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Tetralogy of Fallot and late complications - clinical case report

Diyana Kyuchukova, Simona Nikolaeva, Dilyana Tonkova


Introduction: The tetralogy of Fallot (TOF) is the most common cyanogenic congenital heart defect. Being named after the French scientist Arthur Fallot, it is characterized by the presence of dextro­position of the aorta, ventricular septal defect, obstruction of the right ventricular outflow tract and right ventricular hypertrophy. The mortality rate in untreated patients reaches up to 50% by the age of six. In spite of an operation being the only definite treatment, a series of postoperative potential complications, such as rhythm and conduction disorders, ventricle dilation and dysfunction, aneu­rysm formation and rupture at the site of right ventricle outflow tract repair or sudden cardiac death in operated TOF patients are often reported.

Materials and methods: We present a case report in order to evaluate the occurrence and significance of complications linked to this rare defect even after corrective surgery. Our patient is a 60-year-old woman with a surgical intervention for TOF, diagnosed in her early childhood. In December 2017 she was admitted to the hospital due to complaints of breathlessness, orthopnea, fatigue and heart pal­pitations.

Results: Routine physical examination including electrocardiography, echocardiography and X-ray indicated heart failure stage three-four by the New York Heart Association Classification, atrial fi­brillation, pulmonary hypertension stage three and tricuspid insufficiency second stage. Taking into account the complexity of the case, surgical reintervention as a therapeutical option was eliminat­ed. After the patient regained sinus rhythm and was compensated to a maximum extent, she was dis­charged with optimal drug therapy and a recommended follow-up every three months.

Conclusion: TOF is a condition which is not usual for specialists in their everyday routine practice and deserves to be carefully approached as it is treatable, but neglected despite the possible risks it holds.


tetralogy of Fallot; complications



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