaxis should be administered before respiratory and oral procedures.<br />
<br />
==References==<br />
{{reflist|2}}<br />
<br />
{{WikiDoc Help Menu}}<br />
{{WikiDoc Sources}}<br />
[[Category:Cardiology]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Abdulkareem Opeoluwalukanhttps://www.wikidoc.org/index.php?title=Pentalogy_of_Fallot&diff=1619812Pentalogy of Fallot2020-06-30T15:53:00Z<p>Abdulkareem Opeoluwalukan: /* Overview */</p>
<hr />
<div>__NOTOC__<br />
{{SI}}<br />
{{CMG}} {{AE}}[[User:Abdulkareem Opeoluwalukan|Abdulkareem Opeoluwalukan, M.D]].<br />
==Overview==<br />
Pentalogy of Fallot is defined as the occurrence of Tetralogy of Fallot plus an [[atrial septal defect]].[[File:Pentalogy_of_fallot_image_1.png |200p|thumb|center| Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa. paolo.pazzi@up.ac.za.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3984729/]]<br />
<br />
==Historical Perspective==<br />
tetrallogy of fallot was first discovered by Niel Stenson, a Denish physician Anatomist, in 1671<ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref>.<br />
<br />
The association between Rigt ventriular outflow tract obstruction and a large ventricular septal defect and tetrallogy of fallot. was made in 1888 by Etinne-Louise]<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref>.<br />
<br />
In 1924, Canadian, Maude Abbott was the first to discover the association between ventricular septal defect , pulmonary stenosis, overriding aorta and right ventricular hypertrophy and the development of tetrallogy of Fallot.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref<br />
In 1939, the first surgical treatment was developed by Dr Helen Taussig in Johns Hopkins&lt;nowiki&gt;&lt;nowiki&gt;<nowiki><ref name="pmid30020660"></nowiki>&lt;/nowiki&gt;&lt;/nowiki&gt;{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Classification==<br />
There is no established system for the classification of [pentallogy of fallot ].<br />
<br />
<br /><br />
<br />
==Pathophysiology==<br />
<br />
<br />
<br />
<br />
It is thought that tetrallogy of fallot is the result of anterocephalad deviation of the aortico pulmonary septum<ref name="pmid25870631">{{cite journal |vauthors=Beig JR, Ahmed W, Hafeez I, Gupta A, Tramboo NA, Rather HA |title=Pentalogy of fallot with a single coronary artery: a rare case report |journal=J Tehran Heart Cent |volume=9 |issue=3 |pages=132–4 |date=2014 |pmid=25870631 |pmc=4393836 |doi= |url=}}</ref> thus leading to <br />
* ventricular septal defect<br />
* right ventricular outflow tract obstruction <br />
*overriding aorta <br />
* right ventricular hypertrophy with an additional ASD( atrial septal defect) with ostium secundum type being the most common followed by ostium primum <ref name="pmid25870631">{{cite journal |vauthors=Beig JR, Ahmed W, Hafeez I, Gupta A, Tramboo NA, Rather HA |title=Pentalogy of fallot with a single coronary artery: a rare case report |journal=J Tehran Heart Cent |volume=9 |issue=3 |pages=132–4 |date=2014 |pmid=25870631 |pmc=4393836 |doi= |url=}}</ref>. thus making it a pentallogy of fallot. even though there are no reports on the molecular pathophysiology of pentallogy of fallot, conotruncal heart defects like tetrallogy of fallot are associated with neural crest migration defect. systemic pathophysiology of tetrallogy of fallot depends on the extent of right ventricular outflow tract obstruction. severe pulmonic stenosis leads to a significant decrease in pulmonary circulation and worsening right to left shunt leading to cyanosis. A collateral PDA makes Tetralogy of fallot compatible with life as it preserves pulmonic circulation <ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. 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C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
==Causes==<br />
<br />
<br />
<br />
<br />
The cause of pentalogy of fallot has not been identified. To review risk factors for the development of pentalogy of fallot, click [[tetralogy of fallot causes#Overview|here]].<br />
<br />
==Differentiating pentalogy of fallot from other Diseases==<br />
pentalogy of Fallot must be differentiated from other diseases that cause .<br />
<br />
===right to left shunt=== <br />
* transposition of great arteries with pulmonic stenosis,<br />
* double outlet right ventricle including Taussig-Bing anomaly, <br />
*tricuspid atresia,<br />
* Ebstein Anomaly,<br />
* pulmonary atresia with intact ventricular septum ,<br />
<br />
=== Respiratory diseases===<br />
* Bronchiolitis,<br />
*viral and bacterial pneumonia <br />
* pneumothorax because when they are in heart failure they present with signs of respiratory distress, cyanosis and failure to thrive<br />
<br />
=== Bidirectional shunt diseases===<br />
* total anomalous pulmonary venous return,<br />
* hypoplastic left heart syndrome,<br />
* single ventricle <br />
* truncus arteriosus <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Epidemiology and Demographics==<br />
The epidemiology of pentalogy of fallot has not been well studied.<br />
<br />
==Risk Factors==<br />
<br />
<br />
<br />
<br />
Common risk factors in the development of pentalogy of fallot includes<ref name="SilvaNeves2019">{{cite journal|last1=Silva|first1=Joana A.|last2=Neves|first2=Ana L.|last3=Flor-de-Lima|first3=Filipa|last4=Soares|first4=Paulo|last5=Guimarães|first5=Hercília|title=Risk Factors and Outcomes of Tetralogy of Fallot: From Fetal to Neonatal Life|journal=Pediatric Cardiology|volume=41|issue=1|year=2019|pages=155–164|issn=0172-0643|doi=10.1007/s00246-019-02239-4}}</ref><br />
<br />
* Alcoholism in mother <br />
* Maternal Diabetes <br />
* Advanced maternal age i.e greater than 40 years <br />
* Malnutrition in pregnancy <br />
* Family history of tetralogy of fallot <br />
* Viral illness during pregnancy like Rubella. <br />
* presence of Down syndrome or DiGeorge syndrome<br />
<br />
==Screening==<br />
There is insufficient evidence to recommend routine screening for pentalogy of fallot.<br />
<br />
==Natural History, Complications, and Prognosis==<br />
If left untreated, patients with pentalogy of fallot may progress to develop finger clubbing, stunted growth, cardiac arrhythmias, hypoplastic pulmonary artery and polycythemia with relative iron deficiency.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
Prognosis is generally excellent provided the VSD has been closed and the right ventricular outflow tract has been relieved,<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
<br />
<br />
There are no established criteria for the diagnosis of pentalogy fallot.<br />
<br />
===History and Symptoms===<br />
<br />
The hallmark of pentalogy of fallot is cyanosis. A positive history of cyanosis and easy fatigability leading to squatting during exercise is suggestive of cyanotic congenital heart defct <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
. The most common symptoms of pentalogy of fallot include cyanosis, easy fatigabillity , and hypercyanotic spells with crying , feeding and defecating<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
==Physical Examination==<br />
<br />
=== Appearance===<br />
* patients with pentalogy of fallot usually appear small due to failure to thrive. <br />
* patients may be found in squatting position( compensatory mechanism)<br />
<br />
=== Vital Signs===<br />
* Tachycardia with regular pulse <br />
* Tachypnea <br />
* low grade fever in patients with concomitant infective endocarditis<br />
<br />
=== HEENT===<br />
* Retinal vessel engorgement may be present<br />
<br />
=== Heart===<br />
<br />
A thrill may be present at left sternal border.<br />
*A right ventricular impulse may be prominent.<br />
*Second heart sound (S2) is single as P2 is absent.<br />
*A harsh systolic ejection murmur best heard at the left sternal border is usually present.<br />
*P2 is faint and delayed in mild cyanosis and inaudible in severe cyanosis.<br />
*A diastolic murmur may be heard due to aortic regurgitation.<br />
<br />
=== Extremities===<br />
*Clubbing<br />
*Cyanosis is most prominent at lips and nail beds<br />
<br />
===Laboratory Findings===<br />
<br />
<br />
Some patients with pentalogy of fallot may have polycythemia <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
which is usually suggestive of worsening hypoxia and compensatory production of erythropoetin.<br />
<br />
.<br />
<br />
===Electrocardiogram===<br />
<br />
An ECG may be helpful in the diagnosis of pentalogy of fallot <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
Findings on an ECG suggestive of pentalogy of fallot include right axis deviation and right ventricular hypertrophy.<br />
[[File: Right_ventrriular_hypertophy.png|200p|thumb|right|Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran,]]<br />
<br />
===X-ray===<br />
<br />
<br />
<br />
<br />
An x-ray may be helpful in the diagnosis of pentalogy of Fallot. Findings on an x-ray suggestive of pentalogy of fallot include boot shaped heart or coeur en sabot.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref> [[File:Boot_shaped_heart.png|200p|thumb|left| Typical preoperative chest X‐ray of a 16‐month‐old boy with tetralogy of Fallot.]]<br />
<br />
<br />
<br />
<br />
.<br />
<br />
===Echocardiography or Ultrasound===<br />
<br />
<br />
<br />
<br />
Echocardiography may be helpful in the diagnosis of pentalogy of fallot. Findings on an echocardiography diagnostic of pentallogy of fallot include Ventricular septal defect, Atrial septal defect , Right ventricular outflow tract obstruction and overriding aorta<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref> [[File:Pentalogy_of_fallot_image_2.png|200p|thumb|left | Department of Biochemistry, University of Allahabad, Allahabad-211002, India.]]<br />
<br />
===CT scan===<br />
<br />
<br />
Thoracic CT angiography may be helpful in the diagnosis of pentallogy of fallot. Findings on CT scan diagnostic of pentalogy of fallot include ventricular septal defect, right ventricular hypertrophy, pulmonary atresia and major aortopulmonary collateral arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref> <br />
<br />
<br />
<br />
===MRI===<br />
<br />
<br />
cardiac MRI may be helpful in the diagnosis of pentalogy of fallot. Findings on MRI diagnostic of pentalogy of fallot include RVOT stenosis, VSD, ASD,Overriding aorta, right ventricular hypertrophy and hypoplastic pulmonary arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
<br />
<br />
===Other Imaging Findings===<br />
Other imaging findings for pentalogy of fallot include Right ventricular angiopraphy, which demonstrates infundibular and pulmonary artery anatomy, and left ventricular angiography, which demonstrates VSD, ASD, and Overiding aorta <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
===Other Diagnostic Studies===<br />
<br />
There are no other diagnostic studies associated with pentalogy of Fallot<br />
<br />
==Treatment==<br />
===Medical Therapy===<br />
The mainstay of treatment for pentalogy of fallot is Surgery.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
Pharmacologic medical therapy is recommended among patients with severe RVOTO and hypercyanotic spells<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
Pharmacologic medical therapies for pentalogy of fallot include <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
* prostaglandin E1 in neonates with ductal dependent pulmonary blood flow<br />
* Morphine and ketamine for sedation<br />
*vasopressors like phenylephrine<br />
*propanolol to decrease the need for palliative surgical intervention.<br />
* iron treatment to decrease frequency of spells. <br />
<br />
Patients with hypercyanotic spells are treated with oxygen,volume expansion and morphine sedation.<br />
<br />
===Surgery===<br />
<br />
<br />
<br />
Surgery is the mainstay of treatment for pentalogy of fallot. interventional procedures are used to relieve pulmonary obstructions and embolize colaterals. <br />
different surgical procedures can be done to treat pentalogy of fallot and it includes <br />
* pulmonary valvotomy( for stenotic pulmonic valve)<br />
* pulmonary valvectomy( for small and thickened pulmonic valve) <br />
* closure of ASD/VSD<br />
* shunt surgery for severe cyanosis or in patients with frequent spells in the first year of life <br />
* Blalock -Taussig Shunt- communication between the right or left pulmonary artery and the right or left subclavian artery. <br />
* Waterson-Cooley Shunt- communication between the ascending aorta with the right pulmonary artery <br />
* Potts shunt-communication between the descending aorta and left pulmonary artery <br />
* Central shunt- Communication between the main pulmonary artery and ascending aorta.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
===Primary Prevention===<br />
There are no established measures for the primary prevention of [pentalogy of fallot ].<br />
<br />
===Secondary Prevention===<br />
There are no established measures for the secondary prevention of [pentalogy of fallot].<br />
===Prevention of Cyanosis===<br />
The following factors may reduce systemic vascular resistance (SVR) and exacerbate shunting which in turn exacerbate cyanosis and should be avoided if at all possible:<br />
<br />
*Acidosis<br />
*Bathing in hot water<br />
*Fever<br />
*Stress<br />
*Infection<br />
*Posture (upright, not squatting)<br />
*Exercise<br />
*Beta-adrenergic agonists<br />
*Dehydration<br />
*Closure of the patent ductus arteriosus<br />
===Prevention of Infective Endocarditis===<br />
Antibiotic prophylaxis should be administered before respiratory and oral procedures.<br />
<br />
==References==<br />
{{reflist|2}}<br />
<br />
{{WikiDoc Help Menu}}<br />
{{WikiDoc Sources}}<br />
[[Category:Cardiology]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Abdulkareem Opeoluwalukanhttps://www.wikidoc.org/index.php?title=Pentalogy_of_Fallot&diff=1619285Pentalogy of Fallot2020-06-29T19:30:40Z<p>Abdulkareem Opeoluwalukan: /* Overview */</p>
<hr />
<div>__NOTOC__<br />
{{SI}}<br />
{{CMG}} {{AE}}[[User:Abdulkareem Opeoluwalukan|Abdulkareem Opeoluwalukan, M.D]].<br />
==Overview==<br />
Pentalogy of Fallot is defined as the occurrence of Tetralogy of Fallot plus an [[atrial septal defect]].[[File:Pentalogy_of_fallot_image_1.png |200p|thumb|center| Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa. paolo.pazzi@up.ac.za.]]<br />
<br />
==Historical Perspective==<br />
tetrallogy of fallot was first discovered by Niel Stenson, a Denish physician Anatomist, in 1671<ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref>.<br />
<br />
The association between Rigt ventriular outflow tract obstruction and a large ventricular septal defect and tetrallogy of fallot. was made in 1888 by Etinne-Louise]<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref>.<br />
<br />
In 1924, Canadian, Maude Abbott was the first to discover the association between ventricular septal defect , pulmonary stenosis, overriding aorta and right ventricular hypertrophy and the development of tetrallogy of Fallot.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref<br />
In 1939, the first surgical treatment was developed by Dr Helen Taussig in Johns Hopkins&lt;nowiki&gt;&lt;nowiki&gt;<nowiki><ref name="pmid30020660"></nowiki>&lt;/nowiki&gt;&lt;/nowiki&gt;{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Classification==<br />
There is no established system for the classification of [pentallogy of fallot ].<br />
<br />
<br /><br />
<br />
==Pathophysiology==<br />
<br />
<br />
<br />
<br />
It is thought that tetrallogy of fallot is the result of anterocephalad deviation of the aortico pulmonary septum<ref name="pmid25870631">{{cite journal |vauthors=Beig JR, Ahmed W, Hafeez I, Gupta A, Tramboo NA, Rather HA |title=Pentalogy of fallot with a single coronary artery: a rare case report |journal=J Tehran Heart Cent |volume=9 |issue=3 |pages=132–4 |date=2014 |pmid=25870631 |pmc=4393836 |doi= |url=}}</ref> thus leading to <br />
* ventricular septal defect<br />
* right ventricular outflow tract obstruction <br />
*overriding aorta <br />
* right ventricular hypertrophy with an additional ASD( atrial septal defect) with ostium secundum type being the most common followed by ostium primum <ref name="pmid25870631">{{cite journal |vauthors=Beig JR, Ahmed W, Hafeez I, Gupta A, Tramboo NA, Rather HA |title=Pentalogy of fallot with a single coronary artery: a rare case report |journal=J Tehran Heart Cent |volume=9 |issue=3 |pages=132–4 |date=2014 |pmid=25870631 |pmc=4393836 |doi= |url=}}</ref>. thus making it a pentallogy of fallot. even though there are no reports on the molecular pathophysiology of pentallogy of fallot, conotruncal heart defects like tetrallogy of fallot are associated with neural crest migration defect. systemic pathophysiology of tetrallogy of fallot depends on the extent of right ventricular outflow tract obstruction. severe pulmonic stenosis leads to a significant decrease in pulmonary circulation and worsening right to left shunt leading to cyanosis. A collateral PDA makes Tetralogy of fallot compatible with life as it preserves pulmonic circulation <ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. 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C.|last170=Maguire|first170=Jamie|last171=Mody|first171=Istvan|last172=Janssens|first172=Katrien|last173=Vanhoenacker|first173=Filip|last174=Van Hul|first174=Wim|last175=Gdynia|first175=Hans-Jürgen|last176=Ludolph|first176=Albert C.|last177=Leonard|first177=James V.|last178=Cate|first178=Hugo Ten|last179=Geboes|first179=Karel|last180=Van Assche|first180=Gert|last181=Cate|first181=Hugo Ten|last182=Berden|first182=Jo H. M.|last183=Van Kuppevelt|first183=Toin H.|last184=Rops|first184=Angelique L.|last185=Cate|first185=Hugo Ten|last186=Cate|first186=Hugo Ten|last187=Frank|first187=Jorge|last188=Schwarz|first188=Thomas|last189=Ambros-Rudolph|first189=Christina M.|last190=Lamounier-Zepter|first190=Valéria|last191=Thomas|first191=Christie P.|last192=Thomas|first192=Christie P.|last193=Thomas|first193=Christie P.|last194=Koch|first194=Christian A.|last195=Weinstein|first195=Lee S.|last196=Silve|first196=Caroline|last197=Leung|first197=Alexander K. C.|last198=Uitto|first198=Jouni|last199=Jiang|first199=Qiujie|last200=Leung|first200=Alexander K. C.|last201=Robson|first201=William Lane M.|last202=Leung|first202=Alexander K. C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
==Causes==<br />
<br />
<br />
<br />
<br />
The cause of pentalogy of fallot has not been identified. To review risk factors for the development of pentalogy of fallot, click [[tetralogy of fallot causes#Overview|here]].<br />
<br />
==Differentiating pentalogy of fallot from other Diseases==<br />
pentalogy of Fallot must be differentiated from other diseases that cause .<br />
<br />
===right to left shunt=== <br />
* transposition of great arteries with pulmonic stenosis,<br />
* double outlet right ventricle including Taussig-Bing anomaly, <br />
*tricuspid atresia,<br />
* Ebstein Anomaly,<br />
* pulmonary atresia with intact ventricular septum ,<br />
<br />
=== Respiratory diseases===<br />
* Bronchiolitis,<br />
*viral and bacterial pneumonia <br />
* pneumothorax because when they are in heart failure they present with signs of respiratory distress, cyanosis and failure to thrive<br />
<br />
=== Bidirectional shunt diseases===<br />
* total anomalous pulmonary venous return,<br />
* hypoplastic left heart syndrome,<br />
* single ventricle <br />
* truncus arteriosus <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Epidemiology and Demographics==<br />
The epidemiology of pentalogy of fallot has not been well studied.<br />
<br />
==Risk Factors==<br />
<br />
<br />
<br />
<br />
Common risk factors in the development of pentalogy of fallot includes<ref name="SilvaNeves2019">{{cite journal|last1=Silva|first1=Joana A.|last2=Neves|first2=Ana L.|last3=Flor-de-Lima|first3=Filipa|last4=Soares|first4=Paulo|last5=Guimarães|first5=Hercília|title=Risk Factors and Outcomes of Tetralogy of Fallot: From Fetal to Neonatal Life|journal=Pediatric Cardiology|volume=41|issue=1|year=2019|pages=155–164|issn=0172-0643|doi=10.1007/s00246-019-02239-4}}</ref><br />
<br />
* Alcoholism in mother <br />
* Maternal Diabetes <br />
* Advanced maternal age i.e greater than 40 years <br />
* Malnutrition in pregnancy <br />
* Family history of tetralogy of fallot <br />
* Viral illness during pregnancy like Rubella. <br />
* presence of Down syndrome or DiGeorge syndrome<br />
<br />
==Screening==<br />
There is insufficient evidence to recommend routine screening for pentalogy of fallot.<br />
<br />
==Natural History, Complications, and Prognosis==<br />
If left untreated, patients with pentalogy of fallot may progress to develop finger clubbing, stunted growth, cardiac arrhythmias, hypoplastic pulmonary artery and polycythemia with relative iron deficiency.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
Prognosis is generally excellent provided the VSD has been closed and the right ventricular outflow tract has been relieved,<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
<br />
<br />
There are no established criteria for the diagnosis of pentalogy fallot.<br />
<br />
===History and Symptoms===<br />
<br />
The hallmark of pentalogy of fallot is cyanosis. A positive history of cyanosis and easy fatigability leading to squatting during exercise is suggestive of cyanotic congenital heart defct <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
. The most common symptoms of pentalogy of fallot include cyanosis, easy fatigabillity , and hypercyanotic spells with crying , feeding and defecating<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
==Physical Examination==<br />
<br />
=== Appearance===<br />
* patients with pentalogy of fallot usually appear small due to failure to thrive. <br />
* patients may be found in squatting position( compensatory mechanism)<br />
<br />
=== Vital Signs===<br />
* Tachycardia with regular pulse <br />
* Tachypnea <br />
* low grade fever in patients with concomitant infective endocarditis<br />
<br />
=== HEENT===<br />
* Retinal vessel engorgement may be present<br />
<br />
=== Heart===<br />
<br />
