Tetralogy of Fallot and coarctation of the aorta: successful repair in an infant

Tetralogy of Fallot with coarctation of the aorta: a newly recognised developmental and anatomic syndrome

Tetralogy of Fallot and coarctation of the aorta is an exceptional association. We report here four cases of infants referred for tetralogy of Fallot with or without pulmonary atresia associated with aortic coarctation from 1974 to 2013. All had a right aortic arch, and the coarctation was abnormally situated between the right common carotid and the right subclavian arteries. In all, two infants had an abnormal left subclavian artery and one child had DiGeorge syndrome. All underwent staged surgical repair of the left and right-sided obstructions. A review of the literature shows two types of coarctation in this context. In left aortic arch, coarctation is situated distal to the left subclavian artery. In right aortic arch, coarctation is distal to the right common carotid artery, mirror-image of interrupted left aortic arch type B, associated with anomalies of the branches of the aorta, and should be considered a complex anomaly of aortic arches in the setting of an outflow tract defect due to abnormal migration of cardiac neural crest cells. Screening for this unusual association is critical in the initial assessment of all patients with tetralogy of Fallot.

One-stage repair of tetralogy of Fallot with coarctation of the aorta

We describe the rare case of a 10-month-old girl who had coarctation of the aorta in association with tetralogy of Fallot. The surgical management and postoperative course is described. This case highlights the rare association of coarctation with tetralogy of Fallot, with a large intracardiac right-to-left shunt. Although an exception to the rule, it challenges the reduced fetal blood flow theory and the smooth muscle cell migration theory as embryological explanations for the development of coarctation.

Coarctation of the aorta in the setting of tetralogy of Fallot: an uncommon cause of myocardial dysfunction

The combination of both right and left heart obstruction has only rarely been described in the medical literature. We present three cases of coarctation of the aorta in patients with variants of tetralogy of Fallot and hypothesise that this condition may be more common than previously suspected and could represent a hidden cause of morbidity in patients with pulmonary atresia/ventricular septal defect.

Successful staged neonatal repair of tetralogy of Fallot with long-segment hypoplasia of the aorta

We describe an extremely rare combination of tetralogy of Fallot (TOF), right-sided cervical aortic arch with long-segment hypoplasia, and other vascular anomalies. A two-stage surgical approach included aortic arch reconstruction followed by right ventricular muscle bundle division and ventricular septal defect closure a few weeks later. The initial clinical presentation, perioperative course, and imaging studies are presented along with a review of the relevant literature. This is the first report of successful neonatal repair of TOF with long-segment hypoplasia of the aorta.

Pulmonary atresia with intact ventricular septum coexisting with coarctation of the aorta

A newborn with pulmonary atresia, intact ventricular septum, and a bicommissural aortic valve underwent percutaneous pulmonary valvotomy at 1 day of age. Severe coarctation of the aorta became apparent only after spontaneous closure of the ductus arteriosus at 5 weeks of age, requiring repair by surgical end-to-end anastomosis. This is the first report of a child with pulmonary atresia with intact ventricular septum in association with coarctation of the aorta.

Coarctation co-existing with tetralogy of Fallot and pulmonary atresia

We describe the finding of unsuspected aortic coarctation, discovered by catheterisation at 4 months, in a neonate first daignosed on the fourth day of life as having tetralogy of Fallot with pulmonary atresia and major aorto-to-pulmonary collateral arteries. This previously unreported combination contravenes the established theory of patterns of flow during fetal life, and presented difficult issues in clinical management.

Tetralogy of Fallot, absent pulmonary valve, partial anomalous pulmonary venous return and coarctation of the aorta

We describe a unique combination of tetralogy of Fallot, absent pulmonary valve, aortic coarctation with partial anomalous pulmonary venous connection and a retroaortic innominate vein. Surgical repair was successfully accomplished in two stages: coarctation repair preceded correction of the intracardiac anomalies.

Tetralogy of Fallot and coarctation of the aorta: a rare combination and its clinical implications

A neonate with tetralogy of Fallot and aortic coarctation is described. The clinical course was remarkable, with early congestive heart failure followed by rapidly progressive left ventricular myocardial thickening and the presentation of hypercyanotic spells. Primary repair of tetralogy without correction of coarctation was attempted unsuccessfully at 1 month of age. Death followed postoperative bradycardia, hypotension, and low cardiac output. Fetal and neonatal hemodynamics and the clinical implication of this rare combination of defects are discussed. Initial surgical intervention should relieve left-sided obstruction.

Coarctation of the aorta associated with pulmonary valve stenosis

A 7-year-old patient had coarctation of the aorta associated with moderate and dysplastic pulmonary valve stenosis. The child underwent corrective surgery of the coarctation. This unusual association cannot be satisfactorily explained by the theory of fetal flow patterns.