The Egyptian Heart Journal (Apr 2024)

Surgically repaired tetralogy of Fallot in the 7th decade: a late presentation of severe pulmonic regurgitation

  • Kyle Varkoly,
  • Akarsh Parekh,
  • Melissa Ianitelli,
  • Mostafa Hamada,
  • Alexandra Lucas,
  • Thomas Forbes

DOI
https://doi.org/10.1186/s43044-024-00477-3
Journal volume & issue
Vol. 76, no. 1
pp. 1 – 5

Abstract

Read online

Abstract Background Surgically repaired tetralogy of Fallot (TOF) is a congenital heart disease with a cumulative survival rate of 72% in the 4th decade of life in longitudinal single-cohort studies. Debate surrounds conservative versus surgical management in adults with TOF once pulmonary regurgitation occurs. Case presentation A 73-year-old male with surgically corrected TOF presented with heart failure symptoms. He underwent ToF repair with a classic right Blalock–Taussig shunt at 2 years of age with transannular patching at 18 years of age. Echocardiography revealed elevated right ventricular systolic pressures, severe right ventricular dilatation, and pulmonary regurgitation. Our patient’s new-onset right-sided heart failure was managed medically with diuresis. He received a new pulmonic valve via percutaneous approach on a later planned hospitalization with resolution of symptoms and improved tricuspid regurgitation. Conclusion It is a class I recommendation for pulmonic valve intervention once greater than moderate PR occurs; however, medical optimization should take place first. Following adequate RV load optimization, our patient underwent successful transcatheter pulmonic valve implantation with resolution of symptoms and cessation of diuretic.

Keywords