A thrill may be present at left sternal border.<br />
*A right ventricular impulse may be prominent.<br />
*Second heart sound (S2) is single as P2 is absent.<br />
*A harsh systolic ejection murmur best heard at the left sternal border is usually present.<br />
*P2 is faint and delayed in mild cyanosis and inaudible in severe cyanosis.<br />
*A diastolic murmur may be heard due to aortic regurgitation.<br />
<br />
=== Extremities===<br />
*Clubbing<br />
*Cyanosis is most prominent at lips and nail beds<br />
<br />
===Laboratory Findings===<br />
<br />
<br />
Some patients with pentalogy of fallot may have polycythemia <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
which is usually suggestive of worsening hypoxia and compensatory production of erythropoetin.<br />
<br />
.<br />
<br />
===Electrocardiogram===<br />
<br />
An ECG may be helpful in the diagnosis of pentalogy of fallot <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
Findings on an ECG suggestive of pentalogy of fallot include right axis deviation and right ventricular hypertrophy.<br />
[[File: Right_ventrriular_hypertophy.png|200p|thumb|right|Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran,]]<br />
<br />
===X-ray===<br />
<br />
<br />
<br />
<br />
An x-ray may be helpful in the diagnosis of pentalogy of Fallot. Findings on an x-ray suggestive of pentalogy of fallot include boot shaped heart or coeur en sabot.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref> [[File:Boot_shaped_heart.png|200p|thumb|left| Typical preoperative chest X‐ray of a 16‐month‐old boy with tetralogy of Fallot.]]<br />
<br />
<br />
<br />
<br />
.<br />
<br />
===Echocardiography or Ultrasound===<br />
<br />
<br />
<br />
<br />
Echocardiography may be helpful in the diagnosis of pentalogy of fallot. Findings on an echocardiography diagnostic of pentallogy of fallot include Ventricular septal defect, Atrial septal defect , Right ventricular outflow tract obstruction and overriding aorta<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref> [[File:Pentalogy_of_fallot_image_2.png|200p|thumb|left | Department of Biochemistry, University of Allahabad, Allahabad-211002, India.]]<br />
<br />
===CT scan===<br />
<br />
<br />
Thoracic CT angiography may be helpful in the diagnosis of pentallogy of fallot. Findings on CT scan diagnostic of pentalogy of fallot include ventricular septal defect, right ventricular hypertrophy, pulmonary atresia and major aortopulmonary collateral arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref> <br />
<br />
<br />
<br />
===MRI===<br />
<br />
<br />
cardiac MRI may be helpful in the diagnosis of pentalogy of fallot. Findings on MRI diagnostic of pentalogy of fallot include RVOT stenosis, VSD, ASD,Overriding aorta, right ventricular hypertrophy and hypoplastic pulmonary arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
<br />
<br />
===Other Imaging Findings===<br />
Other imaging findings for pentalogy of fallot include Right ventricular angiopraphy, which demonstrates infundibular and pulmonary artery anatomy, and left ventricular angiography, which demonstrates VSD, ASD, and Overiding aorta <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
===Other Diagnostic Studies===<br />
<br />
There are no other diagnostic studies associated with pentalogy of Fallot<br />
<br />
==Treatment==<br />
===Medical Therapy===<br />
The mainstay of treatment for pentalogy of fallot is Surgery.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
Pharmacologic medical therapy is recommended among patients with severe RVOTO and hypercyanotic spells<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
Pharmacologic medical therapies for pentalogy of fallot include <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
* prostaglandin E1 in neonates with ductal dependent pulmonary blood flow<br />
* Morphine and ketamine for sedation<br />
*vasopressors like phenylephrine<br />
*propanolol to decrease the need for palliative surgical intervention.<br />
* iron treatment to decrease frequency of spells. <br />
<br />
Patients with hypercyanotic spells are treated with oxygen,volume expansion and morphine sedation.<br />
<br />
===Surgery===<br />
<br />
<br />
<br />
Surgery is the mainstay of treatment for pentalogy of fallot. interventional procedures are used to relieve pulmonary obstructions and embolize colaterals. <br />
different surgical procedures can be done to treat pentalogy of fallot and it includes <br />
* pulmonary valvotomy( for stenotic pulmonic valve)<br />
* pulmonary valvectomy( for small and thickened pulmonic valve) <br />
* closure of ASD/VSD<br />
* shunt surgery for severe cyanosis or in patients with frequent spells in the first year of life <br />
* Blalock -Taussig Shunt- communication between the right or left pulmonary artery and the right or left subclavian artery. <br />
* Waterson-Cooley Shunt- communication between the ascending aorta with the right pulmonary artery <br />
* Potts shunt-communication between the descending aorta and left pulmonary artery <br />
* Central shunt- Communication between the main pulmonary artery and ascending aorta.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
===Primary Prevention===<br />
There are no established measures for the primary prevention of [pentalogy of fallot ].<br />
<br />
===Secondary Prevention===<br />
There are no established measures for the secondary prevention of [pentalogy of fallot].<br />
===Prevention of Cyanosis===<br />
The following factors may reduce systemic vascular resistance (SVR) and exacerbate shunting which in turn exacerbate cyanosis and should be avoided if at all possible:<br />
<br />
*Acidosis<br />
*Bathing in hot water<br />
*Fever<br />
*Stress<br />
*Infection<br />
*Posture (upright, not squatting)<br />
*Exercise<br />
*Beta-adrenergic agonists<br />
*Dehydration<br />
*Closure of the patent ductus arteriosus<br />
===Prevention of Infective Endocarditis===<br />
Antibiotic prophylaxis should be administered before respiratory and oral procedures.<br />
<br />
==References==<br />
{{reflist|2}}<br />
<br />
{{WikiDoc Help Menu}}<br />
{{WikiDoc Sources}}<br />
[[Category:Cardiology]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Abdulkareem Opeoluwalukanhttps://www.wikidoc.org/index.php?title=Pentalogy_of_Fallot&diff=1619283Pentalogy of Fallot2020-06-29T19:29:18Z<p>Abdulkareem Opeoluwalukan: /* Overview */</p>
<hr />
<div>__NOTOC__<br />
{{SI}}<br />
{{CMG}} {{AE}}[[User:Abdulkareem Opeoluwalukan|Abdulkareem Opeoluwalukan, M.D]].<br />
==Overview==<br />
Pentalogy of Fallot is defined as the occurrence of Tetralogy of Fallot plus an [[atrial septal defect]].[[File:Pentalogy_of_fallot_image_1.png |200p|thumb| Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa. paolo.pazzi@up.ac.za.]]<br />
<br />
==Historical Perspective==<br />
tetrallogy of fallot was first discovered by Niel Stenson, a Denish physician Anatomist, in 1671<ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref>.<br />
<br />
The association between Rigt ventriular outflow tract obstruction and a large ventricular septal defect and tetrallogy of fallot. was made in 1888 by Etinne-Louise]<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref>.<br />
<br />
In 1924, Canadian, Maude Abbott was the first to discover the association between ventricular septal defect , pulmonary stenosis, overriding aorta and right ventricular hypertrophy and the development of tetrallogy of Fallot.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref<br />
In 1939, the first surgical treatment was developed by Dr Helen Taussig in Johns Hopkins&lt;nowiki&gt;&lt;nowiki&gt;<nowiki><ref name="pmid30020660"></nowiki>&lt;/nowiki&gt;&lt;/nowiki&gt;{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Classification==<br />
There is no established system for the classification of [pentallogy of fallot ].<br />
<br />
<br /><br />
<br />
==Pathophysiology==<br />
<br />
<br />
<br />
<br />
It is thought that tetrallogy of fallot is the result of anterocephalad deviation of the aortico pulmonary septum<ref name="pmid25870631">{{cite journal |vauthors=Beig JR, Ahmed W, Hafeez I, Gupta A, Tramboo NA, Rather HA |title=Pentalogy of fallot with a single coronary artery: a rare case report |journal=J Tehran Heart Cent |volume=9 |issue=3 |pages=132–4 |date=2014 |pmid=25870631 |pmc=4393836 |doi= |url=}}</ref> thus leading to <br />
* ventricular septal defect<br />
* right ventricular outflow tract obstruction <br />
*overriding aorta <br />
* right ventricular hypertrophy with an additional ASD( atrial septal defect) with ostium secundum type being the most common followed by ostium primum <ref name="pmid25870631">{{cite journal |vauthors=Beig JR, Ahmed W, Hafeez I, Gupta A, Tramboo NA, Rather HA |title=Pentalogy of fallot with a single coronary artery: a rare case report |journal=J Tehran Heart Cent |volume=9 |issue=3 |pages=132–4 |date=2014 |pmid=25870631 |pmc=4393836 |doi= |url=}}</ref>. thus making it a pentallogy of fallot. even though there are no reports on the molecular pathophysiology of pentallogy of fallot, conotruncal heart defects like tetrallogy of fallot are associated with neural crest migration defect. systemic pathophysiology of tetrallogy of fallot depends on the extent of right ventricular outflow tract obstruction. severe pulmonic stenosis leads to a significant decrease in pulmonary circulation and worsening right to left shunt leading to cyanosis. A collateral PDA makes Tetralogy of fallot compatible with life as it preserves pulmonic circulation <ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. 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C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. C.|last91=Sauve|first91=Reginald S.|last92=Matejas|first92=Verena|last93=Zenker|first93=Martin|last94=Leung|first94=Alexander K. C.|last95=Leung|first95=Alexander K. C.|last96=Robson|first96=William Lane M.|last97=Beissert|first97=Stefan|last98=Leung|first98=Alexander K. C.|last99=Robson|first99=William Lane M.|last100=Woo|first100=Tom Y.|last101=Leung|first101=Alexander K. 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C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
==Causes==<br />
<br />
<br />
<br />
<br />
The cause of pentalogy of fallot has not been identified. To review risk factors for the development of pentalogy of fallot, click [[tetralogy of fallot causes#Overview|here]].<br />
<br />
==Differentiating pentalogy of fallot from other Diseases==<br />
pentalogy of Fallot must be differentiated from other diseases that cause .<br />
<br />
===right to left shunt=== <br />
* transposition of great arteries with pulmonic stenosis,<br />
* double outlet right ventricle including Taussig-Bing anomaly, <br />
*tricuspid atresia,<br />
* Ebstein Anomaly,<br />
* pulmonary atresia with intact ventricular septum ,<br />
<br />
=== Respiratory diseases===<br />
* Bronchiolitis,<br />
*viral and bacterial pneumonia <br />
* pneumothorax because when they are in heart failure they present with signs of respiratory distress, cyanosis and failure to thrive<br />
<br />
=== Bidirectional shunt diseases===<br />
* total anomalous pulmonary venous return,<br />
* hypoplastic left heart syndrome,<br />
* single ventricle <br />
* truncus arteriosus <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Epidemiology and Demographics==<br />
The epidemiology of pentalogy of fallot has not been well studied.<br />
<br />
==Risk Factors==<br />
<br />
<br />
<br />
<br />
Common risk factors in the development of pentalogy of fallot includes<ref name="SilvaNeves2019">{{cite journal|last1=Silva|first1=Joana A.|last2=Neves|first2=Ana L.|last3=Flor-de-Lima|first3=Filipa|last4=Soares|first4=Paulo|last5=Guimarães|first5=Hercília|title=Risk Factors and Outcomes of Tetralogy of Fallot: From Fetal to Neonatal Life|journal=Pediatric Cardiology|volume=41|issue=1|year=2019|pages=155–164|issn=0172-0643|doi=10.1007/s00246-019-02239-4}}</ref><br />
<br />
* Alcoholism in mother <br />
* Maternal Diabetes <br />
* Advanced maternal age i.e greater than 40 years <br />
* Malnutrition in pregnancy <br />
* Family history of tetralogy of fallot <br />
* Viral illness during pregnancy like Rubella. <br />
* presence of Down syndrome or DiGeorge syndrome<br />
<br />
==Screening==<br />
There is insufficient evidence to recommend routine screening for pentalogy of fallot.<br />
<br />
==Natural History, Complications, and Prognosis==<br />
If left untreated, patients with pentalogy of fallot may progress to develop finger clubbing, stunted growth, cardiac arrhythmias, hypoplastic pulmonary artery and polycythemia with relative iron deficiency.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
Prognosis is generally excellent provided the VSD has been closed and the right ventricular outflow tract has been relieved,<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
<br />
<br />
There are no established criteria for the diagnosis of pentalogy fallot.<br />
<br />
===History and Symptoms===<br />
<br />
The hallmark of pentalogy of fallot is cyanosis. A positive history of cyanosis and easy fatigability leading to squatting during exercise is suggestive of cyanotic congenital heart defct <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
. The most common symptoms of pentalogy of fallot include cyanosis, easy fatigabillity , and hypercyanotic spells with crying , feeding and defecating<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
==Physical Examination==<br />
<br />
=== Appearance===<br />
* patients with pentalogy of fallot usually appear small due to failure to thrive. <br />
* patients may be found in squatting position( compensatory mechanism)<br />
<br />
=== Vital Signs===<br />
* Tachycardia with regular pulse <br />
* Tachypnea <br />
* low grade fever in patients with concomitant infective endocarditis<br />
<br />
=== HEENT===<br />
* Retinal vessel engorgement may be present<br />
<br />
=== Heart===<br />
<br />
A thrill may be present at left sternal border.<br />
*A right ventricular impulse may be prominent.<br />
*Second heart sound (S2) is single as P2 is absent.<br />
*A harsh systolic ejection murmur best heard at the left sternal border is usually present.<br />
*P2 is faint and delayed in mild cyanosis and inaudible in severe cyanosis.<br />
*A diastolic murmur may be heard due to aortic regurgitation.<br />
<br />
=== Extremities===<br />
*Clubbing<br />
*Cyanosis is most prominent at lips and nail beds<br />
<br />
===Laboratory Findings===<br />
<br />
<br />
Some patients with pentalogy of fallot may have polycythemia <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
which is usually suggestive of worsening hypoxia and compensatory production of erythropoetin.<br />
<br />
.<br />
<br />
===Electrocardiogram===<br />
<br />
An ECG may be helpful in the diagnosis of pentalogy of fallot <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
Findings on an ECG suggestive of pentalogy of fallot include right axis deviation and right ventricular hypertrophy.<br />
[[File: Right_ventrriular_hypertophy.png|200p|thumb|right|Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran,]]<br />
<br />
===X-ray===<br />
<br />
<br />
<br />
<br />
An x-ray may be helpful in the diagnosis of pentalogy of Fallot. Findings on an x-ray suggestive of pentalogy of fallot include boot shaped heart or coeur en sabot.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref> [[File:Boot_shaped_heart.png|200p|thumb|left| Typical preoperative chest X‐ray of a 16‐month‐old boy with tetralogy of Fallot.]]<br />
<br />
<br />
<br />
<br />
.<br />
<br />
===Echocardiography or Ultrasound===<br />
<br />
<br />
<br />
<br />
Echocardiography may be helpful in the diagnosis of pentalogy of fallot. Findings on an echocardiography diagnostic of pentallogy of fallot include Ventricular septal defect, Atrial septal defect , Right ventricular outflow tract obstruction and overriding aorta<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref> [[File:Pentalogy_of_fallot_image_2.png|200p|thumb|left | Department of Biochemistry, University of Allahabad, Allahabad-211002, India.]]<br />
<br />
===CT scan===<br />
<br />
<br />
Thoracic CT angiography may be helpful in the diagnosis of pentallogy of fallot. Findings on CT scan diagnostic of pentalogy of fallot include ventricular septal defect, right ventricular hypertrophy, pulmonary atresia and major aortopulmonary collateral arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref> <br />
<br />
<br />
<br />
===MRI===<br />
<br />
<br />
cardiac MRI may be helpful in the diagnosis of pentalogy of fallot. Findings on MRI diagnostic of pentalogy of fallot include RVOT stenosis, VSD, ASD,Overriding aorta, right ventricular hypertrophy and hypoplastic pulmonary arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
<br />
<br />
===Other Imaging Findings===<br />
Other imaging findings for pentalogy of fallot include Right ventricular angiopraphy, which demonstrates infundibular and pulmonary artery anatomy, and left ventricular angiography, which demonstrates VSD, ASD, and Overiding aorta <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
===Other Diagnostic Studies===<br />
<br />
There are no other diagnostic studies associated with pentalogy of Fallot<br />
<br />
==Treatment==<br />
===Medical Therapy===<br />
The mainstay of treatment for pentalogy of fallot is Surgery.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
Pharmacologic medical therapy is recommended among patients with severe RVOTO and hypercyanotic spells<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
Pharmacologic medical therapies for pentalogy of fallot include <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
* prostaglandin E1 in neonates with ductal dependent pulmonary blood flow<br />
* Morphine and ketamine for sedation<br />
*vasopressors like phenylephrine<br />
*propanolol to decrease the need for palliative surgical intervention.<br />
* iron treatment to decrease frequency of spells. <br />
<br />
Patients with hypercyanotic spells are treated with oxygen,volume expansion and morphine sedation.<br />
<br />
===Surgery===<br />
<br />
<br />
<br />
Surgery is the mainstay of treatment for pentalogy of fallot. interventional procedures are used to relieve pulmonary obstructions and embolize colaterals. <br />
different surgical procedures can be done to treat pentalogy of fallot and it includes <br />
* pulmonary valvotomy( for stenotic pulmonic valve)<br />
* pulmonary valvectomy( for small and thickened pulmonic valve) <br />
* closure of ASD/VSD<br />
* shunt surgery for severe cyanosis or in patients with frequent spells in the first year of life <br />
* Blalock -Taussig Shunt- communication between the right or left pulmonary artery and the right or left subclavian artery. <br />
* Waterson-Cooley Shunt- communication between the ascending aorta with the right pulmonary artery <br />
* Potts shunt-communication between the descending aorta and left pulmonary artery <br />
* Central shunt- Communication between the main pulmonary artery and ascending aorta.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
===Primary Prevention===<br />
There are no established measures for the primary prevention of [pentalogy of fallot ].<br />
<br />
===Secondary Prevention===<br />
There are no established measures for the secondary prevention of [pentalogy of fallot].<br />
===Prevention of Cyanosis===<br />
The following factors may reduce systemic vascular resistance (SVR) and exacerbate shunting which in turn exacerbate cyanosis and should be avoided if at all possible:<br />
<br />
*Acidosis<br />
*Bathing in hot water<br />
*Fever<br />
*Stress<br />
*Infection<br />
*Posture (upright, not squatting)<br />
*Exercise<br />
*Beta-adrenergic agonists<br />
*Dehydration<br />
*Closure of the patent ductus arteriosus<br />
===Prevention of Infective Endocarditis===<br />
Antibiotic prophylaxis should be administered before respiratory and oral procedures.<br />
<br />
==References==<br />
{{reflist|2}}<br />
<br />
{{WikiDoc Help Menu}}<br />
{{WikiDoc Sources}}<br />
[[Category:Cardiology]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Abdulkareem Opeoluwalukanhttps://www.wikidoc.org/index.php?title=Pentalogy_of_Fallot&diff=1619280Pentalogy of Fallot2020-06-29T19:20:28Z<p>Abdulkareem Opeoluwalukan: /* Skin */</p>
<hr />
<div>__NOTOC__<br />
{{SI}}<br />
{{CMG}} {{AE}}[[User:Abdulkareem Opeoluwalukan|Abdulkareem Opeoluwalukan, M.D]].<br />
==Overview==<br />
Pentalogy of Fallot is defined as the occurrence of Tetralogy of Fallot plus an [[atrial septal defect]].[[File:Pentalogy_of_fallot_image_1.png |200p|thumb|center|The twelve-lead electrocardiogram shows atrial fibrillation rhythm, normal axis, right bundle branch block pattern, secondary ST-T changes, and right ventricular hypertrophy|]]<br />
<br />
==Historical Perspective==<br />
tetrallogy of fallot was first discovered by Niel Stenson, a Denish physician Anatomist, in 1671<ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref>.<br />
<br />
The association between Rigt ventriular outflow tract obstruction and a large ventricular septal defect and tetrallogy of fallot. was made in 1888 by Etinne-Louise]<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref>.<br />
<br />
In 1924, Canadian, Maude Abbott was the first to discover the association between ventricular septal defect , pulmonary stenosis, overriding aorta and right ventricular hypertrophy and the development of tetrallogy of Fallot.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref<br />
In 1939, the first surgical treatment was developed by Dr Helen Taussig in Johns Hopkins&lt;nowiki&gt;&lt;nowiki&gt;<nowiki><ref name="pmid30020660"></nowiki>&lt;/nowiki&gt;&lt;/nowiki&gt;{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Classification==<br />
There is no established system for the classification of [pentallogy of fallot ].<br />
<br />
<br /><br />
<br />
==Pathophysiology==<br />
<br />
<br />
<br />
<br />
