Uncorrected tetralogy of Fallot: adult presentation in the 61st year of life

Management of Fallot's Uncorrected Tetralogy in Adulthood: A Narrative Review

The majority of cyanotic congenital cardiac defects are caused by the tetralogy of Fallot. Some symptoms include a biventricular connection of the aortic root, right ventricular hypertrophy, blockage of the right ventricular outflow tract, and a ventricular septal defect. Our understanding of tetralogy of Fallot (TOF) has significantly advanced since it was first described in 1888, and early diagnosis has led to improved surgical management and increased life expectancy. Adults with unrepaired and repaired TOF present with a range of late complications, including heart failure, the need for re-interventions, and late arrhythmias. Right ventricular (RV) failure, often caused by chronic pulmonary regurgitation, is a significant cause of heart failure in patients with TOF. Current treatment options are limited, and mainstay surgical procedures such as pulmonary-valve replacement (PVR), trans-annular repair (TAR), or infundibular widening repair have not shown a significant reduction in preventing right ventricular (RV) failure or death. Here, we explain the mechanisms of RV failure in ToF, chronic pulmonary regurgitation, heart failure, and secondary polycythemia. HF management in untreated adults is discussed. The progression of the disease, as well as complications, are also discussed. The treatment plan and the need to investigate the best management approach for this unsolved problem are included. This review aims to fill the knowledge gaps and supply valuable information regarding mechanisms of RV failure, chronic pulmonary regurgitation, and secondary polycythemia. To summarize, a new combat strategy must be found to battle RVF, and a more profound vision of these mechanisms is required. If it is not corrected, it will be one of the future research lines that will contribute to designing more efficacious treatment techniques for adults with TOF.

Challenges and outcomes of pregnancy in an uncorrected Tetralogy of Fallot with pulmonary atresia and major aorta-pulmonary collateral arteries (MAPCA): a case report

BACKGROUND

Tetralogy of Fallot is a severe type of congenital heart disease (CHD) and one of the leading indirect causes of mortality & morbidity among women with CHD. We came across a rare case of an uncorrected Tetralogy of Fallot with pulmonary atresia and major aortopulmonary collateral arteries in pregnancy.

CASE PRESENTATION

We are reporting the challenges in managing a pregnancy of 25-years-old G3 P0110, previous one stillbirth and who was diagnosed to have congenital heart disease during pregnancy following spontaneous abortion.

CONCLUSIONS

This case report highlights the role of multidisciplinary care in managing such a high risk case. It also emphasizes the role of cardiac examination of every woman before pregnancy so that definitive treatment or optimization can be done in time for a better outcome.

Anaesthetic Challenges and Transesophageal Echocardiography-Guided Perioperative Management in a Patient with Uncorrected Adult Congenital Heart Disease Presenting for Emergency Laparoscopic Hysterectomy

Anaesthetic management of a patient with adult congenital heart disease with a single ventricle physiology presenting for an emergency laparoscopic surgery is challenging. The importance of a multidisciplinary approach, astute understanding of the pathophysiology and optimisation of intraoperative hemodynamic goals cannot be overemphasised. The present report describes the anaesthetic challenges and the role of transoesophageal echocardiography in perioperative management of a patient with uncorrected tetralogy of Fallot with pulmonary atresia, who successfully underwent an emergency laparoscopic hysterectomy under general anaesthesia.

Incidental Diagnosis After a Car Accident: A Rare Case of Asymptomatic Uncorrected Tetralogy of Fallot

Tetralogy of Fallot (TOF) is a heterogeneous congenital heart disease that is occasionally diagnosed during adulthood. However, although they are often asymptomatic, adult patients with uncorrected TOF often have a poor prognosis. Poor outcomes indicate the importance of the identification and management of these patients, especially in the context of intercurrent disease or noncardiac surgery. We describe a case of clinically silent TOF in a 51-year-old woman. TOF was unmasked during a major noncardiac surgery for a polytrauma and successfully treated with the cooperation of a multidisciplinary team. (Level of Difficulty: Advanced.).

Intracerebral hemorrhage in an adult patient with Tetralogy of Fallot: Case report and review of the literature

RATIONALE

Tetralogy of Fallot (TOF) accounts for approximately 5% of all congenital heart disease. However, only 1% of patients with TOF survive to the age of 40 years without undergoing surgery. Additionally, the relationship between intracerebral hemorrhage and unrepaired TOF remains unknown. We report a rare case of unrepaired TOF in a patient who presented with intracerebral hemorrhage, and we also present a literature review.

PATIENT CONCERNS

A 40-year-old man presented with headache and right-sided limb weakness.

DIAGNOSES

He was diagnosed with TOF approximately a year prior to presentation and did not undergo any definitive treatment or any symptomatic management. Head computed tomography revealed an intracerebral hematoma in the left basal ganglia. The patient was drowsy, and his blood oxygen saturation was 77%.

INTERVENTIONS

Owing to his poor cardiopulmonary status, the patient did not undergo surgery and was treated with only symptomatic supportive therapy.

OUTCOMES

After 2 days of therapy, his disturbance of consciousness and motor ability showed improvement.

LESSONS

Literature reviews reveal that intracerebral hemorrhage is rarely observed in patients with TOF, and to date, only 3 cases have been reported. Furthermore, this patient was 40 years old and did not undergo cardiac surgery. Severe hypoxia, as well as low levels of platelets and coagulation factors in the blood could have led to intracerebral hemorrhage.

A Case of Uncorrected Tetralogy of Fallot Undiagnosed Until Adulthood and Presenting With Polycythemia

Congenital heart defects with right-to-left shunt are one of the hypoxia-related causes of acquired secondary polycythemia (SP). Tetralogy of Fallot (ToF) is the most common congenital cyanotic heart disease in children. Cases of uncorrected ToF in adult ages are rare. This paper reports a woman detected with elevated hemoglobin level during routine tests performed for infertility therapy and subsequently diagnosed SP with related ToF.

Uncorrected tetralogy of fallot in a 25-year old nigerian african

Tetralogy of Fallot is the most common form of cyanotic congenital heart disease. Survival after the age of 12 years without corrective surgery is rare. We present the case of a 25 year-old man with uncorrected tetralogy of Fallot. Possible reasons for the longetivity in this patient are left ventricular hypertrophy and systemic to pulmonary shunting through internal mammary arteries.

Uncorrected pink tetralogy of Fallot in an adult patient: incidental CT findings

Tetralogy of Fallot (TOF), one of the most common congenital heart diseases, has four major components: right ventricular hypertrophy, overriding aorta, membranous ventricular septal defect, and right ventricular outflow tract obstruction. If not already present at birth, cyanosis develops in the first year of life. Survival of the patient depends on the degree of pulmonary obstruction and the pulmonary blood supply. Patients rarely survive after the fourth decade of life. Limitation of blood to the lungs combined with ventricular septal defect results in supply of oxygen-poor blood to the body, causing cyanosis (blue coloration) in the patient. If the pulmonary stenosis is mild and ventricular septal defect is in balance, however, the noncyanotic patient is referred as having "pink tetralogy of Fallot."