Giant Aneurysm of a Classic Blalock-Taussig Shunt in Adult Tetralogy of Fallot.

BACKGROUND

Giant aneurysmal degeneration of a classic Blalock-Taussig (BT) shunt is a rare, life-threatening late complication of tetralogy of Fallot (TOF) palliation.

CASE: A 47-year-old woman with unrepaired TOF palliated in childhood presented with exertional dyspnea and a right thoracic mass. Echocardiography revealed severe right ventricular outflow tract obstruction, a large ventricular septal defect, and a pulsatile extracardiac structure. Computed tomography and cardiac magnetic resonance imaging confirmed a giant (72 × 66 mm) true aneurysm of a right BT shunt. She underwent successful aneurysm excision, ventricular septal defect closure, right ventricular outflow tract reconstruction, and pulmonary valve replacement.

DISCUSSION: This case demonstrates a rare late complication of a classic BT shunt decades after TOF palliation.

CONCLUSION

Classic BT shunts may develop life-threatening aneurysmal degeneration decades after palliation, emphasizing lifelong surveillance and timely definitive management.

TAKE-HOME MESSAGE: Lifelong imaging surveillance and multimodality imaging are essential for detecting late vascular complications.