It is thought that tetrallogy of fallot is the result of anterocephalad deviation of the aortico pulmonary septum<ref name="pmid25870631">{{cite journal |vauthors=Beig JR, Ahmed W, Hafeez I, Gupta A, Tramboo NA, Rather HA |title=Pentalogy of fallot with a single coronary artery: a rare case report |journal=J Tehran Heart Cent |volume=9 |issue=3 |pages=132–4 |date=2014 |pmid=25870631 |pmc=4393836 |doi= |url=}}</ref> thus leading to <br />
* ventricular septal defect<br />
* right ventricular outflow tract obstruction <br />
*overriding aorta <br />
* right ventricular hypertrophy with an additional ASD( atrial septal defect) with ostium secundum type being the most common followed by ostium primum <ref name="pmid25870631">{{cite journal |vauthors=Beig JR, Ahmed W, Hafeez I, Gupta A, Tramboo NA, Rather HA |title=Pentalogy of fallot with a single coronary artery: a rare case report |journal=J Tehran Heart Cent |volume=9 |issue=3 |pages=132–4 |date=2014 |pmid=25870631 |pmc=4393836 |doi= |url=}}</ref>. thus making it a pentallogy of fallot. even though there are no reports on the molecular pathophysiology of pentallogy of fallot, conotruncal heart defects like tetrallogy of fallot are associated with neural crest migration defect. systemic pathophysiology of tetrallogy of fallot depends on the extent of right ventricular outflow tract obstruction. severe pulmonic stenosis leads to a significant decrease in pulmonary circulation and worsening right to left shunt leading to cyanosis. A collateral PDA makes Tetralogy of fallot compatible with life as it preserves pulmonic circulation <ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. 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C.|last203=Yildiz|first203=Orhan|last204=Kayabas|first204=Uner|last205=Hegele|first205=Richard G.|last206=Tournier|first206=Jean-Nicolas|last207=Halefoğlu|first207=Ahmet Mesrur|last208=Hutson|first208=Mary Redmond|last209=Kirby|first209=Margaret L.|last210=Okada|first210=Fumito|last211=Ando|first211=Yumiko|last212=Ono|first212=Asami|last213=Mori|first213=Hiromu|last214=Moore|first214=Timothy M.|last215=Townsley|first215=Mary I.|last216=Krauth|first216=Maria-T.|last217=Pabinger|first217=Ingrid|last218=Ballmann|first218=Manfred|last219=Hegele|first219=Richard G.|last220=Trow|first220=Terence K.|last221=McLaughlin|first221=Vallerie V.|last222=Hegele|first222=Richard G.|last223=Fetouh Yassin|first223=Atteyet-Alla|last224=Uebing|first224=Anselm|last225=Gatzoulis|first225=Michael A.|last226=Gardiner|first226=Helena M.|last227=Ma|first227=Lucia K.|last228=Ma|first228=Patrick T. S.|last229=Leung|first229=Alexander K. C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
==Causes==<br />
<br />
<br />
<br />
<br />
The cause of pentalogy of fallot has not been identified. To review risk factors for the development of pentalogy of fallot, click [[tetralogy of fallot causes#Overview|here]].<br />
<br />
==Differentiating pentalogy of fallot from other Diseases==<br />
pentalogy of Fallot must be differentiated from other diseases that cause .<br />
<br />
===right to left shunt=== <br />
* transposition of great arteries with pulmonic stenosis,<br />
* double outlet right ventricle including Taussig-Bing anomaly, <br />
*tricuspid atresia,<br />
* Ebstein Anomaly,<br />
* pulmonary atresia with intact ventricular septum ,<br />
<br />
=== Respiratory diseases===<br />
* Bronchiolitis,<br />
*viral and bacterial pneumonia <br />
* pneumothorax because when they are in heart failure they present with signs of respiratory distress, cyanosis and failure to thrive<br />
<br />
=== Bidirectional shunt diseases===<br />
* total anomalous pulmonary venous return,<br />
* hypoplastic left heart syndrome,<br />
* single ventricle <br />
* truncus arteriosus <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Epidemiology and Demographics==<br />
The epidemiology of pentalogy of fallot has not been well studied.<br />
<br />
==Risk Factors==<br />
<br />
<br />
<br />
<br />
Common risk factors in the development of pentalogy of fallot includes<ref name="SilvaNeves2019">{{cite journal|last1=Silva|first1=Joana A.|last2=Neves|first2=Ana L.|last3=Flor-de-Lima|first3=Filipa|last4=Soares|first4=Paulo|last5=Guimarães|first5=Hercília|title=Risk Factors and Outcomes of Tetralogy of Fallot: From Fetal to Neonatal Life|journal=Pediatric Cardiology|volume=41|issue=1|year=2019|pages=155–164|issn=0172-0643|doi=10.1007/s00246-019-02239-4}}</ref><br />
<br />
* Alcoholism in mother <br />
* Maternal Diabetes <br />
* Advanced maternal age i.e greater than 40 years <br />
* Malnutrition in pregnancy <br />
* Family history of tetralogy of fallot <br />
* Viral illness during pregnancy like Rubella. <br />
* presence of Down syndrome or DiGeorge syndrome<br />
<br />
==Screening==<br />
There is insufficient evidence to recommend routine screening for pentalogy of fallot.<br />
<br />
==Natural History, Complications, and Prognosis==<br />
If left untreated, patients with pentalogy of fallot may progress to develop finger clubbing, stunted growth, cardiac arrhythmias, hypoplastic pulmonary artery and polycythemia with relative iron deficiency.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
Prognosis is generally excellent provided the VSD has been closed and the right ventricular outflow tract has been relieved,<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
<br />
<br />
There are no established criteria for the diagnosis of pentalogy fallot.<br />
<br />
===History and Symptoms===<br />
<br />
The hallmark of pentalogy of fallot is cyanosis. A positive history of cyanosis and easy fatigability leading to squatting during exercise is suggestive of cyanotic congenital heart defct <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
. The most common symptoms of pentalogy of fallot include cyanosis, easy fatigabillity , and hypercyanotic spells with crying , feeding and defecating<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
==Physical Examination==<br />
<br />
=== Appearance===<br />
* patients with pentalogy of fallot usually appear small due to failure to thrive. <br />
* patients may be found in squatting position( compensatory mechanism)<br />
<br />
=== Vital Signs===<br />
* Tachycardia with regular pulse <br />
* Tachypnea <br />
* low grade fever in patients with concomitant infective endocarditis<br />
<br />
=== HEENT===<br />
* Retinal vessel engorgement may be present<br />
<br />
=== Heart===<br />
<br />
A thrill may be present at left sternal border.<br />
*A right ventricular impulse may be prominent.<br />
*Second heart sound (S2) is single as P2 is absent.<br />
*A harsh systolic ejection murmur best heard at the left sternal border is usually present.<br />
*P2 is faint and delayed in mild cyanosis and inaudible in severe cyanosis.<br />
*A diastolic murmur may be heard due to aortic regurgitation.<br />
<br />
=== Extremities===<br />
*Clubbing<br />
*Cyanosis is most prominent at lips and nail beds<br />
<br />
===Laboratory Findings===<br />
<br />
<br />
Some patients with pentalogy of fallot may have polycythemia <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
which is usually suggestive of worsening hypoxia and compensatory production of erythropoetin.<br />
<br />
.<br />
<br />
===Electrocardiogram===<br />
<br />
An ECG may be helpful in the diagnosis of pentalogy of fallot <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
Findings on an ECG suggestive of pentalogy of fallot include right axis deviation and right ventricular hypertrophy.<br />
[[File: Right_ventrriular_hypertophy.png|200p|thumb|right|Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran,]]<br />
<br />
===X-ray===<br />
<br />
<br />
<br />
<br />
An x-ray may be helpful in the diagnosis of pentalogy of Fallot. Findings on an x-ray suggestive of pentalogy of fallot include boot shaped heart or coeur en sabot.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref> [[File:Boot_shaped_heart.png|200p|thumb|left| Typical preoperative chest X‐ray of a 16‐month‐old boy with tetralogy of Fallot.]]<br />
<br />
<br />
<br />
<br />
.<br />
<br />
===Echocardiography or Ultrasound===<br />
<br />
<br />
<br />
<br />
Echocardiography may be helpful in the diagnosis of pentalogy of fallot. Findings on an echocardiography diagnostic of pentallogy of fallot include Ventricular septal defect, Atrial septal defect , Right ventricular outflow tract obstruction and overriding aorta<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref> [[File:Pentalogy_of_fallot_image_2.png|200p|thumb|left | Department of Biochemistry, University of Allahabad, Allahabad-211002, India.]]<br />
<br />
===CT scan===<br />
<br />
<br />
Thoracic CT angiography may be helpful in the diagnosis of pentallogy of fallot. Findings on CT scan diagnostic of pentalogy of fallot include ventricular septal defect, right ventricular hypertrophy, pulmonary atresia and major aortopulmonary collateral arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref> <br />
<br />
<br />
<br />
===MRI===<br />
<br />
<br />
cardiac MRI may be helpful in the diagnosis of pentalogy of fallot. Findings on MRI diagnostic of pentalogy of fallot include RVOT stenosis, VSD, ASD,Overriding aorta, right ventricular hypertrophy and hypoplastic pulmonary arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
<br />
<br />
===Other Imaging Findings===<br />
Other imaging findings for pentalogy of fallot include Right ventricular angiopraphy, which demonstrates infundibular and pulmonary artery anatomy, and left ventricular angiography, which demonstrates VSD, ASD, and Overiding aorta <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
===Other Diagnostic Studies===<br />
<br />
There are no other diagnostic studies associated with pentalogy of Fallot<br />
<br />
==Treatment==<br />
===Medical Therapy===<br />
The mainstay of treatment for pentalogy of fallot is Surgery.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
Pharmacologic medical therapy is recommended among patients with severe RVOTO and hypercyanotic spells<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
Pharmacologic medical therapies for pentalogy of fallot include <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
* prostaglandin E1 in neonates with ductal dependent pulmonary blood flow<br />
* Morphine and ketamine for sedation<br />
*vasopressors like phenylephrine<br />
*propanolol to decrease the need for palliative surgical intervention.<br />
* iron treatment to decrease frequency of spells. <br />
<br />
Patients with hypercyanotic spells are treated with oxygen,volume expansion and morphine sedation.<br />
<br />
===Surgery===<br />
<br />
<br />
<br />
Surgery is the mainstay of treatment for pentalogy of fallot. interventional procedures are used to relieve pulmonary obstructions and embolize colaterals. <br />
different surgical procedures can be done to treat pentalogy of fallot and it includes <br />
* pulmonary valvotomy( for stenotic pulmonic valve)<br />
* pulmonary valvectomy( for small and thickened pulmonic valve) <br />
* closure of ASD/VSD<br />
* shunt surgery for severe cyanosis or in patients with frequent spells in the first year of life <br />
* Blalock -Taussig Shunt- communication between the right or left pulmonary artery and the right or left subclavian artery. <br />
* Waterson-Cooley Shunt- communication between the ascending aorta with the right pulmonary artery <br />
* Potts shunt-communication between the descending aorta and left pulmonary artery <br />
* Central shunt- Communication between the main pulmonary artery and ascending aorta.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
===Primary Prevention===<br />
There are no established measures for the primary prevention of [pentalogy of fallot ].<br />
<br />
===Secondary Prevention===<br />
There are no established measures for the secondary prevention of [pentalogy of fallot].<br />
===Prevention of Cyanosis===<br />
The following factors may reduce systemic vascular resistance (SVR) and exacerbate shunting which in turn exacerbate cyanosis and should be avoided if at all possible:<br />
<br />
*Acidosis<br />
*Bathing in hot water<br />
*Fever<br />
*Stress<br />
*Infection<br />
*Posture (upright, not squatting)<br />
*Exercise<br />
*Beta-adrenergic agonists<br />
*Dehydration<br />
*Closure of the patent ductus arteriosus<br />
===Prevention of Infective Endocarditis===<br />
Antibiotic prophylaxis should be administered before respiratory and oral procedures.<br />
<br />
==References==<br />
{{reflist|2}}<br />
<br />
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{{WH}}<br />
{{WS}}</div>Abdulkareem Opeoluwalukanhttps://www.wikidoc.org/index.php?title=User:Abdulkareem_Opeoluwalukan&diff=1619063User:Abdulkareem Opeoluwalukan2020-06-29T13:46:33Z<p>Abdulkareem Opeoluwalukan: /* Lukan Abdul-Kareem Opeoluwa M.D Associate editor-in-chief */</p>
<hr />
<div>[[File:WhatsApp Image 2020-05-07 at 1.36.56 AM.jpeg|300px|thumb|right]]<br />
== Lukan Abdul-Kareem Opeoluwa M.D '''Associate editor-in-chief''' ==<br />
Contact Email- opeoluwalukan@yahoo.com. <br />
<br />
== Medical Education ==<br />
Doctor of Medicine (M.D) from Kharkov National Medical University, Kharkov , Ukraine.<br />
<br />
== Current Position ==<br />
<blockquote>Associate Editor in chief in wikidoc </blockquote><br />
<br />
== Work Experience ==<br />
'''February 2019 - present''' medical officer at Red wood clinics Abeokuta Nigeria. <br />
<br />
'''october 1- 30 2019''' observership at Apex urgent care , Houston Texas USA. <br />
<br />
'''November 2017- November 2018''' Intern at Federal Medical center Abeokuta, Nigeria.<br />
<br />
== Professional Affiliations and Memberships ==<br />
'''July 2017- present''', member Nigerian medical association <br />
<br />
'''July 2017 - present''' , member medical and dental council of Nigeria <br />
<br />
'''February 2020''' - present , Educational commission for foreign medical graduates certified<br />
<br />
Paul Harris Fellow , Rotary International.<br />
<br />
== Hobbies and other activities ==<br />
Singing <br />
<br />
sports( table tennis and sprinting) <br />
<br />
travelling <br />
<br />
== communication languages ==<br />
English <br />
<br />
Russian <br />
<br />
Yoruba</div>Abdulkareem Opeoluwalukanhttps://www.wikidoc.org/index.php?title=Pentalogy_of_Fallot&diff=1619059Pentalogy of Fallot2020-06-29T13:39:04Z<p>Abdulkareem Opeoluwalukan: /* Pathophysiology */</p>
<hr />
<div>__NOTOC__<br />
{{SI}}<br />
{{CMG}} {{AE}}[[User:Abdulkareem Opeoluwalukan|Abdulkareem Opeoluwalukan, M.D]].<br />
==Overview==<br />
Pentalogy of Fallot is defined as the occurrence of Tetralogy of Fallot plus an [[atrial septal defect]].[[File:Pentalogy_of_fallot_image_1.png |200p|thumb|center|The twelve-lead electrocardiogram shows atrial fibrillation rhythm, normal axis, right bundle branch block pattern, secondary ST-T changes, and right ventricular hypertrophy|]]<br />
<br />
==Historical Perspective==<br />
tetrallogy of fallot was first discovered by Niel Stenson, a Denish physician Anatomist, in 1671<ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref>.<br />
<br />
The association between Rigt ventriular outflow tract obstruction and a large ventricular septal defect and tetrallogy of fallot. was made in 1888 by Etinne-Louise]<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref>.<br />
<br />
In 1924, Canadian, Maude Abbott was the first to discover the association between ventricular septal defect , pulmonary stenosis, overriding aorta and right ventricular hypertrophy and the development of tetrallogy of Fallot.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref<br />
In 1939, the first surgical treatment was developed by Dr Helen Taussig in Johns Hopkins<nowiki>&lt;nowiki&gt;<ref name="pmid30020660">&lt;/nowiki&gt;</nowiki>{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Classification==<br />
There is no established system for the classification of [pentallogy of fallot ].<br />
<br />
<br /><br />
<br />
==Pathophysiology==<br />
<br />
<br />
<br />
<br />
It is thought that tetrallogy of fallot is the result of anterocephalad deviation of the aortico pulmonary septum<ref name="pmid25870631">{{cite journal |vauthors=Beig JR, Ahmed W, Hafeez I, Gupta A, Tramboo NA, Rather HA |title=Pentalogy of fallot with a single coronary artery: a rare case report |journal=J Tehran Heart Cent |volume=9 |issue=3 |pages=132–4 |date=2014 |pmid=25870631 |pmc=4393836 |doi= |url=}}</ref> thus leading to <br />
* ventricular septal defect<br />
* right ventricular outflow tract obstruction <br />
*overriding aorta <br />
* right ventricular hypertrophy with an additional ASD( atrial septal defect) with ostium secundum type being the most common followed by ostium primum <ref name="pmid25870631">{{cite journal |vauthors=Beig JR, Ahmed W, Hafeez I, Gupta A, Tramboo NA, Rather HA |title=Pentalogy of fallot with a single coronary artery: a rare case report |journal=J Tehran Heart Cent |volume=9 |issue=3 |pages=132–4 |date=2014 |pmid=25870631 |pmc=4393836 |doi= |url=}}</ref>. thus making it a pentallogy of fallot. even though there are no reports on the molecular pathophysiology of pentallogy of fallot, conotruncal heart defects like tetrallogy of fallot are associated with neural crest migration defect. systemic pathophysiology of tetrallogy of fallot depends on the extent of right ventricular outflow tract obstruction. severe pulmonic stenosis leads to a significant decrease in pulmonary circulation and worsening right to left shunt leading to cyanosis. A collateral PDA makes Tetralogy of fallot compatible with life as it preserves pulmonic circulation <ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. 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C.|last230=Prieto|first230=Lourdes|last231=Latson|first231=Larry|last232=Keller|first232=Nancy R.|last233=Robertson|first233=David|last234=Fairbanks|first234=Lynette D.|last235=Simmonds|first235=H. Anne|last236=Brunner|first236=Martina|last237=Zouboulis|first237=Christos C.|last238=Everts|first238=Vincent|last239=Helfrich|first239=Miep|last240=Leung|first240=Alexander K. C.|last241=Wong|first241=Andrew L.|last242=Von Den Driesch|first242=Peter|last243=Bitsch|first243=Roland|last244=Bitsch|first244=Roland|last245=Bitsch|first245=Roland|last246=García-Cazorla|first246=Angels|last247=Saudubray|first247=Jean Marie|title=Pentalogy of Fallot|year=2009|pages=1602–1605|doi=10.1007/978-3-540-29676-8_1393}}</ref><br />
<br />
==Causes==<br />
<br />
<br />
<br />
<br />
The cause of pentalogy of fallot has not been identified. To review risk factors for the development of pentalogy of fallot, click [[tetralogy of fallot causes#Overview|here]].<br />
<br />
==Differentiating pentalogy of fallot from other Diseases==<br />
pentalogy of Fallot must be differentiated from other diseases that cause .<br />
<br />
===right to left shunt=== <br />
* transposition of great arteries with pulmonic stenosis,<br />
* double outlet right ventricle including Taussig-Bing anomaly, <br />
*tricuspid atresia,<br />
* Ebstein Anomaly,<br />
* pulmonary atresia with intact ventricular septum ,<br />
<br />
=== Respiratory diseases===<br />
* Bronchiolitis,<br />
*viral and bacterial pneumonia <br />
* pneumothorax because when they are in heart failure they present with signs of respiratory distress, cyanosis and failure to thrive<br />
<br />
=== Bidirectional shunt diseases===<br />
* total anomalous pulmonary venous return,<br />
* hypoplastic left heart syndrome,<br />
* single ventricle <br />
* truncus arteriosus <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Epidemiology and Demographics==<br />
The epidemiology of pentalogy of fallot has not been well studied.<br />
<br />
==Risk Factors==<br />
<br />
<br />
<br />
<br />
Common risk factors in the development of pentalogy of fallot includes<ref name="SilvaNeves2019">{{cite journal|last1=Silva|first1=Joana A.|last2=Neves|first2=Ana L.|last3=Flor-de-Lima|first3=Filipa|last4=Soares|first4=Paulo|last5=Guimarães|first5=Hercília|title=Risk Factors and Outcomes of Tetralogy of Fallot: From Fetal to Neonatal Life|journal=Pediatric Cardiology|volume=41|issue=1|year=2019|pages=155–164|issn=0172-0643|doi=10.1007/s00246-019-02239-4}}</ref><br />
<br />
* Alcoholism in mother <br />
* Maternal Diabetes <br />
* Advanced maternal age i.e greater than 40 years <br />
* Malnutrition in pregnancy <br />
* Family history of tetralogy of fallot <br />
* Viral illness during pregnancy like Rubella. <br />
* presence of Down syndrome or DiGeorge syndrome<br />
<br />
==Screening==<br />
There is insufficient evidence to recommend routine screening for pentalogy of fallot.<br />
<br />
==Natural History, Complications, and Prognosis==<br />
If left untreated, patients with pentalogy of fallot may progress to develop finger clubbing, stunted growth, cardiac arrhythmias, hypoplastic pulmonary artery and polycythemia with relative iron deficiency.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
Prognosis is generally excellent provided the VSD has been closed and the right ventricular outflow tract has been relieved,<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
<br />
<br />
There are no established criteria for the diagnosis of pentalogy fallot.<br />
<br />
===History and Symptoms===<br />
<br />
The hallmark of pentalogy of fallot is cyanosis. A positive history of cyanosis and easy fatigability leading to squatting during exercise is suggestive of cyanotic congenital heart defct <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
. The most common symptoms of pentalogy of fallot include cyanosis, easy fatigabillity , and hypercyanotic spells with crying , feeding and defecating<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
==Physical Examination==<br />
<br />
=== Appearance===<br />
* patients with pentalogy of fallot usually appear small due to failure to thrive. <br />
* patients may be found in squatting position( compensatory mechanism)<br />
<br />
=== Vital Signs===<br />
* Tachycardia with regular pulse <br />
* Tachypnea <br />
* low grade fever in patients with concomitant infective endocarditis<br />
<br />
=== Skin===<br />
* cyanosis may be present<br />
<br />
=== HEENT===<br />
* Retinal vessel engorgement may be present<br />
<br />
===pulmonary===<br />
*Pulmonary examination of patients with tetralogy of Fallot is usually normal.<br />
<br />
=== Heart===<br />
