Deterioration of cutaneous microcirculatory status and its clinical correlation in tetralogy of Fallot

The purpose of this study was to evaluate the hemodynamic deterioration in cutaneous microcirculation and its clinical correlation in patients with tetralogy of Fallot (TF). Laser Doppler flowmetry and capillary microscopy were used to assess thermoregulatory and nutritional microcirculation, respectively. A significant increase in blood flow in thermoregulatory vessels was noticed only in TF patients with hemoglobin (Hb) levels under 19 g/dl. In patients with Hb levels above 19 g/dl, the blood flow declined into the normal range. This result indicated an extreme decrease of blood flow velocity in the thermoregulatory vessels in patients with Hb concentration higher than 19 g/dl. All TF patients with Hb concentrations higher than 19 g/dl revealed Maricq's type III capillaries. Type III capillaries revealed a significant retardation of capillary blood cell velocity (CBV). There was a reciprocal relationship between CBV and hematocrit (Hct). All the responses of the cutaneous microcirculation revealed a good correlation with the clinical severity of TF. All patients with type III capillaries (with Hb concentrations higher than 19 g/dl or Hct level higher than 60%) indicated an advanced disease progression. Laser Doppler flowmetry and capillary microscopy provide a sensitive noninvasive approach for the evaluation of the hemodynamic disturbances in TF and conditions resulting from long-term hypoxia.