The Trilogy of Fallot is a very rare form of congenital heart disease (CHD) composed of three defects [1] [2]:

• Atrial septal defect (ASD) - Interatrial connection caused by an opening in the atrial septum causes right-to-left shunting of blood.
• Pulmonary valve stenosis - A common feature shared with Tetralogy of Fallot, one of the most frequently encountered CHDs.
• Hypertrophy of the right ventricle - As a result of the increased effort needed to propel the blood through the stenotic pulmonary valve, hypertrophy of this cardiac chamber occurs and completes the trilogy of Fallot.

Although earlier reports suggested that Trilogy of Fallot is not an uncommon CHD [2], its reports are quite scarce [1] [3]. Clinical signs and symptoms seem to appear from the congestion of blood in the right heart and the portal system, and congestive heart failure may develop without early recognition [1] [2]. Similarly to other CHDs, manifestations of cyanosis, clubbing of fingers, and abnormal auscultatory findings during the physical examination are typically encountered in patients suffering from Trilogy of Fallot [2] [4].

• Atrial Septal Defect

  Fallot, Étienne-Louis A., French physician, 1850-1911. pentalogy of Fallot - Fallot tetralogy with, in addition, a patent foramen ovale or atrial septal defect. trilogy of Fallot - atrial septal defect associated with pulmonic stenosis and right ventricular [medical-dictionary.thefreedictionary.com]

  Trilogy of Fallot is comprised of pulmonary stenosis, hypertrophy of the right ventricle and an atrial septal defect, and is a distinct clinical entity from Tetralogy of Fallot, one of the most common congenital heart diseases in clinical practice. [symptoma.com]

  The trilogy of Fallot is a congenital heart disease consisting of the following defects: pulmonary valve stenosis, right ventricular hypertrophy and atrial septal defect. This disease is 1.6-1.8% of all congenital heart defects. [en.wikipedia.org]

  However, Tetralogy of Fallot is associated with a ventricular septal defect instead of an atrial septal defect, and it also involves an overriding aorta. [wikidoc.org]

  septal defect (ASD) or patent foramen ovale (PFO). [scitechnol.com]

• Liver Dysfunction

  Keywords Liver Injury Hyperthyroidism Hepatic Fibrosis Intrahepatic Cholestasis Acute Liver Injury Background Liver dysfunction is a common complication observed in hyperthyroidism, either as a result of hyperthyroidism and/or the use of antithyroid drugs [bmcgastroenterol.biomedcentral.com]

• Heart Disease

  Very few reports describe this type of heart disease, and the diagnosis can be made only through imaging studies, principally echocardiography. [symptoma.com]

  The trilogy of Fallot is a congenital heart disease consisting of the following defects: pulmonary valve stenosis, right ventricular hypertrophy and atrial septal defect. This disease is 1.6-1.8% of all congenital heart defects. [en.wikipedia.org]

  Disease and Heart Disease in Pregnancy, Kaiser Foundation Hospitals, Panorama City, California, USA [books.google.com]

  And also done a fellowship in structural heart disease at Royal Brompton Hospital, UK and training in Intravascular Ultrasound at Cleveland Clinic, USA PDF HTML [omicsonline.org]

  Key Words: Blood in Vomiting, Congenital Heart Disease, Trilogy of Fallot, Congestive Heart failure Full Text: PDF Refbacks There are currently no refbacks. This work is licensed under a Creative Commons Attribution 3.0 License. [pkheartjournal.com]

• Heart Murmur

  In many patients, a palpable thrill can be detected, and a heart murmur, either at the left base or in the projection of the pulmonary valve, is readily noted. [symptoma.com]

  Infants come to attention because of a heart murmur or cyanosis. Symptoms can be appreciable when... References 1. Joly F, Carlotti J, Sicot PA Jr (1950) Congenital heart disease. II. Fallot’s trilogies. [link.springer.com]

  Another common sign of tetralogy of Fallot is a heart murmur. A heart murmur is an extra or unusual sound that doctors may hear while listening to the heart. The sound occurs because the heart defect causes abnormal blood flow through the heart. [pediatricct.surgery.ucsf.edu]

• Tremor

  Physical examination revealed a 112 heart beats per minute with evidences of tremor, generalized icterus, and pigmentation of the skin on the bilateral tibia. [bmcgastroenterol.biomedcentral.com]

• Encephalopathy

  During the following 9 days, his liver function profiles progressively deteriorated, and grade II encephalopathy developed. The patient subsequently experienced hypoxemia, hypotension, decreased urinary outflow, and metabolic acidosis. [bmcgastroenterol.biomedcentral.com]

Clinical suspicion toward any CHD can only be raised with a properly obtained patient history and a meticulous physical examination. The onset and progression of symptoms should be noted, whereas cardiac auscultation is perhaps the vital component of the diagnostic workup. In many patients, a palpable thrill can be detected, and a heart murmur, either at the left base or in the projection of the pulmonary valve, is readily noted [1] [2] [4]. If cardiac-related manifestations are present and support the finding obtained during the physical examination toward CHD as a possible diagnosis, electrocardiography (ECG) and imaging studies should be employed promptly [4] [5] [6]. Echocardiography is the primary method for detecting CHDs, including Trilogy of Fallot, and the use of standard 2D and Doppler techniques, as well as the increasingly available 3D imaging, are sufficient methods for confirming the diagnosis [4] [5] [6]. The benefit of US is that it is able to make the diagnosis prenatally as well, which allows enough time to consider the optimal therapeutic approach.

• Liver Biopsy

  Liver biopsy showed intrahepatic cholestasis, mild inflammatory infiltrates, as well as significant fibrosis, indicating both acute and chronic liver injuries. [ncbi.nlm.nih.gov]

  The liver biopsy revealed characteristic features of intrahepatic cholestasis with mild inflammatory infiltrates indicative of acute liver injury. [bmcgastroenterol.biomedcentral.com]

1. Shen C, Zhao C-Y, Liu F, Wang Y-D, Yu J. Acute-on-chronic liver failure due to thiamazole in a patient with hyperthyroidism and trilogy of Fallot: case report. BMC Gastroenterol. 2010;10:93.
2. SWAN H, MARCHIORO T, KINARD S, BLOUNT SG. Trilogy of Fallot. Experience with twenty-two surgical cases. Arch Surg. 1960;81:291-298.
3. Wang YQ, Chen RK, Ye WW, et al. Open-heart surgery in 48 patients via a small right anterolateral thoracotomy. Tex Heart Inst J. 1999;26(2):124-128.
4. Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011.
5. Bailliard F, Anderson RH. Tetralogy of Fallot. Orphanet J Rare Dis. 2009;4:2.
6. Villafañe J, Feinstein JA, Jenkins KJ, et al. Hot topics in tetralogy of Fallot. J Am Coll Cardiol. 2013;62(23):2155-2166.