<br />
A thrill may be present at left sternal border.<br />
*A right ventricular impulse may be prominent.<br />
*First heart sound (S1) is normal<br />
*Second heart sound (S2) is single as P2 is absent.<br />
*A harsh systolic ejection murmur best heard at the left sternal border is usually present.<br />
*The loudness and length of systolic murmur is inversely proportional to the severity of right ventricular outflow tract obstruction (RVOTO). In other words as the RVOTO worsens, the murmur softens. The more cyanotic the patient, the softer the murmur.<br />
* As the RVOTO progresses towards occlusion the right ventricular blood is diverted to left ventricle through ventricular septal defect. This causes the pulmonic murmur to become shorter and softer.<br />
*P2 is faint and delayed in mild cyanosis and inaudible in severe cyanosis.<br />
*A diastolic murmur may be heard due to aortic regurgitation.<br />
<br />
=== Abdomen===<br />
*Abdominal examination of patients with tetralogy of Fallot is usually normal.<br />
<br />
=== Extremities===<br />
*Clubbing<br />
*Cyanosis is most prominent at lips and nail beds<br />
<br />
===Laboratory Findings===<br />
<br />
<br />
Some patients with pentalogy of fallot may have polycythemia <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
which is usually suggestive of worsening hypoxia and compensatory production of erythropoetin.<br />
<br />
.<br />
<br />
===Electrocardiogram===<br />
<br />
An ECG may be helpful in the diagnosis of pentalogy of fallot <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
Findings on an ECG suggestive of pentalogy of fallot include right axis deviation and right ventricular hypertrophy.<br />
[[File: Right_ventrriular_hypertophy.png|200p|thumb|right|Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran,]]<br />
<br />
===X-ray===<br />
<br />
<br />
<br />
<br />
An x-ray may be helpful in the diagnosis of pentalogy of Fallot. Findings on an x-ray suggestive of pentalogy of fallot include boot shaped heart or coeur en sabot.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref> [[File:Boot_shaped_heart.png|200p|thumb|left| Typical preoperative chest X‐ray of a 16‐month‐old boy with tetralogy of Fallot.]]<br />
<br />
<br />
<br />
<br />
.<br />
<br />
===Echocardiography or Ultrasound===<br />
<br />
<br />
<br />
<br />
Echocardiography may be helpful in the diagnosis of pentalogy of fallot. Findings on an echocardiography diagnostic of pentallogy of fallot include Ventricular septal defect, Atrial septal defect , Right ventricular outflow tract obstruction and overriding aorta<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref> [[File:Pentalogy_of_fallot_image_2.png|200p|thumb|left | Department of Biochemistry, University of Allahabad, Allahabad-211002, India.]]<br />
<br />
===CT scan===<br />
<br />
<br />
Thoracic CT angiography may be helpful in the diagnosis of pentallogy of fallot. Findings on CT scan diagnostic of pentalogy of fallot include ventricular septal defect, right ventricular hypertrophy, pulmonary atresia and major aortopulmonary collateral arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref> <br />
<br />
<br />
<br />
===MRI===<br />
<br />
<br />
cardiac MRI may be helpful in the diagnosis of pentalogy of fallot. Findings on MRI diagnostic of pentalogy of fallot include RVOT stenosis, VSD, ASD,Overriding aorta, right ventricular hypertrophy and hypoplastic pulmonary arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
<br />
<br />
===Other Imaging Findings===<br />
Other imaging findings for pentalogy of fallot include Right ventricular angiopraphy, which demonstrates infundibular and pulmonary artery anatomy, and left ventricular angiography, which demonstrates VSD, ASD, and Overiding aorta <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
===Other Diagnostic Studies===<br />
<br />
There are no other diagnostic studies associated with pentalogy of Fallot<br />
<br />
==Treatment==<br />
===Medical Therapy===<br />
The mainstay of treatment for pentalogy of fallot is Surgery.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
Pharmacologic medical therapy is recommended among patients with severe RVOTO and hypercyanotic spells<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
Pharmacologic medical therapies for pentalogy of fallot include <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
* prostaglandin E1 in neonates with ductal dependent pulmonary blood flow<br />
* Morphine and ketamine for sedation<br />
*vasopressors like phenylephrine<br />
*propanolol to decrease the need for palliative surgical intervention.<br />
* iron treatment to decrease frequency of spells. <br />
<br />
Patients with hypercyanotic spells are treated with oxygen,volume expansion and morphine sedation.<br />
<br />
===Surgery===<br />
<br />
<br />
<br />
Surgery is the mainstay of treatment for pentalogy of fallot. interventional procedures are used to relieve pulmonary obstructions and embolize colaterals. <br />
different surgical procedures can be done to treat pentalogy of fallot and it includes <br />
* pulmonary valvotomy( for stenotic pulmonic valve)<br />
* pulmonary valvectomy( for small and thickened pulmonic valve) <br />
* closure of ASD/VSD<br />
* shunt surgery for severe cyanosis or in patients with frequent spells in the first year of life <br />
* Blalock -Taussig Shunt- communication between the right or left pulmonary artery and the right or left subclavian artery. <br />
* Waterson-Cooley Shunt- communication between the ascending aorta with the right pulmonary artery <br />
* Potts shunt-communication between the descending aorta and left pulmonary artery <br />
* Central shunt- Communication between the main pulmonary artery and ascending aorta.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
===Primary Prevention===<br />
There are no established measures for the primary prevention of [pentalogy of fallot ].<br />
<br />
===Secondary Prevention===<br />
There are no established measures for the secondary prevention of [pentalogy of fallot].<br />
===Prevention of Cyanosis===<br />
The following factors may reduce systemic vascular resistance (SVR) and exacerbate shunting which in turn exacerbate cyanosis and should be avoided if at all possible:<br />
<br />
*Acidosis<br />
*Bathing in hot water<br />
*Fever<br />
*Stress<br />
*Infection<br />
*Posture (upright, not squatting)<br />
*Exercise<br />
*Beta-adrenergic agonists<br />
*Dehydration<br />
*Closure of the patent ductus arteriosus<br />
===Prevention of Infective Endocarditis===<br />
Antibiotic prophylaxis should be administered before respiratory and oral procedures.<br />
<br />
==References==<br />
{{reflist|2}}<br />
<br />
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{{WH}}<br />
{{WS}}</div>Abdulkareem Opeoluwalukanhttps://www.wikidoc.org/index.php?title=Pentalogy_of_Fallot&diff=1619055Pentalogy of Fallot2020-06-29T13:32:01Z<p>Abdulkareem Opeoluwalukan: /* Electrocardiogram */</p>
<hr />
<div>__NOTOC__<br />
{{SI}}<br />
{{CMG}} {{AE}}[[User:Abdulkareem Opeoluwalukan|Abdulkareem Opeoluwalukan, M.D]].<br />
==Overview==<br />
Pentalogy of Fallot is defined as the occurrence of Tetralogy of Fallot plus an [[atrial septal defect]].[[File:Pentalogy_of_fallot_image_1.png |200p|thumb|center|The twelve-lead electrocardiogram shows atrial fibrillation rhythm, normal axis, right bundle branch block pattern, secondary ST-T changes, and right ventricular hypertrophy|]]<br />
<br />
==Historical Perspective==<br />
tetrallogy of fallot was first discovered by Niel Stenson, a Denish physician Anatomist, in 1671<ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref>.<br />
<br />
The association between Rigt ventriular outflow tract obstruction and a large ventricular septal defect and tetrallogy of fallot. was made in 1888 by Etinne-Louise]<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref>.<br />
<br />
In 1924, Canadian, Maude Abbott was the first to discover the association between ventricular septal defect , pulmonary stenosis, overriding aorta and right ventricular hypertrophy and the development of tetrallogy of Fallot.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref<br />
In 1939, the first surgical treatment was developed by Dr Helen Taussig in Johns Hopkins<nowiki><ref name="pmid30020660"></nowiki>{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Classification==<br />
There is no established system for the classification of [pentallogy of fallot ].<br />
<br />
<br /><br />
<br />
==Pathophysiology==<br />
<br />
<br />
<br />
<br />
It is thought that tetrallogy of fallot is the result of anterocephalad deviation of the aortico pulmonary septum<ref name="pmid25870631">{{cite journal |vauthors=Beig JR, Ahmed W, Hafeez I, Gupta A, Tramboo NA, Rather HA |title=Pentalogy of fallot with a single coronary artery: a rare case report |journal=J Tehran Heart Cent |volume=9 |issue=3 |pages=132–4 |date=2014 |pmid=25870631 |pmc=4393836 |doi= |url=}}</ref> thus leading to <br />
* ventricular septal defect<br />
* right ventricular outflow tract obstruction <br />
*overriding aorta <br />
* right ventricular hypertrophy with an additional ASD( atrial septal defect) with ostium secundum type being the most common followed by ostium primum <ref name="pmid25870631">{{cite journal |vauthors=Beig JR, Ahmed W, Hafeez I, Gupta A, Tramboo NA, Rather HA |title=Pentalogy of fallot with a single coronary artery: a rare case report |journal=J Tehran Heart Cent |volume=9 |issue=3 |pages=132–4 |date=2014 |pmid=25870631 |pmc=4393836 |doi= |url=}}</ref>. thus making it a pentallogy of fallot. even though there are no reports on the molecular pathophysiology of pentallogy of fallot, conotruncal heart defects like tetrallogy of fallot are associated with neural crest migration defect. systemic pathophysiology of tetrallogy of fallot depends on the extent of right ventricular outflow tract obstruction, severe pulmonic stenosis leads to a significant decrease in pulmonary circulation and worsening right to left shunt leading to cyanosis.A collateral PDA makes Tetrallogy of fallot compatible with life as it preserves pulmonic circulation <ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. 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<br />
==Causes==<br />
<br />
<br />
<br />
<br />
The cause of pentalogy of fallot has not been identified. To review risk factors for the development of pentalogy of fallot, click [[tetralogy of fallot causes#Overview|here]].<br />
<br />
==Differentiating pentalogy of fallot from other Diseases==<br />
pentallogy of Fallot must be differentiated from other diseases that cause .<br />
<br />
===right to left shunt=== <br />
* transposition of great arteries with pulmonic stenosis,<br />
* double outlet right ventricle including Taussig-Bing anomaly, <br />
*tricuspid atresia,<br />
* Ebstein Anomaly,<br />
* pulmonary atresia with intact ventricular septum ,<br />
<br />
=== Respiratory diseases===<br />
* Bronchiolitis,<br />
*viral and bacterial pneumonia <br />
* pneumothorax because when they are in heart failure they present with signs of respiratory distress, cyanosis and failure to thrive<br />
<br />
=== Bidirectional shunt diseases===<br />
* total anomalous pulmonary venous return,<br />
* hypoplastic left heart syndrome,<br />
* single ventricle <br />
* truncus arteriosus <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Epidemiology and Demographics==<br />
The epidemiology of pentalogy of fallot has not been well studied.<br />
<br />
==Risk Factors==<br />
<br />
<br />
<br />
<br />
Common risk factors in the development of pentalogy of fallot includes<ref name="SilvaNeves2019">{{cite journal|last1=Silva|first1=Joana A.|last2=Neves|first2=Ana L.|last3=Flor-de-Lima|first3=Filipa|last4=Soares|first4=Paulo|last5=Guimarães|first5=Hercília|title=Risk Factors and Outcomes of Tetralogy of Fallot: From Fetal to Neonatal Life|journal=Pediatric Cardiology|volume=41|issue=1|year=2019|pages=155–164|issn=0172-0643|doi=10.1007/s00246-019-02239-4}}</ref><br />
<br />
* Alcoholism in mother <br />
* Maternal Diabetes <br />
* Advanced maternal age i.e greater than 40 years <br />
* Malnutrition in pregnancy <br />
* Family history of tetralogy of fallot <br />
* Viral illness during pregnancy like Rubella. <br />
* presence of Down syndrome or DiGeorge syndrome<br />
<br />
==Screening==<br />
There is insufficient evidence to recommend routine screening for pentalogy of fallot.<br />
<br />
==Natural History, Complications, and Prognosis==<br />
If left untreated, patients with pentalogy of fallot may progress to develop finger clubbing, stunted growth, cardiac arrhythmias, hypoplastic pulmonary artery and polycythemia with relative iron deficiency.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
Prognosis is generally excellent provided the VSD has been closed and the right ventricular outflow tract has been relieved,<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
<br />
<br />
There are no established criteria for the diagnosis of pentalogy fallot.<br />
<br />
===History and Symptoms===<br />
<br />
The hallmark of pentalogy of fallot is cyanosis. A positive history of cyanosis and easy fatigability leading to squatting during exercise is suggestive of cyanotic congenital heart defct <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
. The most common symptoms of pentalogy of fallot include cyanosis, easy fatigabillity , and hypercyanotic spells with crying , feeding and defecating<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
==Physical Examination==<br />
<br />
=== Appearance===<br />
* patients with pentalogy of fallot usually appear small due to failure to thrive. <br />
* patients may be found in squatting position( compensatory mechanism)<br />
<br />
=== Vital Signs===<br />
* Tachycardia with regular pulse <br />
* Tachypnea <br />
* low grade fever in patients with concomitant infective endocarditis<br />
<br />
=== Skin===<br />
* cyanosis may be present<br />
<br />
=== HEENT===<br />
* Retinal vessel engorgement may be present<br />
<br />
===pulmonary===<br />
*Pulmonary examination of patients with tetralogy of Fallot is usually normal.<br />
<br />
=== Heart===<br />
<br />
A thrill may be present at left sternal border.<br />
*A right ventricular impulse may be prominent.<br />
*First heart sound (S1) is normal<br />
*Second heart sound (S2) is single as P2 is absent.<br />
*A harsh systolic ejection murmur best heard at the left sternal border is usually present.<br />
*The loudness and length of systolic murmur is inversely proportional to the severity of right ventricular outflow tract obstruction (RVOTO). In other words as the RVOTO *worsens, the murmur softens. The more cyanotic the patient, the softer the murmur.<br />
* As the RVOTO progresses towards occlusion the right ventricular blood is diverted to left ventricle through ventricular septal defect. This causes the pulmonic murmur to become shorter and softer.<br />
*P2 is faint and delayed in mild cyanosis and inaudible in severe cyanosis.<br />
*A diastolic murmur may be heard due to aortic regurgitation.<br />
<br />
=== Abdomen===<br />
*Abdominal examination of patients with tetralogy of Fallot is usually normal.<br />
<br />
=== Extremities===<br />
*Clubbing<br />
*Cyanosis is most prominent at lips and nail beds<br />
<br />
===Laboratory Findings===<br />
<br />
<br />
Some patients with pentalogy of fallot may have polycythemia <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
which is usually suggestive of worsening hypoxia and compensatory production of erythropoetin.<br />
<br />
.<br />
<br />
===Electrocardiogram===<br />
<br />
An ECG may be helpful in the diagnosis of pentalogy of fallot <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
Findings on an ECG suggestive of pentalogy of fallot include right axis deviation and right ventricular hypertrophy.<br />
[[File: Right_ventrriular_hypertophy.png|200p|thumb|right|Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran,]]<br />
<br />
===X-ray===<br />
<br />
<br />
<br />
<br />
An x-ray may be helpful in the diagnosis of pentalogy of Fallot. Findings on an x-ray suggestive of pentalogy of fallot include boot shaped heart or coeur en sabot.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref> [[File:Boot_shaped_heart.png|200p|thumb|left| Typical preoperative chest X‐ray of a 16‐month‐old boy with tetralogy of Fallot.]]<br />
<br />
<br />
<br />
<br />
.<br />
<br />
===Echocardiography or Ultrasound===<br />
<br />
<br />
<br />
<br />
Echocardiography may be helpful in the diagnosis of pentalogy of fallot. Findings on an echocardiography diagnostic of pentallogy of fallot include Ventricular septal defect, Atrial septal defect , Right ventricular outflow tract obstruction and overriding aorta<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref> [[File:Pentalogy_of_fallot_image_2.png|200p|thumb|left | Department of Biochemistry, University of Allahabad, Allahabad-211002, India.]]<br />
<br />
===CT scan===<br />
<br />
<br />
Thoracic CT angiography may be helpful in the diagnosis of pentallogy of fallot. Findings on CT scan diagnostic of pentalogy of fallot include ventricular septal defect, right ventricular hypertrophy, pulmonary atresia and major aortopulmonary collateral arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref> <br />
<br />
<br />
<br />
===MRI===<br />
<br />
<br />
cardiac MRI may be helpful in the diagnosis of pentalogy of fallot. Findings on MRI diagnostic of pentalogy of fallot include RVOT stenosis, VSD, ASD,Overriding aorta, right ventricular hypertrophy and hypoplastic pulmonary arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
<br />
<br />
===Other Imaging Findings===<br />
Other imaging findings for pentalogy of fallot include Right ventricular angiopraphy, which demonstrates infundibular and pulmonary artery anatomy, and left ventricular angiography, which demonstrates VSD, ASD, and Overiding aorta <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
===Other Diagnostic Studies===<br />
<br />
There are no other diagnostic studies associated with pentalogy of Fallot<br />
<br />
==Treatment==<br />
===Medical Therapy===<br />
The mainstay of treatment for pentalogy of fallot is Surgery.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
Pharmacologic medical therapy is recommended among patients with severe RVOTO and hypercyanotic spells<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
Pharmacologic medical therapies for pentalogy of fallot include <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
* prostaglandin E1 in neonates with ductal dependent pulmonary blood flow<br />
* Morphine and ketamine for sedation<br />
*vasopressors like phenylephrine<br />
*propanolol to decrease the need for palliative surgical intervention.<br />
* iron treatment to decrease frequency of spells. <br />
<br />
Patients with hypercyanotic spells are treated with oxygen,volume expansion and morphine sedation.<br />
<br />
===Surgery===<br />
<br />
<br />
<br />
Surgery is the mainstay of treatment for pentalogy of fallot. interventional procedures are used to relieve pulmonary obstructions and embolize colaterals. <br />
different surgical procedures can be done to treat pentalogy of fallot and it includes <br />
* pulmonary valvotomy( for stenotic pulmonic valve)<br />
* pulmonary valvectomy( for small and thickened pulmonic valve) <br />
* closure of ASD/VSD<br />
* shunt surgery for severe cyanosis or in patients with frequent spells in the first year of life <br />
* Blalock -Taussig Shunt- communication between the right or left pulmonary artery and the right or left subclavian artery. <br />
* Waterson-Cooley Shunt- communication between the ascending aorta with the right pulmonary artery <br />
* Potts shunt-communication between the descending aorta and left pulmonary artery <br />
* Central shunt- Communication between the main pulmonary artery and ascending aorta.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
===Primary Prevention===<br />
There are no established measures for the primary prevention of [pentalogy of fallot ].<br />
<br />
===Secondary Prevention===<br />
There are no established measures for the secondary prevention of [pentalogy of fallot].<br />
===Prevention of Cyanosis===<br />
The following factors may reduce systemic vascular resistance (SVR) and exacerbate shunting which in turn exacerbate cyanosis and should be avoided if at all possible:<br />
<br />
*Acidosis<br />
*Bathing in hot water<br />
*Fever<br />
*Stress<br />
*Infection<br />
*Posture (upright, not squatting)<br />
*Exercise<br />
*Beta-adrenergic agonists<br />
*Dehydration<br />
*Closure of the patent ductus arteriosus<br />
===Prevention of Infective Endocarditis===<br />
Antibiotic prophylaxis should be administered before respiratory and oral procedures.<br />
<br />
==References==<br />
{{reflist|2}}<br />
<br />
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<br />
{{WH}}<br />
{{WS}}</div>Abdulkareem Opeoluwalukanhttps://www.wikidoc.org/index.php?title=Pentalogy_of_Fallot&diff=1619047Pentalogy of Fallot2020-06-29T13:16:52Z<p>Abdulkareem Opeoluwalukan: /* Echocardiography or Ultrasound */</p>
<hr />
<div>__NOTOC__<br />
{{SI}}<br />
{{CMG}} {{AE}}[[User:Abdulkareem Opeoluwalukan|Abdulkareem Opeoluwalukan, M.D]].<br />
==Overview==<br />
Pentalogy of Fallot is defined as the occurrence of Tetralogy of Fallot plus an [[atrial septal defect]].[[File:Pentalogy_of_fallot_image_1.png |200p|thumb|center|The twelve-lead electrocardiogram shows atrial fibrillation rhythm, normal axis, right bundle branch block pattern, secondary ST-T changes, and right ventricular hypertrophy|]]<br />
<br />
==Historical Perspective==<br />
tetrallogy of fallot was first discovered by Niel Stenson, a Denish physician Anatomist, in 1671<ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref>.<br />
<br />
The association between Rigt ventriular outflow tract obstruction and a large ventricular septal defect and tetrallogy of fallot. was made in 1888 by Etinne-Louise]<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref>.<br />
<br />
In 1924, Canadian, Maude Abbott was the first to discover the association between ventricular septal defect , pulmonary stenosis, overriding aorta and right ventricular hypertrophy and the development of tetrallogy of Fallot.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref<br />
In 1939, the first surgical treatment was developed by Dr Helen Taussig in Johns Hopkins<nowiki><ref name="pmid30020660"></nowiki>{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Classification==<br />
There is no established system for the classification of [pentallogy of fallot ].<br />
<br />
<br /><br />
<br />
==Pathophysiology==<br />
<br />
<br />
<br />
<br />
It is thought that tetrallogy of fallot is the result of anterocephalad deviation of the aortico pulmonary septum<ref name="pmid25870631">{{cite journal |vauthors=Beig JR, Ahmed W, Hafeez I, Gupta A, Tramboo NA, Rather HA |title=Pentalogy of fallot with a single coronary artery: a rare case report |journal=J Tehran Heart Cent |volume=9 |issue=3 |pages=132–4 |date=2014 |pmid=25870631 |pmc=4393836 |doi= |url=}}</ref> thus leading to <br />
* ventricular septal defect<br />
* right ventricular outflow tract obstruction <br />
*overriding aorta <br />
* right ventricular hypertrophy with an additional ASD( atrial septal defect) with ostium secundum type being the most common followed by ostium primum <ref name="pmid25870631">{{cite journal |vauthors=Beig JR, Ahmed W, Hafeez I, Gupta A, Tramboo NA, Rather HA |title=Pentalogy of fallot with a single coronary artery: a rare case report |journal=J Tehran Heart Cent |volume=9 |issue=3 |pages=132–4 |date=2014 |pmid=25870631 |pmc=4393836 |doi= |url=}}</ref>. thus making it a pentallogy of fallot. even though there are no reports on the molecular pathophysiology of pentallogy of fallot, conotruncal heart defects like tetrallogy of fallot are associated with neural crest migration defect. systemic pathophysiology of tetrallogy of fallot depends on the extent of right ventricular outflow tract obstruction, severe pulmonic stenosis leads to a significant decrease in pulmonary circulation and worsening right to left shunt leading to cyanosis.A collateral PDA makes Tetrallogy of fallot compatible with life as it preserves pulmonic circulation <ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. 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<br />
==Causes==<br />
<br />
<br />
<br />
<br />
The cause of pentalogy of fallot has not been identified. To review risk factors for the development of pentalogy of fallot, click [[tetralogy of fallot causes#Overview|here]].<br />
<br />
==Differentiating pentalogy of fallot from other Diseases==<br />
pentallogy of Fallot must be differentiated from other diseases that cause .<br />
<br />
===right to left shunt=== <br />
* transposition of great arteries with pulmonic stenosis,<br />
* double outlet right ventricle including Taussig-Bing anomaly, <br />
*tricuspid atresia,<br />
* Ebstein Anomaly,<br />
* pulmonary atresia with intact ventricular septum ,<br />
<br />
=== Respiratory diseases===<br />
* Bronchiolitis,<br />
*viral and bacterial pneumonia <br />
* pneumothorax because when they are in heart failure they present with signs of respiratory distress, cyanosis and failure to thrive<br />
<br />
=== Bidirectional shunt diseases===<br />
* total anomalous pulmonary venous return,<br />
* hypoplastic left heart syndrome,<br />
* single ventricle <br />
* truncus arteriosus <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Epidemiology and Demographics==<br />
The epidemiology of pentalogy of fallot has not been well studied.<br />
<br />
==Risk Factors==<br />
<br />
<br />
<br />
<br />
Common risk factors in the development of pentalogy of fallot includes<ref name="SilvaNeves2019">{{cite journal|last1=Silva|first1=Joana A.|last2=Neves|first2=Ana L.|last3=Flor-de-Lima|first3=Filipa|last4=Soares|first4=Paulo|last5=Guimarães|first5=Hercília|title=Risk Factors and Outcomes of Tetralogy of Fallot: From Fetal to Neonatal Life|journal=Pediatric Cardiology|volume=41|issue=1|year=2019|pages=155–164|issn=0172-0643|doi=10.1007/s00246-019-02239-4}}</ref><br />
<br />
* Alcoholism in mother <br />
* Maternal Diabetes <br />
* Advanced maternal age i.e greater than 40 years <br />
* Malnutrition in pregnancy <br />
* Family history of tetralogy of fallot <br />
* Viral illness during pregnancy like Rubella. <br />
* presence of Down syndrome or DiGeorge syndrome<br />
<br />
==Screening==<br />
There is insufficient evidence to recommend routine screening for pentalogy of fallot.<br />
<br />
==Natural History, Complications, and Prognosis==<br />
If left untreated, patients with pentalogy of fallot may progress to develop finger clubbing, stunted growth, cardiac arrhythmias, hypoplastic pulmonary artery and polycythemia with relative iron deficiency.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
Prognosis is generally excellent provided the VSD has been closed and the right ventricular outflow tract has been relieved,<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
<br />
<br />
There are no established criteria for the diagnosis of pentalogy fallot.<br />
<br />
===History and Symptoms===<br />
<br />
The hallmark of pentalogy of fallot is cyanosis. A positive history of cyanosis and easy fatigability leading to squatting during exercise is suggestive of cyanotic congenital heart defct <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
. The most common symptoms of pentalogy of fallot include cyanosis, easy fatigabillity , and hypercyanotic spells with crying , feeding and defecating<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
==Physical Examination==<br />
<br />
=== Appearance===<br />
* patients with pentalogy of fallot usually appear small due to failure to thrive. <br />
* patients may be found in squatting position( compensatory mechanism)<br />
<br />
=== Vital Signs===<br />
* Tachycardia with regular pulse <br />
* Tachypnea <br />
* low grade fever in patients with concomitant infective endocarditis<br />
<br />
=== Skin===<br />
* cyanosis may be present<br />
<br />
=== HEENT===<br />
* Retinal vessel engorgement may be present<br />
<br />
===pulmonary===<br />
*Pulmonary examination of patients with tetralogy of Fallot is usually normal.<br />
<br />
=== Heart===<br />
<br />
A thrill may be present at left sternal border.<br />
*A right ventricular impulse may be prominent.<br />
*First heart sound (S1) is normal<br />
*Second heart sound (S2) is single as P2 is absent.<br />
*A harsh systolic ejection murmur best heard at the left sternal border is usually present.<br />
*The loudness and length of systolic murmur is inversely proportional to the severity of right ventricular outflow tract obstruction (RVOTO). In other words as the RVOTO *worsens, the murmur softens. The more cyanotic the patient, the softer the murmur.<br />
* As the RVOTO progresses towards occlusion the right ventricular blood is diverted to left ventricle through ventricular septal defect. This causes the pulmonic murmur to become shorter and softer.<br />
*P2 is faint and delayed in mild cyanosis and inaudible in severe cyanosis.<br />
*A diastolic murmur may be heard due to aortic regurgitation.<br />
<br />
=== Abdomen===<br />
*Abdominal examination of patients with tetralogy of Fallot is usually normal.<br />
<br />
=== Extremities===<br />
*Clubbing<br />
*Cyanosis is most prominent at lips and nail beds<br />
<br />
===Laboratory Findings===<br />
<br />
<br />
Some patients with pentalogy of fallot may have polycythemia <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
which is usually suggestive of worsening hypoxia and compensatory production of erythropoetin.<br />
<br />
.<br />
<br />
===Electrocardiogram===<br />
<br />
An ECG may be helpful in the diagnosis of pentalogy of fallot <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
Findings on an ECG suggestive of pentalogy of fallot include right axis deviation and right ventricular hypertrophy.<br />
[[File: Right_ventrriular_hypertophy.png|200p|thumb|right|The twelve-lead electrocardiogram shows atrial fibrillation rhythm, normal axis, right bundle branch block pattern, secondary ST-T changes, and right ventricular hypertrophy]]<br />
<br />
===X-ray===<br />
<br />
<br />
<br />
<br />
An x-ray may be helpful in the diagnosis of pentalogy of Fallot. Findings on an x-ray suggestive of pentalogy of fallot include boot shaped heart or coeur en sabot.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref> [[File:Boot_shaped_heart.png|200p|thumb|left| Typical preoperative chest X‐ray of a 16‐month‐old boy with tetralogy of Fallot.]]<br />
<br />
<br />
<br />
<br />
.<br />
<br />
===Echocardiography or Ultrasound===<br />
<br />
<br />
<br />
<br />
Echocardiography may be helpful in the diagnosis of pentalogy of fallot. Findings on an echocardiography diagnostic of pentallogy of fallot include Ventricular septal defect, Atrial septal defect , Right ventricular outflow tract obstruction and overriding aorta<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref> [[File:Pentalogy_of_fallot_image_2.png|200p|thumb|left | Department of Biochemistry, University of Allahabad, Allahabad-211002, India.]]<br />
<br />
===CT scan===<br />
<br />
<br />
Thoracic CT angiography may be helpful in the diagnosis of pentallogy of fallot. Findings on CT scan diagnostic of pentalogy of fallot include ventricular septal defect, right ventricular hypertrophy, pulmonary atresia and major aortopulmonary collateral arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref> <br />
<br />
<br />
<br />
===MRI===<br />
<br />
<br />
cardiac MRI may be helpful in the diagnosis of pentalogy of fallot. Findings on MRI diagnostic of pentalogy of fallot include RVOT stenosis, VSD, ASD,Overriding aorta, right ventricular hypertrophy and hypoplastic pulmonary arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
<br />
<br />
===Other Imaging Findings===<br />
Other imaging findings for pentalogy of fallot include Right ventricular angiopraphy, which demonstrates infundibular and pulmonary artery anatomy, and left ventricular angiography, which demonstrates VSD, ASD, and Overiding aorta <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
===Other Diagnostic Studies===<br />
<br />
There are no other diagnostic studies associated with pentalogy of Fallot<br />
<br />
==Treatment==<br />
===Medical Therapy===<br />
The mainstay of treatment for pentalogy of fallot is Surgery.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
Pharmacologic medical therapy is recommended among patients with severe RVOTO and hypercyanotic spells<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
Pharmacologic medical therapies for pentalogy of fallot include <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
* prostaglandin E1 in neonates with ductal dependent pulmonary blood flow<br />
* Morphine and ketamine for sedation<br />
*vasopressors like phenylephrine<br />
*propanolol to decrease the need for palliative surgical intervention.<br />
* iron treatment to decrease frequency of spells. <br />
<br />
Patients with hypercyanotic spells are treated with oxygen,volume expansion and morphine sedation.<br />
<br />
===Surgery===<br />
<br />
<br />
<br />
Surgery is the mainstay of treatment for pentalogy of fallot. interventional procedures are used to relieve pulmonary obstructions and embolize colaterals. <br />
different surgical procedures can be done to treat pentalogy of fallot and it includes <br />
* pulmonary valvotomy( for stenotic pulmonic valve)<br />
* pulmonary valvectomy( for small and thickened pulmonic valve) <br />
* closure of ASD/VSD<br />
* shunt surgery for severe cyanosis or in patients with frequent spells in the first year of life <br />
* Blalock -Taussig Shunt- communication between the right or left pulmonary artery and the right or left subclavian artery. <br />
* Waterson-Cooley Shunt- communication between the ascending aorta with the right pulmonary artery <br />
* Potts shunt-communication between the descending aorta and left pulmonary artery <br />
* Central shunt- Communication between the main pulmonary artery and ascending aorta.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
===Primary Prevention===<br />
There are no established measures for the primary prevention of [pentalogy of fallot ].<br />
<br />
===Secondary Prevention===<br />
There are no established measures for the secondary prevention of [pentalogy of fallot].<br />
===Prevention of Cyanosis===<br />
The following factors may reduce systemic vascular resistance (SVR) and exacerbate shunting which in turn exacerbate cyanosis and should be avoided if at all possible:<br />
<br />
*Acidosis<br />
*Bathing in hot water<br />
*Fever<br />
*Stress<br />
*Infection<br />
*Posture (upright, not squatting)<br />
*Exercise<br />
*Beta-adrenergic agonists<br />
*Dehydration<br />
*Closure of the patent ductus arteriosus<br />
===Prevention of Infective Endocarditis===<br />
Antibiotic prophylaxis should be administered before respiratory and oral procedures.<br />
<br />
==References==<br />
{{reflist|2}}<br />
<br />
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{{WikiDoc Sources}}<br />
[[Category:Cardiology]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Abdulkareem Opeoluwalukanhttps://www.wikidoc.org/index.php?title=Pentalogy_of_Fallot&diff=1619045Pentalogy of Fallot2020-06-29T13:10:36Z<p>Abdulkareem Opeoluwalukan: /* Echocardiography or Ultrasound */</p>
<hr />
<div>__NOTOC__<br />
{{SI}}<br />
{{CMG}} {{AE}}[[User:Abdulkareem Opeoluwalukan|Abdulkareem Opeoluwalukan, M.D]].<br />
==Overview==<br />
Pentalogy of Fallot is defined as the occurrence of Tetralogy of Fallot plus an [[atrial septal defect]].[[File:Pentalogy_of_fallot_image_1.png |200p|thumb|center|The twelve-lead electrocardiogram shows atrial fibrillation rhythm, normal axis, right bundle branch block pattern, secondary ST-T changes, and right ventricular hypertrophy|]]<br />
<br />
==Historical Perspective==<br />
tetrallogy of fallot was first discovered by Niel Stenson, a Denish physician Anatomist, in 1671<ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref>.<br />
<br />
The association between Rigt ventriular outflow tract obstruction and a large ventricular septal defect and tetrallogy of fallot. was made in 1888 by Etinne-Louise]<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref>.<br />
<br />
In 1924, Canadian, Maude Abbott was the first to discover the association between ventricular septal defect , pulmonary stenosis, overriding aorta and right ventricular hypertrophy and the development of tetrallogy of Fallot.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref<br />
In 1939, the first surgical treatment was developed by Dr Helen Taussig in Johns Hopkins<nowiki><ref name="pmid30020660"></nowiki>{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Classification==<br />
There is no established system for the classification of [pentallogy of fallot ].<br />
<br />
<br /><br />
<br />
==Pathophysiology==<br />
<br />
<br />
<br />
<br />
It is thought that tetrallogy of fallot is the result of anterocephalad deviation of the aortico pulmonary septum<ref name="pmid25870631">{{cite journal |vauthors=Beig JR, Ahmed W, Hafeez I, Gupta A, Tramboo NA, Rather HA |title=Pentalogy of fallot with a single coronary artery: a rare case report |journal=J Tehran Heart Cent |volume=9 |issue=3 |pages=132–4 |date=2014 |pmid=25870631 |pmc=4393836 |doi= |url=}}</ref> thus leading to <br />
* ventricular septal defect<br />
* right ventricular outflow tract obstruction <br />
*overriding aorta <br />
* right ventricular hypertrophy with an additional ASD( atrial septal defect) with ostium secundum type being the most common followed by ostium primum <ref name="pmid25870631">{{cite journal |vauthors=Beig JR, Ahmed W, Hafeez I, Gupta A, Tramboo NA, Rather HA |title=Pentalogy of fallot with a single coronary artery: a rare case report |journal=J Tehran Heart Cent |volume=9 |issue=3 |pages=132–4 |date=2014 |pmid=25870631 |pmc=4393836 |doi= |url=}}</ref>. thus making it a pentallogy of fallot. even though there are no reports on the molecular pathophysiology of pentallogy of fallot, conotruncal heart defects like tetrallogy of fallot are associated with neural crest migration defect. systemic pathophysiology of tetrallogy of fallot depends on the extent of right ventricular outflow tract obstruction, severe pulmonic stenosis leads to a significant decrease in pulmonary circulation and worsening right to left shunt leading to cyanosis.A collateral PDA makes Tetrallogy of fallot compatible with life as it preserves pulmonic circulation <ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. 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<br />
==Causes==<br />
<br />
<br />
<br />
<br />
The cause of pentalogy of fallot has not been identified. To review risk factors for the development of pentalogy of fallot, click [[tetralogy of fallot causes#Overview|here]].<br />
<br />
==Differentiating pentalogy of fallot from other Diseases==<br />
pentallogy of Fallot must be differentiated from other diseases that cause .<br />
<br />
===right to left shunt=== <br />
* transposition of great arteries with pulmonic stenosis,<br />
* double outlet right ventricle including Taussig-Bing anomaly, <br />
*tricuspid atresia,<br />
* Ebstein Anomaly,<br />
* pulmonary atresia with intact ventricular septum ,<br />
<br />
=== Respiratory diseases===<br />
* Bronchiolitis,<br />
*viral and bacterial pneumonia <br />
* pneumothorax because when they are in heart failure they present with signs of respiratory distress, cyanosis and failure to thrive<br />
<br />
=== Bidirectional shunt diseases===<br />
* total anomalous pulmonary venous return,<br />
* hypoplastic left heart syndrome,<br />
* single ventricle <br />
* truncus arteriosus <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Epidemiology and Demographics==<br />
The epidemiology of pentalogy of fallot has not been well studied.<br />
<br />
==Risk Factors==<br />
<br />
<br />
<br />
<br />
Common risk factors in the development of pentalogy of fallot includes<ref name="SilvaNeves2019">{{cite journal|last1=Silva|first1=Joana A.|last2=Neves|first2=Ana L.|last3=Flor-de-Lima|first3=Filipa|last4=Soares|first4=Paulo|last5=Guimarães|first5=Hercília|title=Risk Factors and Outcomes of Tetralogy of Fallot: From Fetal to Neonatal Life|journal=Pediatric Cardiology|volume=41|issue=1|year=2019|pages=155–164|issn=0172-0643|doi=10.1007/s00246-019-02239-4}}</ref><br />
<br />
* Alcoholism in mother <br />
* Maternal Diabetes <br />
* Advanced maternal age i.e greater than 40 years <br />
* Malnutrition in pregnancy <br />
* Family history of tetralogy of fallot <br />
* Viral illness during pregnancy like Rubella. <br />
* presence of Down syndrome or DiGeorge syndrome<br />
<br />
==Screening==<br />
There is insufficient evidence to recommend routine screening for pentalogy of fallot.<br />
<br />
==Natural History, Complications, and Prognosis==<br />
If left untreated, patients with pentalogy of fallot may progress to develop finger clubbing, stunted growth, cardiac arrhythmias, hypoplastic pulmonary artery and polycythemia with relative iron deficiency.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
Prognosis is generally excellent provided the VSD has been closed and the right ventricular outflow tract has been relieved,<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
<br />
<br />
There are no established criteria for the diagnosis of pentalogy fallot.<br />
<br />
===History and Symptoms===<br />
<br />
The hallmark of pentalogy of fallot is cyanosis. A positive history of cyanosis and easy fatigability leading to squatting during exercise is suggestive of cyanotic congenital heart defct <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
. The most common symptoms of pentalogy of fallot include cyanosis, easy fatigabillity , and hypercyanotic spells with crying , feeding and defecating<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
==Physical Examination==<br />
<br />
=== Appearance===<br />
* patients with pentalogy of fallot usually appear small due to failure to thrive. <br />
* patients may be found in squatting position( compensatory mechanism)<br />
<br />
=== Vital Signs===<br />
* Tachycardia with regular pulse <br />
* Tachypnea <br />
* low grade fever in patients with concomitant infective endocarditis<br />
<br />
=== Skin===<br />
* cyanosis may be present<br />
<br />
=== HEENT===<br />
* Retinal vessel engorgement may be present<br />
<br />
===pulmonary===<br />
*Pulmonary examination of patients with tetralogy of Fallot is usually normal.<br />
<br />
=== Heart===<br />
<br />
A thrill may be present at left sternal border.<br />
*A right ventricular impulse may be prominent.<br />
*First heart sound (S1) is normal<br />
*Second heart sound (S2) is single as P2 is absent.<br />
*A harsh systolic ejection murmur best heard at the left sternal border is usually present.<br />
*The loudness and length of systolic murmur is inversely proportional to the severity of right ventricular outflow tract obstruction (RVOTO). In other words as the RVOTO *worsens, the murmur softens. The more cyanotic the patient, the softer the murmur.<br />
* As the RVOTO progresses towards occlusion the right ventricular blood is diverted to left ventricle through ventricular septal defect. This causes the pulmonic murmur to become shorter and softer.<br />
*P2 is faint and delayed in mild cyanosis and inaudible in severe cyanosis.<br />
*A diastolic murmur may be heard due to aortic regurgitation.<br />
<br />
=== Abdomen===<br />
*Abdominal examination of patients with tetralogy of Fallot is usually normal.<br />
<br />
=== Extremities===<br />
*Clubbing<br />
*Cyanosis is most prominent at lips and nail beds<br />
<br />
===Laboratory Findings===<br />
<br />
<br />
Some patients with pentalogy of fallot may have polycythemia <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
which is usually suggestive of worsening hypoxia and compensatory production of erythropoetin.<br />
<br />
.<br />
<br />
===Electrocardiogram===<br />
<br />
An ECG may be helpful in the diagnosis of pentalogy of fallot <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
Findings on an ECG suggestive of pentalogy of fallot include right axis deviation and right ventricular hypertrophy.<br />
[[File: Right_ventrriular_hypertophy.png|200p|thumb|right|The twelve-lead electrocardiogram shows atrial fibrillation rhythm, normal axis, right bundle branch block pattern, secondary ST-T changes, and right ventricular hypertrophy]]<br />
<br />
===X-ray===<br />
<br />
<br />
<br />
<br />
An x-ray may be helpful in the diagnosis of pentalogy of Fallot. Findings on an x-ray suggestive of pentalogy of fallot include boot shaped heart or coeur en sabot.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref> [[File:Boot_shaped_heart.png|200p|thumb|left| Typical preoperative chest X‐ray of a 16‐month‐old boy with tetralogy of Fallot.]]<br />
<br />
<br />
<br />
<br />
.<br />
<br />
===Echocardiography or Ultrasound===<br />
<br />
<br />
<br />
<br />
Echocardiography may be helpful in the diagnosis of pentalogy of fallot. Findings on an echocardiography diagnostic of pentallogy of fallot include Ventricular septal defect, Atrial septal defect , Right ventricular outflow tract obstruction and overriding aorta<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref> [[File:Echo_pentalogy_of_fallot.png|200p|thumb|left|Department of Biochemistry, University of Allahabad, Allahabad-211002, India.]]<br />
<br />
===CT scan===<br />
<br />
<br />
Thoracic CT angiography may be helpful in the diagnosis of pentallogy of fallot. Findings on CT scan diagnostic of pentalogy of fallot include ventricular septal defect, right ventricular hypertrophy, pulmonary atresia and major aortopulmonary collateral arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref> <br />
<br />
<br />
<br />
===MRI===<br />
<br />
<br />
cardiac MRI may be helpful in the diagnosis of pentalogy of fallot. Findings on MRI diagnostic of pentalogy of fallot include RVOT stenosis, VSD, ASD,Overriding aorta, right ventricular hypertrophy and hypoplastic pulmonary arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
<br />
<br />
===Other Imaging Findings===<br />
Other imaging findings for pentalogy of fallot include Right ventricular angiopraphy, which demonstrates infundibular and pulmonary artery anatomy, and left ventricular angiography, which demonstrates VSD, ASD, and Overiding aorta <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
===Other Diagnostic Studies===<br />
<br />
There are no other diagnostic studies associated with pentalogy of Fallot<br />
<br />
==Treatment==<br />
===Medical Therapy===<br />
The mainstay of treatment for pentalogy of fallot is Surgery.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
Pharmacologic medical therapy is recommended among patients with severe RVOTO and hypercyanotic spells<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
Pharmacologic medical therapies for pentalogy of fallot include <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
* prostaglandin E1 in neonates with ductal dependent pulmonary blood flow<br />
* Morphine and ketamine for sedation<br />
*vasopressors like phenylephrine<br />
*propanolol to decrease the need for palliative surgical intervention.<br />
* iron treatment to decrease frequency of spells. <br />
<br />
Patients with hypercyanotic spells are treated with oxygen,volume expansion and morphine sedation.<br />
<br />
===Surgery===<br />
<br />
<br />
<br />
Surgery is the mainstay of treatment for pentalogy of fallot. interventional procedures are used to relieve pulmonary obstructions and embolize colaterals. <br />
different surgical procedures can be done to treat pentalogy of fallot and it includes <br />
* pulmonary valvotomy( for stenotic pulmonic valve)<br />
* pulmonary valvectomy( for small and thickened pulmonic valve) <br />
* closure of ASD/VSD<br />
* shunt surgery for severe cyanosis or in patients with frequent spells in the first year of life <br />
* Blalock -Taussig Shunt- communication between the right or left pulmonary artery and the right or left subclavian artery. <br />
* Waterson-Cooley Shunt- communication between the ascending aorta with the right pulmonary artery <br />
* Potts shunt-communication between the descending aorta and left pulmonary artery <br />
* Central shunt- Communication between the main pulmonary artery and ascending aorta.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
===Primary Prevention===<br />
There are no established measures for the primary prevention of [pentalogy of fallot ].<br />
<br />
===Secondary Prevention===<br />
There are no established measures for the secondary prevention of [pentalogy of fallot].<br />
===Prevention of Cyanosis===<br />
The following factors may reduce systemic vascular resistance (SVR) and exacerbate shunting which in turn exacerbate cyanosis and should be avoided if at all possible:<br />
<br />
*Acidosis<br />
*Bathing in hot water<br />
*Fever<br />
*Stress<br />
*Infection<br />
*Posture (upright, not squatting)<br />
*Exercise<br />
*Beta-adrenergic agonists<br />
*Dehydration<br />
*Closure of the patent ductus arteriosus<br />
===Prevention of Infective Endocarditis===<br />
Antibiotic prophylaxis should be administered before respiratory and oral procedures.<br />
<br />
==References==<br />
{{reflist|2}}<br />
<br />
{{WikiDoc Help Menu}}<br />
{{WikiDoc Sources}}<br />
[[Category:Cardiology]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Abdulkareem Opeoluwalukanhttps://www.wikidoc.org/index.php?title=Pentalogy_of_Fallot&diff=1619042Pentalogy of Fallot2020-06-29T12:59:02Z<p>Abdulkareem Opeoluwalukan: /* Overview */</p>
<hr />
<div>__NOTOC__<br />
{{SI}}<br />
{{CMG}} {{AE}}[[User:Abdulkareem Opeoluwalukan|Abdulkareem Opeoluwalukan, M.D]].<br />
==Overview==<br />
Pentalogy of Fallot is defined as the occurrence of Tetralogy of Fallot plus an [[atrial septal defect]].[[File:Pentalogy_of_fallot_image_1.png |200p|thumb|center|The twelve-lead electrocardiogram shows atrial fibrillation rhythm, normal axis, right bundle branch block pattern, secondary ST-T changes, and right ventricular hypertrophy|]]<br />
<br />
==Historical Perspective==<br />
tetrallogy of fallot was first discovered by Niel Stenson, a Denish physician Anatomist, in 1671<ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref>.<br />
<br />
The association between Rigt ventriular outflow tract obstruction and a large ventricular septal defect and tetrallogy of fallot. was made in 1888 by Etinne-Louise]<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref>.<br />
<br />
In 1924, Canadian, Maude Abbott was the first to discover the association between ventricular septal defect , pulmonary stenosis, overriding aorta and right ventricular hypertrophy and the development of tetrallogy of Fallot.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref<br />
In 1939, the first surgical treatment was developed by Dr Helen Taussig in Johns Hopkins<nowiki><ref name="pmid30020660"></nowiki>{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Classification==<br />
There is no established system for the classification of [pentallogy of fallot ].<br />
<br />
<br /><br />
<br />
==Pathophysiology==<br />
<br />
<br />
<br />
<br />
It is thought that tetrallogy of fallot is the result of anterocephalad deviation of the aortico pulmonary septum<ref name="pmid25870631">{{cite journal |vauthors=Beig JR, Ahmed W, Hafeez I, Gupta A, Tramboo NA, Rather HA |title=Pentalogy of fallot with a single coronary artery: a rare case report |journal=J Tehran Heart Cent |volume=9 |issue=3 |pages=132–4 |date=2014 |pmid=25870631 |pmc=4393836 |doi= |url=}}</ref> thus leading to <br />
* ventricular septal defect<br />
* right ventricular outflow tract obstruction <br />
*overriding aorta <br />
* right ventricular hypertrophy with an additional ASD( atrial septal defect) with ostium secundum type being the most common followed by ostium primum <ref name="pmid25870631">{{cite journal |vauthors=Beig JR, Ahmed W, Hafeez I, Gupta A, Tramboo NA, Rather HA |title=Pentalogy of fallot with a single coronary artery: a rare case report |journal=J Tehran Heart Cent |volume=9 |issue=3 |pages=132–4 |date=2014 |pmid=25870631 |pmc=4393836 |doi= |url=}}</ref>. thus making it a pentallogy of fallot. even though there are no reports on the molecular pathophysiology of pentallogy of fallot, conotruncal heart defects like tetrallogy of fallot are associated with neural crest migration defect. systemic pathophysiology of tetrallogy of fallot depends on the extent of right ventricular outflow tract obstruction, severe pulmonic stenosis leads to a significant decrease in pulmonary circulation and worsening right to left shunt leading to cyanosis.A collateral PDA makes Tetrallogy of fallot compatible with life as it preserves pulmonic circulation <ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. 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C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. 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<br />
==Causes==<br />
<br />
<br />
<br />
<br />
The cause of pentalogy of fallot has not been identified. To review risk factors for the development of pentalogy of fallot, click [[tetralogy of fallot causes#Overview|here]].<br />
<br />
==Differentiating pentalogy of fallot from other Diseases==<br />
pentallogy of Fallot must be differentiated from other diseases that cause .<br />
<br />
===right to left shunt=== <br />
* transposition of great arteries with pulmonic stenosis,<br />
* double outlet right ventricle including Taussig-Bing anomaly, <br />
*tricuspid atresia,<br />
* Ebstein Anomaly,<br />
* pulmonary atresia with intact ventricular septum ,<br />
<br />
=== Respiratory diseases===<br />
* Bronchiolitis,<br />
*viral and bacterial pneumonia <br />
* pneumothorax because when they are in heart failure they present with signs of respiratory distress, cyanosis and failure to thrive<br />
<br />
=== Bidirectional shunt diseases===<br />
* total anomalous pulmonary venous return,<br />
* hypoplastic left heart syndrome,<br />
* single ventricle <br />
* truncus arteriosus <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Epidemiology and Demographics==<br />
The epidemiology of pentalogy of fallot has not been well studied.<br />
<br />
==Risk Factors==<br />
<br />
<br />
<br />
<br />
Common risk factors in the development of pentalogy of fallot includes<ref name="SilvaNeves2019">{{cite journal|last1=Silva|first1=Joana A.|last2=Neves|first2=Ana L.|last3=Flor-de-Lima|first3=Filipa|last4=Soares|first4=Paulo|last5=Guimarães|first5=Hercília|title=Risk Factors and Outcomes of Tetralogy of Fallot: From Fetal to Neonatal Life|journal=Pediatric Cardiology|volume=41|issue=1|year=2019|pages=155–164|issn=0172-0643|doi=10.1007/s00246-019-02239-4}}</ref><br />
<br />
* Alcoholism in mother <br />
* Maternal Diabetes <br />
* Advanced maternal age i.e greater than 40 years <br />
* Malnutrition in pregnancy <br />
* Family history of tetralogy of fallot <br />
* Viral illness during pregnancy like Rubella. <br />
* presence of Down syndrome or DiGeorge syndrome<br />
<br />
==Screening==<br />
There is insufficient evidence to recommend routine screening for pentalogy of fallot.<br />
<br />
==Natural History, Complications, and Prognosis==<br />
If left untreated, patients with pentalogy of fallot may progress to develop finger clubbing, stunted growth, cardiac arrhythmias, hypoplastic pulmonary artery and polycythemia with relative iron deficiency.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
Prognosis is generally excellent provided the VSD has been closed and the right ventricular outflow tract has been relieved,<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
<br />
<br />
There are no established criteria for the diagnosis of pentalogy fallot.<br />
<br />
===History and Symptoms===<br />
<br />
The hallmark of pentalogy of fallot is cyanosis. A positive history of cyanosis and easy fatigability leading to squatting during exercise is suggestive of cyanotic congenital heart defct <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
. The most common symptoms of pentalogy of fallot include cyanosis, easy fatigabillity , and hypercyanotic spells with crying , feeding and defecating<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
==Physical Examination==<br />
<br />
=== Appearance===<br />
* patients with pentalogy of fallot usually appear small due to failure to thrive. <br />
* patients may be found in squatting position( compensatory mechanism)<br />
<br />
=== Vital Signs===<br />
* Tachycardia with regular pulse <br />
* Tachypnea <br />
* low grade fever in patients with concomitant infective endocarditis<br />
<br />
=== Skin===<br />
* cyanosis may be present<br />
<br />
=== HEENT===<br />
* Retinal vessel engorgement may be present<br />
<br />
===pulmonary===<br />
*Pulmonary examination of patients with tetralogy of Fallot is usually normal.<br />
<br />
=== Heart===<br />
<br />
A thrill may be present at left sternal border.<br />
*A right ventricular impulse may be prominent.<br />
*First heart sound (S1) is normal<br />
*Second heart sound (S2) is single as P2 is absent.<br />
*A harsh systolic ejection murmur best heard at the left sternal border is usually present.<br />
*The loudness and length of systolic murmur is inversely proportional to the severity of right ventricular outflow tract obstruction (RVOTO). In other words as the RVOTO *worsens, the murmur softens. The more cyanotic the patient, the softer the murmur.<br />
* As the RVOTO progresses towards occlusion the right ventricular blood is diverted to left ventricle through ventricular septal defect. This causes the pulmonic murmur to become shorter and softer.<br />
*P2 is faint and delayed in mild cyanosis and inaudible in severe cyanosis.<br />
*A diastolic murmur may be heard due to aortic regurgitation.<br />
<br />
=== Abdomen===<br />
*Abdominal examination of patients with tetralogy of Fallot is usually normal.<br />
<br />
=== Extremities===<br />
*Clubbing<br />
*Cyanosis is most prominent at lips and nail beds<br />
<br />
===Laboratory Findings===<br />
<br />
<br />
Some patients with pentalogy of fallot may have polycythemia <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
which is usually suggestive of worsening hypoxia and compensatory production of erythropoetin.<br />
<br />
.<br />
<br />
===Electrocardiogram===<br />
<br />
An ECG may be helpful in the diagnosis of pentalogy of fallot <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
Findings on an ECG suggestive of pentalogy of fallot include right axis deviation and right ventricular hypertrophy.<br />
[[File: Right_ventrriular_hypertophy.png|200p|thumb|right|The twelve-lead electrocardiogram shows atrial fibrillation rhythm, normal axis, right bundle branch block pattern, secondary ST-T changes, and right ventricular hypertrophy]]<br />
<br />
===X-ray===<br />
<br />
<br />
<br />
<br />
An x-ray may be helpful in the diagnosis of pentalogy of Fallot. Findings on an x-ray suggestive of pentalogy of fallot include boot shaped heart or coeur en sabot.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref> [[File:Boot_shaped_heart.png|200p|thumb|left| Typical preoperative chest X‐ray of a 16‐month‐old boy with tetralogy of Fallot.]]<br />
<br />
<br />
<br />
<br />
.<br />
<br />
===Echocardiography or Ultrasound===<br />
<br />
<br />
<br />
<br />
Echocardiography may be helpful in the diagnosis of pentalogy of fallot. Findings on an echocardiography diagnostic of pentallogy of fallot include Ventricular septal defect, Atrial septal defect , Right ventricular outflow tract obstruction and overriding aorta<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
<br />
<br />
===CT scan===<br />
<br />
<br />
Thoracic CT angiography may be helpful in the diagnosis of pentallogy of fallot. Findings on CT scan diagnostic of pentalogy of fallot include ventricular septal defect, right ventricular hypertrophy, pulmonary atresia and major aortopulmonary collateral arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref> <br />
<br />
<br />
<br />
===MRI===<br />
<br />
<br />
cardiac MRI may be helpful in the diagnosis of pentalogy of fallot. Findings on MRI diagnostic of pentalogy of fallot include RVOT stenosis, VSD, ASD,Overriding aorta, right ventricular hypertrophy and hypoplastic pulmonary arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
<br />
<br />
===Other Imaging Findings===<br />
Other imaging findings for pentalogy of fallot include Right ventricular angiopraphy, which demonstrates infundibular and pulmonary artery anatomy, and left ventricular angiography, which demonstrates VSD, ASD, and Overiding aorta <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
===Other Diagnostic Studies===<br />
<br />
There are no other diagnostic studies associated with pentalogy of Fallot<br />
<br />
==Treatment==<br />
===Medical Therapy===<br />
The mainstay of treatment for pentalogy of fallot is Surgery.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
Pharmacologic medical therapy is recommended among patients with severe RVOTO and hypercyanotic spells<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
Pharmacologic medical therapies for pentalogy of fallot include <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
* prostaglandin E1 in neonates with ductal dependent pulmonary blood flow<br />
* Morphine and ketamine for sedation<br />
*vasopressors like phenylephrine<br />
*propanolol to decrease the need for palliative surgical intervention.<br />
* iron treatment to decrease frequency of spells. <br />
<br />
Patients with hypercyanotic spells are treated with oxygen,volume expansion and morphine sedation.<br />
<br />
===Surgery===<br />
<br />
<br />
<br />
Surgery is the mainstay of treatment for pentalogy of fallot. interventional procedures are used to relieve pulmonary obstructions and embolize colaterals. <br />
different surgical procedures can be done to treat pentalogy of fallot and it includes <br />
* pulmonary valvotomy( for stenotic pulmonic valve)<br />
* pulmonary valvectomy( for small and thickened pulmonic valve) <br />
* closure of ASD/VSD<br />
* shunt surgery for severe cyanosis or in patients with frequent spells in the first year of life <br />
* Blalock -Taussig Shunt- communication between the right or left pulmonary artery and the right or left subclavian artery. <br />
* Waterson-Cooley Shunt- communication between the ascending aorta with the right pulmonary artery <br />
* Potts shunt-communication between the descending aorta and left pulmonary artery <br />
* Central shunt- Communication between the main pulmonary artery and ascending aorta.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
===Primary Prevention===<br />
There are no established measures for the primary prevention of [pentalogy of fallot ].<br />
<br />
===Secondary Prevention===<br />
There are no established measures for the secondary prevention of [pentalogy of fallot].<br />
===Prevention of Cyanosis===<br />
The following factors may reduce systemic vascular resistance (SVR) and exacerbate shunting which in turn exacerbate cyanosis and should be avoided if at all possible:<br />
<br />
*Acidosis<br />
*Bathing in hot water<br />
*Fever<br />
*Stress<br />
*Infection<br />
*Posture (upright, not squatting)<br />
*Exercise<br />
*Beta-adrenergic agonists<br />
*Dehydration<br />
*Closure of the patent ductus arteriosus<br />
===Prevention of Infective Endocarditis===<br />
Antibiotic prophylaxis should be administered before respiratory and oral procedures.<br />
<br />
==References==<br />
{{reflist|2}}<br />
<br />
{{WikiDoc Help Menu}}<br />
{{WikiDoc Sources}}<br />
[[Category:Cardiology]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Abdulkareem Opeoluwalukanhttps://www.wikidoc.org/index.php?title=Pentalogy_of_Fallot&diff=1619041Pentalogy of Fallot2020-06-29T12:57:42Z<p>Abdulkareem Opeoluwalukan: /* Overview */</p>
<hr />
<div>__NOTOC__<br />
{{SI}}<br />
{{CMG}} {{AE}}[[User:Abdulkareem Opeoluwalukan|Abdulkareem Opeoluwalukan, M.D]].<br />
==Overview==<br />
Pentalogy of Fallot is defined as the occurrence of Tetralogy of Fallot plus an [[atrial septal defect]].[[File:Pentalogy_of_fallot_image_1.png |300p|thumb|right|The twelve-lead electrocardiogram shows atrial fibrillation rhythm, normal axis, right bundle branch block pattern, secondary ST-T changes, and right ventricular hypertrophy|]]<br />
<br />
==Historical Perspective==<br />
tetrallogy of fallot was first discovered by Niel Stenson, a Denish physician Anatomist, in 1671<ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref>.<br />
<br />
The association between Rigt ventriular outflow tract obstruction and a large ventricular septal defect and tetrallogy of fallot. was made in 1888 by Etinne-Louise]<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref>.<br />
<br />
In 1924, Canadian, Maude Abbott was the first to discover the association between ventricular septal defect , pulmonary stenosis, overriding aorta and right ventricular hypertrophy and the development of tetrallogy of Fallot.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref<br />
In 1939, the first surgical treatment was developed by Dr Helen Taussig in Johns Hopkins<nowiki><ref name="pmid30020660"></nowiki>{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Classification==<br />
There is no established system for the classification of [pentallogy of fallot ].<br />
<br />
<br /><br />
<br />
==Pathophysiology==<br />
<br />
<br />
<br />
<br />
It is thought that tetrallogy of fallot is the result of anterocephalad deviation of the aortico pulmonary septum<ref name="pmid25870631">{{cite journal |vauthors=Beig JR, Ahmed W, Hafeez I, Gupta A, Tramboo NA, Rather HA |title=Pentalogy of fallot with a single coronary artery: a rare case report |journal=J Tehran Heart Cent |volume=9 |issue=3 |pages=132–4 |date=2014 |pmid=25870631 |pmc=4393836 |doi= |url=}}</ref> thus leading to <br />
* ventricular septal defect<br />
* right ventricular outflow tract obstruction <br />
*overriding aorta <br />
* right ventricular hypertrophy with an additional ASD( atrial septal defect) with ostium secundum type being the most common followed by ostium primum <ref name="pmid25870631">{{cite journal |vauthors=Beig JR, Ahmed W, Hafeez I, Gupta A, Tramboo NA, Rather HA |title=Pentalogy of fallot with a single coronary artery: a rare case report |journal=J Tehran Heart Cent |volume=9 |issue=3 |pages=132–4 |date=2014 |pmid=25870631 |pmc=4393836 |doi= |url=}}</ref>. thus making it a pentallogy of fallot. even though there are no reports on the molecular pathophysiology of pentallogy of fallot, conotruncal heart defects like tetrallogy of fallot are associated with neural crest migration defect. systemic pathophysiology of tetrallogy of fallot depends on the extent of right ventricular outflow tract obstruction, severe pulmonic stenosis leads to a significant decrease in pulmonary circulation and worsening right to left shunt leading to cyanosis.A collateral PDA makes Tetrallogy of fallot compatible with life as it preserves pulmonic circulation <ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. 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<br />
==Causes==<br />
<br />
<br />
<br />
<br />
The cause of pentalogy of fallot has not been identified. To review risk factors for the development of pentalogy of fallot, click [[tetralogy of fallot causes#Overview|here]].<br />
<br />
==Differentiating pentalogy of fallot from other Diseases==<br />
pentallogy of Fallot must be differentiated from other diseases that cause .<br />
<br />
===right to left shunt=== <br />
* transposition of great arteries with pulmonic stenosis,<br />
* double outlet right ventricle including Taussig-Bing anomaly, <br />
*tricuspid atresia,<br />
* Ebstein Anomaly,<br />
* pulmonary atresia with intact ventricular septum ,<br />
<br />
=== Respiratory diseases===<br />
* Bronchiolitis,<br />
*viral and bacterial pneumonia <br />
* pneumothorax because when they are in heart failure they present with signs of respiratory distress, cyanosis and failure to thrive<br />
<br />
=== Bidirectional shunt diseases===<br />
* total anomalous pulmonary venous return,<br />
* hypoplastic left heart syndrome,<br />
* single ventricle <br />
* truncus arteriosus <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Epidemiology and Demographics==<br />
The epidemiology of pentalogy of fallot has not been well studied.<br />
<br />
==Risk Factors==<br />
<br />
<br />
<br />
<br />
Common risk factors in the development of pentalogy of fallot includes<ref name="SilvaNeves2019">{{cite journal|last1=Silva|first1=Joana A.|last2=Neves|first2=Ana L.|last3=Flor-de-Lima|first3=Filipa|last4=Soares|first4=Paulo|last5=Guimarães|first5=Hercília|title=Risk Factors and Outcomes of Tetralogy of Fallot: From Fetal to Neonatal Life|journal=Pediatric Cardiology|volume=41|issue=1|year=2019|pages=155–164|issn=0172-0643|doi=10.1007/s00246-019-02239-4}}</ref><br />
<br />
* Alcoholism in mother <br />
* Maternal Diabetes <br />
* Advanced maternal age i.e greater than 40 years <br />
* Malnutrition in pregnancy <br />
* Family history of tetralogy of fallot <br />
* Viral illness during pregnancy like Rubella. <br />
* presence of Down syndrome or DiGeorge syndrome<br />
<br />
==Screening==<br />
There is insufficient evidence to recommend routine screening for pentalogy of fallot.<br />
<br />
==Natural History, Complications, and Prognosis==<br />
If left untreated, patients with pentalogy of fallot may progress to develop finger clubbing, stunted growth, cardiac arrhythmias, hypoplastic pulmonary artery and polycythemia with relative iron deficiency.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
Prognosis is generally excellent provided the VSD has been closed and the right ventricular outflow tract has been relieved,<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
<br />
<br />
There are no established criteria for the diagnosis of pentalogy fallot.<br />
<br />
===History and Symptoms===<br />
<br />
The hallmark of pentalogy of fallot is cyanosis. A positive history of cyanosis and easy fatigability leading to squatting during exercise is suggestive of cyanotic congenital heart defct <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
. The most common symptoms of pentalogy of fallot include cyanosis, easy fatigabillity , and hypercyanotic spells with crying , feeding and defecating<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
==Physical Examination==<br />
<br />
=== Appearance===<br />
* patients with pentalogy of fallot usually appear small due to failure to thrive. <br />
* patients may be found in squatting position( compensatory mechanism)<br />
<br />
=== Vital Signs===<br />
* Tachycardia with regular pulse <br />
* Tachypnea <br />
* low grade fever in patients with concomitant infective endocarditis<br />
<br />
=== Skin===<br />
* cyanosis may be present<br />
<br />
=== HEENT===<br />
* Retinal vessel engorgement may be present<br />
<br />
===pulmonary===<br />
*Pulmonary examination of patients with tetralogy of Fallot is usually normal.<br />
<br />
=== Heart===<br />
<br />
A thrill may be present at left sternal border.<br />
*A right ventricular impulse may be prominent.<br />
*First heart sound (S1) is normal<br />
*Second heart sound (S2) is single as P2 is absent.<br />
*A harsh systolic ejection murmur best heard at the left sternal border is usually present.<br />
*The loudness and length of systolic murmur is inversely proportional to the severity of right ventricular outflow tract obstruction (RVOTO). In other words as the RVOTO *worsens, the murmur softens. The more cyanotic the patient, the softer the murmur.<br />
* As the RVOTO progresses towards occlusion the right ventricular blood is diverted to left ventricle through ventricular septal defect. This causes the pulmonic murmur to become shorter and softer.<br />
*P2 is faint and delayed in mild cyanosis and inaudible in severe cyanosis.<br />
*A diastolic murmur may be heard due to aortic regurgitation.<br />
<br />
=== Abdomen===<br />
*Abdominal examination of patients with tetralogy of Fallot is usually normal.<br />
<br />
=== Extremities===<br />
*Clubbing<br />
*Cyanosis is most prominent at lips and nail beds<br />
<br />
===Laboratory Findings===<br />
<br />
<br />
Some patients with pentalogy of fallot may have polycythemia <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
which is usually suggestive of worsening hypoxia and compensatory production of erythropoetin.<br />
<br />
.<br />
<br />
===Electrocardiogram===<br />
<br />
An ECG may be helpful in the diagnosis of pentalogy of fallot <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
Findings on an ECG suggestive of pentalogy of fallot include right axis deviation and right ventricular hypertrophy.<br />
[[File: Right_ventrriular_hypertophy.png|200p|thumb|right|The twelve-lead electrocardiogram shows atrial fibrillation rhythm, normal axis, right bundle branch block pattern, secondary ST-T changes, and right ventricular hypertrophy]]<br />
<br />
===X-ray===<br />
<br />
<br />
<br />
<br />
An x-ray may be helpful in the diagnosis of pentalogy of Fallot. Findings on an x-ray suggestive of pentalogy of fallot include boot shaped heart or coeur en sabot.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref> [[File:Boot_shaped_heart.png|200p|thumb|left| Typical preoperative chest X‐ray of a 16‐month‐old boy with tetralogy of Fallot.]]<br />
<br />
<br />
<br />
<br />
.<br />
<br />
===Echocardiography or Ultrasound===<br />
<br />
<br />
<br />
<br />
Echocardiography may be helpful in the diagnosis of pentalogy of fallot. Findings on an echocardiography diagnostic of pentallogy of fallot include Ventricular septal defect, Atrial septal defect , Right ventricular outflow tract obstruction and overriding aorta<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
<br />
<br />
===CT scan===<br />
<br />
<br />
Thoracic CT angiography may be helpful in the diagnosis of pentallogy of fallot. Findings on CT scan diagnostic of pentalogy of fallot include ventricular septal defect, right ventricular hypertrophy, pulmonary atresia and major aortopulmonary collateral arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref> <br />
<br />
<br />
<br />
===MRI===<br />
<br />
<br />
cardiac MRI may be helpful in the diagnosis of pentalogy of fallot. Findings on MRI diagnostic of pentalogy of fallot include RVOT stenosis, VSD, ASD,Overriding aorta, right ventricular hypertrophy and hypoplastic pulmonary arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
<br />
<br />
===Other Imaging Findings===<br />
Other imaging findings for pentalogy of fallot include Right ventricular angiopraphy, which demonstrates infundibular and pulmonary artery anatomy, and left ventricular angiography, which demonstrates VSD, ASD, and Overiding aorta <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
===Other Diagnostic Studies===<br />
<br />
There are no other diagnostic studies associated with pentalogy of Fallot<br />
<br />
==Treatment==<br />
===Medical Therapy===<br />
The mainstay of treatment for pentalogy of fallot is Surgery.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
Pharmacologic medical therapy is recommended among patients with severe RVOTO and hypercyanotic spells<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
Pharmacologic medical therapies for pentalogy of fallot include <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
* prostaglandin E1 in neonates with ductal dependent pulmonary blood flow<br />
* Morphine and ketamine for sedation<br />
*vasopressors like phenylephrine<br />
*propanolol to decrease the need for palliative surgical intervention.<br />
* iron treatment to decrease frequency of spells. <br />
<br />
Patients with hypercyanotic spells are treated with oxygen,volume expansion and morphine sedation.<br />
<br />
===Surgery===<br />
<br />
<br />
<br />
Surgery is the mainstay of treatment for pentalogy of fallot. interventional procedures are used to relieve pulmonary obstructions and embolize colaterals. <br />
different surgical procedures can be done to treat pentalogy of fallot and it includes <br />
* pulmonary valvotomy( for stenotic pulmonic valve)<br />
* pulmonary valvectomy( for small and thickened pulmonic valve) <br />
* closure of ASD/VSD<br />
* shunt surgery for severe cyanosis or in patients with frequent spells in the first year of life <br />
* Blalock -Taussig Shunt- communication between the right or left pulmonary artery and the right or left subclavian artery. <br />
* Waterson-Cooley Shunt- communication between the ascending aorta with the right pulmonary artery <br />
* Potts shunt-communication between the descending aorta and left pulmonary artery <br />
* Central shunt- Communication between the main pulmonary artery and ascending aorta.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
===Primary Prevention===<br />
There are no established measures for the primary prevention of [pentalogy of fallot ].<br />
<br />
===Secondary Prevention===<br />
There are no established measures for the secondary prevention of [pentalogy of fallot].<br />
===Prevention of Cyanosis===<br />
The following factors may reduce systemic vascular resistance (SVR) and exacerbate shunting which in turn exacerbate cyanosis and should be avoided if at all possible:<br />
<br />
*Acidosis<br />
*Bathing in hot water<br />
*Fever<br />
*Stress<br />
*Infection<br />
*Posture (upright, not squatting)<br />
*Exercise<br />
*Beta-adrenergic agonists<br />
*Dehydration<br />
*Closure of the patent ductus arteriosus<br />
===Prevention of Infective Endocarditis===<br />
Antibiotic prophylaxis should be administered before respiratory and oral procedures.<br />
<br />
==References==<br />
{{reflist|2}}<br />
<br />
{{WikiDoc Help Menu}}<br />
{{WikiDoc Sources}}<br />
[[Category:Cardiology]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Abdulkareem Opeoluwalukanhttps://www.wikidoc.org/index.php?title=Pentalogy_of_Fallot&diff=1619040Pentalogy of Fallot2020-06-29T12:55:29Z<p>Abdulkareem Opeoluwalukan: /* Electrocardiogram */</p>
<hr />
<div>__NOTOC__<br />
{{SI}}<br />
{{CMG}} {{AE}}[[User:Abdulkareem Opeoluwalukan|Abdulkareem Opeoluwalukan, M.D]].<br />
==Overview==<br />
Pentalogy of Fallot is defined as the occurrence of Tetralogy of Fallot plus an [[atrial septal defect]].[[File:Pentalogy_of_fallot_image_1.png |1500p|]]<br />
<br />
==Historical Perspective==<br />
tetrallogy of fallot was first discovered by Niel Stenson, a Denish physician Anatomist, in 1671<ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref>.<br />
<br />
The association between Rigt ventriular outflow tract obstruction and a large ventricular septal defect and tetrallogy of fallot. was made in 1888 by Etinne-Louise]<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref>.<br />
<br />
In 1924, Canadian, Maude Abbott was the first to discover the association between ventricular septal defect , pulmonary stenosis, overriding aorta and right ventricular hypertrophy and the development of tetrallogy of Fallot.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref<br />
In 1939, the first surgical treatment was developed by Dr Helen Taussig in Johns Hopkins<nowiki><ref name="pmid30020660"></nowiki>{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Classification==<br />
There is no established system for the classification of [pentallogy of fallot ].<br />
<br />
<br /><br />
<br />
==Pathophysiology==<br />
<br />
<br />
<br />
<br />
It is thought that tetrallogy of fallot is the result of anterocephalad deviation of the aortico pulmonary septum<ref name="pmid25870631">{{cite journal |vauthors=Beig JR, Ahmed W, Hafeez I, Gupta A, Tramboo NA, Rather HA |title=Pentalogy of fallot with a single coronary artery: a rare case report |journal=J Tehran Heart Cent |volume=9 |issue=3 |pages=132–4 |date=2014 |pmid=25870631 |pmc=4393836 |doi= |url=}}</ref> thus leading to <br />
* ventricular septal defect<br />
* right ventricular outflow tract obstruction <br />
*overriding aorta <br />
* right ventricular hypertrophy with an additional ASD( atrial septal defect) with ostium secundum type being the most common followed by ostium primum <ref name="pmid25870631">{{cite journal |vauthors=Beig JR, Ahmed W, Hafeez I, Gupta A, Tramboo NA, Rather HA |title=Pentalogy of fallot with a single coronary artery: a rare case report |journal=J Tehran Heart Cent |volume=9 |issue=3 |pages=132–4 |date=2014 |pmid=25870631 |pmc=4393836 |doi= |url=}}</ref>. thus making it a pentallogy of fallot. even though there are no reports on the molecular pathophysiology of pentallogy of fallot, conotruncal heart defects like tetrallogy of fallot are associated with neural crest migration defect. systemic pathophysiology of tetrallogy of fallot depends on the extent of right ventricular outflow tract obstruction, severe pulmonic stenosis leads to a significant decrease in pulmonary circulation and worsening right to left shunt leading to cyanosis.A collateral PDA makes Tetrallogy of fallot compatible with life as it preserves pulmonic circulation <ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. 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C.|last102=Cate|first102=Hugo Ten|last103=Light|first103=Richard W.|last104=Bozza|first104=Patricia T.|last105=Salluh|first105=Jorge I.|last106=Jantz|first106=Michael A.|last107=Vargas|first107=Sergio L.|last108=Tomic|first108=Rade|last109=Roman|first109=Jesse|last110=Mobeireek|first110=Abdullah F.|last111=Khalid|first111=Mohammad|last112=Torres|first112=Harrys A.|last113=Chemaly|first113=Roy F.|last114=Tomic|first114=Rade|last115=Roman|first115=Jesse|last116=Light|first116=Richard W.|last117=Dispenzieri|first117=Angela|last118=Krause|first118=Sabine|last119=Lochmüller|first119=Hanns|last120=Weihrauch|first120=Julia|last121=Krieg|first121=Thomas|last122=Kühn|first122=Wolfgang|last123=Walz|first123=Gerd|last124=Merker|first124=Georg H.|last125=Kubitz|first125=Ralf|last126=Häussinger|first126=Dieter|last127=Schnog|first127=John-John B.|last128=Gerdes|first128=Victor E. 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<br />
==Causes==<br />
<br />
<br />
<br />
<br />
The cause of pentalogy of fallot has not been identified. To review risk factors for the development of pentalogy of fallot, click [[tetralogy of fallot causes#Overview|here]].<br />
<br />
==Differentiating pentalogy of fallot from other Diseases==<br />
pentallogy of Fallot must be differentiated from other diseases that cause .<br />
<br />
===right to left shunt=== <br />
* transposition of great arteries with pulmonic stenosis,<br />
* double outlet right ventricle including Taussig-Bing anomaly, <br />
*tricuspid atresia,<br />
* Ebstein Anomaly,<br />
* pulmonary atresia with intact ventricular septum ,<br />
<br />
=== Respiratory diseases===<br />
* Bronchiolitis,<br />
*viral and bacterial pneumonia <br />
* pneumothorax because when they are in heart failure they present with signs of respiratory distress, cyanosis and failure to thrive<br />
<br />
=== Bidirectional shunt diseases===<br />
* total anomalous pulmonary venous return,<br />
* hypoplastic left heart syndrome,<br />
* single ventricle <br />
* truncus arteriosus <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Epidemiology and Demographics==<br />
The epidemiology of pentalogy of fallot has not been well studied.<br />
<br />
==Risk Factors==<br />
<br />
<br />
<br />
<br />
Common risk factors in the development of pentalogy of fallot includes<ref name="SilvaNeves2019">{{cite journal|last1=Silva|first1=Joana A.|last2=Neves|first2=Ana L.|last3=Flor-de-Lima|first3=Filipa|last4=Soares|first4=Paulo|last5=Guimarães|first5=Hercília|title=Risk Factors and Outcomes of Tetralogy of Fallot: From Fetal to Neonatal Life|journal=Pediatric Cardiology|volume=41|issue=1|year=2019|pages=155–164|issn=0172-0643|doi=10.1007/s00246-019-02239-4}}</ref><br />
<br />
* Alcoholism in mother <br />
* Maternal Diabetes <br />
* Advanced maternal age i.e greater than 40 years <br />
* Malnutrition in pregnancy <br />
* Family history of tetralogy of fallot <br />
* Viral illness during pregnancy like Rubella. <br />
* presence of Down syndrome or DiGeorge syndrome<br />
<br />
==Screening==<br />
There is insufficient evidence to recommend routine screening for pentalogy of fallot.<br />
<br />
==Natural History, Complications, and Prognosis==<br />
If left untreated, patients with pentalogy of fallot may progress to develop finger clubbing, stunted growth, cardiac arrhythmias, hypoplastic pulmonary artery and polycythemia with relative iron deficiency.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
Prognosis is generally excellent provided the VSD has been closed and the right ventricular outflow tract has been relieved,<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
<br />
<br />
There are no established criteria for the diagnosis of pentalogy fallot.<br />
<br />
===History and Symptoms===<br />
<br />
The hallmark of pentalogy of fallot is cyanosis. A positive history of cyanosis and easy fatigability leading to squatting during exercise is suggestive of cyanotic congenital heart defct <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
. The most common symptoms of pentalogy of fallot include cyanosis, easy fatigabillity , and hypercyanotic spells with crying , feeding and defecating<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
==Physical Examination==<br />
<br />
=== Appearance===<br />
* patients with pentalogy of fallot usually appear small due to failure to thrive. <br />
* patients may be found in squatting position( compensatory mechanism)<br />
<br />
=== Vital Signs===<br />
* Tachycardia with regular pulse <br />
* Tachypnea <br />
* low grade fever in patients with concomitant infective endocarditis<br />
<br />
=== Skin===<br />
* cyanosis may be present<br />
<br />
=== HEENT===<br />
* Retinal vessel engorgement may be present<br />
<br />
===pulmonary===<br />
*Pulmonary examination of patients with tetralogy of Fallot is usually normal.<br />
<br />
=== Heart===<br />
<br />
A thrill may be present at left sternal border.<br />
*A right ventricular impulse may be prominent.<br />
*First heart sound (S1) is normal<br />
*Second heart sound (S2) is single as P2 is absent.<br />
*A harsh systolic ejection murmur best heard at the left sternal border is usually present.<br />
*The loudness and length of systolic murmur is inversely proportional to the severity of right ventricular outflow tract obstruction (RVOTO). In other words as the RVOTO *worsens, the murmur softens. The more cyanotic the patient, the softer the murmur.<br />
* As the RVOTO progresses towards occlusion the right ventricular blood is diverted to left ventricle through ventricular septal defect. This causes the pulmonic murmur to become shorter and softer.<br />
*P2 is faint and delayed in mild cyanosis and inaudible in severe cyanosis.<br />
*A diastolic murmur may be heard due to aortic regurgitation.<br />
<br />
=== Abdomen===<br />
*Abdominal examination of patients with tetralogy of Fallot is usually normal.<br />
<br />
=== Extremities===<br />
*Clubbing<br />
*Cyanosis is most prominent at lips and nail beds<br />
<br />
===Laboratory Findings===<br />
<br />
<br />
Some patients with pentalogy of fallot may have polycythemia <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
which is usually suggestive of worsening hypoxia and compensatory production of erythropoetin.<br />
<br />
.<br />
<br />
===Electrocardiogram===<br />
<br />
An ECG may be helpful in the diagnosis of pentalogy of fallot <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
Findings on an ECG suggestive of pentalogy of fallot include right axis deviation and right ventricular hypertrophy.<br />
[[File: Right_ventrriular_hypertophy.png|200p|thumb|right|The twelve-lead electrocardiogram shows atrial fibrillation rhythm, normal axis, right bundle branch block pattern, secondary ST-T changes, and right ventricular hypertrophy]]<br />
<br />
===X-ray===<br />
<br />
<br />
<br />
<br />
An x-ray may be helpful in the diagnosis of pentalogy of Fallot. Findings on an x-ray suggestive of pentalogy of fallot include boot shaped heart or coeur en sabot.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref> [[File:Boot_shaped_heart.png|200p|thumb|left| Typical preoperative chest X‐ray of a 16‐month‐old boy with tetralogy of Fallot.]]<br />
<br />
<br />
<br />
<br />
.<br />
<br />
===Echocardiography or Ultrasound===<br />
<br />
<br />
<br />
<br />
Echocardiography may be helpful in the diagnosis of pentalogy of fallot. Findings on an echocardiography diagnostic of pentallogy of fallot include Ventricular septal defect, Atrial septal defect , Right ventricular outflow tract obstruction and overriding aorta<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
<br />
<br />
===CT scan===<br />
<br />
<br />
Thoracic CT angiography may be helpful in the diagnosis of pentallogy of fallot. Findings on CT scan diagnostic of pentalogy of fallot include ventricular septal defect, right ventricular hypertrophy, pulmonary atresia and major aortopulmonary collateral arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref> <br />
<br />
<br />
<br />
===MRI===<br />
<br />
<br />
cardiac MRI may be helpful in the diagnosis of pentalogy of fallot. Findings on MRI diagnostic of pentalogy of fallot include RVOT stenosis, VSD, ASD,Overriding aorta, right ventricular hypertrophy and hypoplastic pulmonary arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
<br />
<br />
===Other Imaging Findings===<br />
Other imaging findings for pentalogy of fallot include Right ventricular angiopraphy, which demonstrates infundibular and pulmonary artery anatomy, and left ventricular angiography, which demonstrates VSD, ASD, and Overiding aorta <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
===Other Diagnostic Studies===<br />
<br />
There are no other diagnostic studies associated with pentalogy of Fallot<br />
<br />
==Treatment==<br />
===Medical Therapy===<br />
The mainstay of treatment for pentalogy of fallot is Surgery.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
Pharmacologic medical therapy is recommended among patients with severe RVOTO and hypercyanotic spells<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
Pharmacologic medical therapies for pentalogy of fallot include <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
* prostaglandin E1 in neonates with ductal dependent pulmonary blood flow<br />
* Morphine and ketamine for sedation<br />
*vasopressors like phenylephrine<br />
*propanolol to decrease the need for palliative surgical intervention.<br />
* iron treatment to decrease frequency of spells. <br />
<br />
Patients with hypercyanotic spells are treated with oxygen,volume expansion and morphine sedation.<br />
<br />
===Surgery===<br />
<br />
<br />
<br />
Surgery is the mainstay of treatment for pentalogy of fallot. interventional procedures are used to relieve pulmonary obstructions and embolize colaterals. <br />
different surgical procedures can be done to treat pentalogy of fallot and it includes <br />
* pulmonary valvotomy( for stenotic pulmonic valve)<br />
* pulmonary valvectomy( for small and thickened pulmonic valve) <br />
* closure of ASD/VSD<br />
* shunt surgery for severe cyanosis or in patients with frequent spells in the first year of life <br />
* Blalock -Taussig Shunt- communication between the right or left pulmonary artery and the right or left subclavian artery. <br />
* Waterson-Cooley Shunt- communication between the ascending aorta with the right pulmonary artery <br />
* Potts shunt-communication between the descending aorta and left pulmonary artery <br />
* Central shunt- Communication between the main pulmonary artery and ascending aorta.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
===Primary Prevention===<br />
There are no established measures for the primary prevention of [pentalogy of fallot ].<br />
<br />
===Secondary Prevention===<br />
There are no established measures for the secondary prevention of [pentalogy of fallot].<br />
===Prevention of Cyanosis===<br />
The following factors may reduce systemic vascular resistance (SVR) and exacerbate shunting which in turn exacerbate cyanosis and should be avoided if at all possible:<br />
<br />
*Acidosis<br />
*Bathing in hot water<br />
*Fever<br />
*Stress<br />
*Infection<br />
*Posture (upright, not squatting)<br />
*Exercise<br />
*Beta-adrenergic agonists<br />
*Dehydration<br />
*Closure of the patent ductus arteriosus<br />
===Prevention of Infective Endocarditis===<br />
Antibiotic prophylaxis should be administered before respiratory and oral procedures.<br />
<br />
==References==<br />
{{reflist|2}}<br />
<br />
{{WikiDoc Help Menu}}<br />
{{WikiDoc Sources}}<br />
[[Category:Cardiology]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Abdulkareem Opeoluwalukanhttps://www.wikidoc.org/index.php?title=Pentalogy_of_Fallot&diff=1619039Pentalogy of Fallot2020-06-29T12:52:29Z<p>Abdulkareem Opeoluwalukan: /* X-ray */</p>
<hr />
<div>__NOTOC__<br />
{{SI}}<br />
{{CMG}} {{AE}}[[User:Abdulkareem Opeoluwalukan|Abdulkareem Opeoluwalukan, M.D]].<br />
==Overview==<br />
Pentalogy of Fallot is defined as the occurrence of Tetralogy of Fallot plus an [[atrial septal defect]].[[File:Pentalogy_of_fallot_image_1.png |1500p|]]<br />
<br />
==Historical Perspective==<br />
tetrallogy of fallot was first discovered by Niel Stenson, a Denish physician Anatomist, in 1671<ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref>.<br />
<br />
The association between Rigt ventriular outflow tract obstruction and a large ventricular septal defect and tetrallogy of fallot. was made in 1888 by Etinne-Louise]<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref>.<br />
<br />
In 1924, Canadian, Maude Abbott was the first to discover the association between ventricular septal defect , pulmonary stenosis, overriding aorta and right ventricular hypertrophy and the development of tetrallogy of Fallot.<ref name="ApitzWebb2009">{{cite journal|last1=Apitz|first1=Christian|last2=Webb|first2=Gary D|last3=Redington|first3=Andrew N|title=Tetralogy of Fallot|journal=The Lancet|volume=374|issue=9699|year=2009|pages=1462–1471|issn=01406736|doi=10.1016/S0140-6736(09)60657-7}}</ref<br />
In 1939, the first surgical treatment was developed by Dr Helen Taussig in Johns Hopkins<nowiki><ref name="pmid30020660"></nowiki>{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Classification==<br />
There is no established system for the classification of [pentallogy of fallot ].<br />
<br />
<br /><br />
<br />
==Pathophysiology==<br />
<br />
<br />
<br />
<br />
It is thought that tetrallogy of fallot is the result of anterocephalad deviation of the aortico pulmonary septum<ref name="pmid25870631">{{cite journal |vauthors=Beig JR, Ahmed W, Hafeez I, Gupta A, Tramboo NA, Rather HA |title=Pentalogy of fallot with a single coronary artery: a rare case report |journal=J Tehran Heart Cent |volume=9 |issue=3 |pages=132–4 |date=2014 |pmid=25870631 |pmc=4393836 |doi= |url=}}</ref> thus leading to <br />
* ventricular septal defect<br />
* right ventricular outflow tract obstruction <br />
*overriding aorta <br />
* right ventricular hypertrophy with an additional ASD( atrial septal defect) with ostium secundum type being the most common followed by ostium primum <ref name="pmid25870631">{{cite journal |vauthors=Beig JR, Ahmed W, Hafeez I, Gupta A, Tramboo NA, Rather HA |title=Pentalogy of fallot with a single coronary artery: a rare case report |journal=J Tehran Heart Cent |volume=9 |issue=3 |pages=132–4 |date=2014 |pmid=25870631 |pmc=4393836 |doi= |url=}}</ref>. thus making it a pentallogy of fallot. even though there are no reports on the molecular pathophysiology of pentallogy of fallot, conotruncal heart defects like tetrallogy of fallot are associated with neural crest migration defect. systemic pathophysiology of tetrallogy of fallot depends on the extent of right ventricular outflow tract obstruction, severe pulmonic stenosis leads to a significant decrease in pulmonary circulation and worsening right to left shunt leading to cyanosis.A collateral PDA makes Tetrallogy of fallot compatible with life as it preserves pulmonic circulation <ref name="Braun-FalcoMankin2009">{{cite journal|last1=Braun-Falco|first1=Markus|last2=Mankin|first2=Henry J.|last3=Wenger|first3=Sharon L.|last4=Braun-Falco|first4=Markus|last5=Kendall|first5=Stephan DiSean|last6=Blobe|first6=Gerard C.|last7=Weber|first7=Christoph K.|last8=Lorenz|first8=Richard|last9=Adler|first9=Guido|last10=Whitcomb|first10=David C.|last11=Yadav|first11=Dhiraj|last12=Bode|first12=Johannes|last13=Wabitsch|first13=Martin|last14=Debatin|first14=Klaus-Michael|last15=Posovzsky|first15=Pamela Fischer|last16=Hassan|first16=Akmal|last17=Megahed|first17=Mosaad|last18=Lundgren|first18=Tord M.|last19=Pfister|first19=Markus|last20=Zenner|first20=Hans-Peter|last21=Berardi|first21=Rossana|last22=Pierantoni|first22=Chiara|last23=Scartozzi|first23=Mario|last24=Cascinu|first24=Stefano|last25=Hendy|first25=Geoffrey N.|last26=Schwarz|first26=Johannes|last27=Storch|first27=Alexander|last28=Schnog|first28=John-John B.|last29=Gerdes|first29=Victor E. A.|last30=Schneider|first30=Susanne A.|last31=Bhatia|first31=Kailash P.|last32=Gittenberger-de Groot|first32=Adriana C.|last33=Bökenkamp|first33=Regina|last34=DeRuiter|first34=Marco C.|last35=Leung|first35=Alexander K. C.|last36=Wong|first36=Andrew L.|last37=Lang|first37=Undine E.|last38=Leung|first38=Alexander K. C.|last39=Leung|first39=Alexander K. C.|last40=Seyhan|first40=Muammer|last41=Hofmann|first41=Silke|last42=Bruckner-Tuderman|first42=Leena|last43=Hofmann|first43=Silke|last44=Bruckner-Tuderman|first44=Leena|last45=Hofmann|first45=Silke|last46=Bruckner-Tuderman|first46=Leena|last47=Kopp|first47=Peter|last48=Forrest|first48=Douglas|last49=Misirlioğlu|first49=Emine Dibek|last50=Alpan|first50=Nursel|last51=Oette|first51=Mark|last52=Imazio|first52=Massimo|last53=Chinnaiyan|first53=Kavitha M.|last54=Mehta|first54=Laxmi S.|last55=Bhat|first55=Mushtaq A.|last56=Bhat|first56=Javeed I.|last57=Stöber|first57=Gerald|last58=Reis|first58=André|last59=Rémi|first59=Jan|last60=Noachtar|first60=Soheyl|last61=Jurkat-Rott|first61=Karin|last62=Lehmann-Horn|first62=Frank|last63=Holzhausen|first63=Marinella|last64=Vergnolle|first64=Nathalie|last65=Schillinger|first65=Martin|last66=Gdynia|first66=Hans-Jürgen|last67=Ludolph|first67=Albert C.|last68=Namdar|first68=Thomas|last69=Eisenberger|first69=Claus Ferdinand|last70=Knoefel|first70=Wolfram Trudo|last71=Ginés|first71=Pere|last72=Guevara|first72=Mónica|last73=Cuesta-Muñoz|first73=Antonio L.|last74=Eijer|first74=Henk|last75=Böhm|first75=Markus|last76=Luger|first76=Thomas A.|last77=Güttler|first77=Flemming|last78=Guldberg|first78=Per|last79=Koch|first79=Richard|last80=Moseley|first80=Kathryn|last81=Eisenhofer|first81=Graeme|last82=Pacak|first82=Karel|last83=Leonard|first83=James V.|last84=Jaeken|first84=Jaak|last85=Becker|first85=Michael A.|last86=Stephani|first86=Ulrich|last87=Frazier|first87=Kendall S.|last88=Böhm|first88=Markus|last89=Luger|first89=Thomas A.|last90=Leung|first90=Alexander K. 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<br />
==Causes==<br />
<br />
<br />
<br />
<br />
The cause of pentalogy of fallot has not been identified. To review risk factors for the development of pentalogy of fallot, click [[tetralogy of fallot causes#Overview|here]].<br />
<br />
==Differentiating pentalogy of fallot from other Diseases==<br />
pentallogy of Fallot must be differentiated from other diseases that cause .<br />
<br />
===right to left shunt=== <br />
* transposition of great arteries with pulmonic stenosis,<br />
* double outlet right ventricle including Taussig-Bing anomaly, <br />
*tricuspid atresia,<br />
* Ebstein Anomaly,<br />
* pulmonary atresia with intact ventricular septum ,<br />
<br />
=== Respiratory diseases===<br />
* Bronchiolitis,<br />
*viral and bacterial pneumonia <br />
* pneumothorax because when they are in heart failure they present with signs of respiratory distress, cyanosis and failure to thrive<br />
<br />
=== Bidirectional shunt diseases===<br />
* total anomalous pulmonary venous return,<br />
* hypoplastic left heart syndrome,<br />
* single ventricle <br />
* truncus arteriosus <ref name="pmid30020660">{{cite journal |vauthors=Diaz-Frias J, Guillaume M |title= |journal= |volume= |issue= |pages= |date= |pmid=30020660 |doi= |url=}}</ref><br />
<br />
==Epidemiology and Demographics==<br />
The epidemiology of pentalogy of fallot has not been well studied.<br />
<br />
==Risk Factors==<br />
<br />
<br />
<br />
<br />
Common risk factors in the development of pentalogy of fallot includes<ref name="SilvaNeves2019">{{cite journal|last1=Silva|first1=Joana A.|last2=Neves|first2=Ana L.|last3=Flor-de-Lima|first3=Filipa|last4=Soares|first4=Paulo|last5=Guimarães|first5=Hercília|title=Risk Factors and Outcomes of Tetralogy of Fallot: From Fetal to Neonatal Life|journal=Pediatric Cardiology|volume=41|issue=1|year=2019|pages=155–164|issn=0172-0643|doi=10.1007/s00246-019-02239-4}}</ref><br />
<br />
* Alcoholism in mother <br />
* Maternal Diabetes <br />
* Advanced maternal age i.e greater than 40 years <br />
* Malnutrition in pregnancy <br />
* Family history of tetralogy of fallot <br />
* Viral illness during pregnancy like Rubella. <br />
* presence of Down syndrome or DiGeorge syndrome<br />
<br />
==Screening==<br />
There is insufficient evidence to recommend routine screening for pentalogy of fallot.<br />
<br />
==Natural History, Complications, and Prognosis==<br />
If left untreated, patients with pentalogy of fallot may progress to develop finger clubbing, stunted growth, cardiac arrhythmias, hypoplastic pulmonary artery and polycythemia with relative iron deficiency.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
Prognosis is generally excellent provided the VSD has been closed and the right ventricular outflow tract has been relieved,<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
<br />
<br />
There are no established criteria for the diagnosis of pentalogy fallot.<br />
<br />
===History and Symptoms===<br />
<br />
The hallmark of pentalogy of fallot is cyanosis. A positive history of cyanosis and easy fatigability leading to squatting during exercise is suggestive of cyanotic congenital heart defct <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
. The most common symptoms of pentalogy of fallot include cyanosis, easy fatigabillity , and hypercyanotic spells with crying , feeding and defecating<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
==Physical Examination==<br />
<br />
=== Appearance===<br />
* patients with pentalogy of fallot usually appear small due to failure to thrive. <br />
* patients may be found in squatting position( compensatory mechanism)<br />
<br />
=== Vital Signs===<br />
* Tachycardia with regular pulse <br />
* Tachypnea <br />
* low grade fever in patients with concomitant infective endocarditis<br />
<br />
=== Skin===<br />
* cyanosis may be present<br />
<br />
=== HEENT===<br />
* Retinal vessel engorgement may be present<br />
<br />
===pulmonary===<br />
*Pulmonary examination of patients with tetralogy of Fallot is usually normal.<br />
<br />
=== Heart===<br />
<br />
A thrill may be present at left sternal border.<br />
*A right ventricular impulse may be prominent.<br />
*First heart sound (S1) is normal<br />
*Second heart sound (S2) is single as P2 is absent.<br />
*A harsh systolic ejection murmur best heard at the left sternal border is usually present.<br />
*The loudness and length of systolic murmur is inversely proportional to the severity of right ventricular outflow tract obstruction (RVOTO). In other words as the RVOTO *worsens, the murmur softens. The more cyanotic the patient, the softer the murmur.<br />
* As the RVOTO progresses towards occlusion the right ventricular blood is diverted to left ventricle through ventricular septal defect. This causes the pulmonic murmur to become shorter and softer.<br />
*P2 is faint and delayed in mild cyanosis and inaudible in severe cyanosis.<br />
*A diastolic murmur may be heard due to aortic regurgitation.<br />
<br />
=== Abdomen===<br />
*Abdominal examination of patients with tetralogy of Fallot is usually normal.<br />
<br />
=== Extremities===<br />
*Clubbing<br />
*Cyanosis is most prominent at lips and nail beds<br />
<br />
===Laboratory Findings===<br />
<br />
<br />
Some patients with pentalogy of fallot may have polycythemia <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
which is usually suggestive of worsening hypoxia and compensatory production of erythropoetin.<br />
<br />
.<br />
<br />
===Electrocardiogram===<br />
<br />
An ECG may be helpful in the diagnosis of pentalogy of fallot <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
Findings on an ECG suggestive of pentalogy of fallot include right axis deviation and right ventricular hypertrophy.<br />
[[File: Right_ventrriular_hypertophy.png]]<br />
<br />
===X-ray===<br />
<br />
<br />
<br />
<br />
An x-ray may be helpful in the diagnosis of pentalogy of Fallot. Findings on an x-ray suggestive of pentalogy of fallot include boot shaped heart or coeur en sabot.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref> [[File:Boot_shaped_heart.png|200p|thumb|left| Typical preoperative chest X‐ray of a 16‐month‐old boy with tetralogy of Fallot.]]<br />
<br />
<br />
<br />
<br />
.<br />
<br />
===Echocardiography or Ultrasound===<br />
<br />
<br />
<br />
<br />
Echocardiography may be helpful in the diagnosis of pentalogy of fallot. Findings on an echocardiography diagnostic of pentallogy of fallot include Ventricular septal defect, Atrial septal defect , Right ventricular outflow tract obstruction and overriding aorta<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
<br />
<br />
===CT scan===<br />
<br />
<br />
Thoracic CT angiography may be helpful in the diagnosis of pentallogy of fallot. Findings on CT scan diagnostic of pentalogy of fallot include ventricular septal defect, right ventricular hypertrophy, pulmonary atresia and major aortopulmonary collateral arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref> <br />
<br />
<br />
<br />
===MRI===<br />
<br />
<br />
cardiac MRI may be helpful in the diagnosis of pentalogy of fallot. Findings on MRI diagnostic of pentalogy of fallot include RVOT stenosis, VSD, ASD,Overriding aorta, right ventricular hypertrophy and hypoplastic pulmonary arteries.<ref name="LapierreDubois2016">{{cite journal|last1=Lapierre|first1=C.|last2=Dubois|first2=J.|last3=Rypens|first3=F.|last4=Raboisson|first4=M.-J.|last5=Déry|first5=J.|title=Tetralogy of Fallot: Preoperative assessment with MR and CT imaging|journal=Diagnostic and Interventional Imaging|volume=97|issue=5|year=2016|pages=531–541|issn=22115684|doi=10.1016/j.diii.2016.01.009}}</ref><br />
<br />
<br />
===Other Imaging Findings===<br />
Other imaging findings for pentalogy of fallot include Right ventricular angiopraphy, which demonstrates infundibular and pulmonary artery anatomy, and left ventricular angiography, which demonstrates VSD, ASD, and Overiding aorta <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
===Other Diagnostic Studies===<br />
<br />
There are no other diagnostic studies associated with pentalogy of Fallot<br />
<br />
==Treatment==<br />
===Medical Therapy===<br />
The mainstay of treatment for pentalogy of fallot is Surgery.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
Pharmacologic medical therapy is recommended among patients with severe RVOTO and hypercyanotic spells<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
<br />
Pharmacologic medical therapies for pentalogy of fallot include <ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
* prostaglandin E1 in neonates with ductal dependent pulmonary blood flow<br />
* Morphine and ketamine for sedation<br />
*vasopressors like phenylephrine<br />
*propanolol to decrease the need for palliative surgical intervention.<br />
* iron treatment to decrease frequency of spells. <br />
<br />
Patients with hypercyanotic spells are treated with oxygen,volume expansion and morphine sedation.<br />
<br />
===Surgery===<br />
<br />
<br />
<br />
Surgery is the mainstay of treatment for pentalogy of fallot. interventional procedures are used to relieve pulmonary obstructions and embolize colaterals. <br />
different surgical procedures can be done to treat pentalogy of fallot and it includes <br />
* pulmonary valvotomy( for stenotic pulmonic valve)<br />
* pulmonary valvectomy( for small and thickened pulmonic valve) <br />
* closure of ASD/VSD<br />
* shunt surgery for severe cyanosis or in patients with frequent spells in the first year of life <br />
* Blalock -Taussig Shunt- communication between the right or left pulmonary artery and the right or left subclavian artery. <br />
* Waterson-Cooley Shunt- communication between the ascending aorta with the right pulmonary artery <br />
* Potts shunt-communication between the descending aorta and left pulmonary artery <br />
* Central shunt- Communication between the main pulmonary artery and ascending aorta.<ref>{{cite journal|doi=10.1007/978-3-540-29676-8_1393.}}</ref><br />
<br />
===Primary Prevention===<br />
There are no established measures for the primary prevention of [pentalogy of fallot ].<br />
<br />
===Secondary Prevention===<br />
There are no established measures for the secondary prevention of [pentalogy of fallot].<br />
===Prevention of Cyanosis===<br />
The following factors may reduce systemic vascular resistance (SVR) and exacerbate shunting which in turn exacerbate cyanosis and should be avoided if at all possible:<br />
<br />
*Acidosis<br />
*Bathing in hot water<br />
*Fever<br />
*Stress<br />
*Infection<br />
*Posture (upright, not squatting)<br />
*Exercise<br />
*Beta-adrenergic agonists<br />
*Dehydration<br />
*Closure of the patent ductus arteriosus<br />
===Prevention of Infective Endocarditis===<br />
Antibiotic prophylaxis should be administered before respiratory and oral procedures.<br />
<br />
==References==<br />
{{reflist|2}}<br />
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{{WS}}</div>Abdulkareem Opeoluwalukanhttps://www.wikidoc.org/index.php?title=File:Boot_shaped_heart.png&diff=1619036File:Boot shaped heart.png2020-06-29T12:47:22Z<p>Abdulkareem Opeoluwalukan: </p>
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<div></div>Abdulkareem Opeoluwalukan