Journal of cardiothoracic surgery · 2026
Successful intracardiac repair of unrepaired tetralogy of fallot in a 51-year-old woman: a case report.
СтатьяКлинический случайНазвание и аннотация: Перевод в очереди
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Kageyama Airi, Itatani Keiichi, Nakai Yosuke, Haibara Jiryo
Аннотация
BACKGROUND: Unrepaired tetralogy of Fallot (TOF) diagnosed in adulthood is extremely rare, and preoperative assessment of right and left ventricular functional reserve is essential for determining surgical indications and strategy.
CASE PRESENTATION: A 51-year-old woman, who had been followed up a ventricular septal defect (VSD) since childhood, was diagnosed with TOF and with right ventricular failure due to progressive fatigue and peripheral edema. Cardiac imaging revealed overriding aorta, a membranous VSD with a pouch, hypoplastic pulmonary valve annulus, and right ventricular outflow tract (RVOT) obstruction caused by anomalous muscular bundles, suggesting TOF anatomy. 4D flow MRI (Time resolved 3D cine phase contrast MRI) demonstrated accelerated systolic flow across the RVOT with minimal pulmonary regurgitation. Surgical repair consisted of a bioprosthetic pulmonary valve replacement with RVOT reconstruction using a bovine pericardial patch, VSD patch closure, and tricuspid valvuloplasty. The postoperative course was uneventful, and RV pressure was significantly reduced. She was discharged on postoperative day 13 and remained asymptomatic at 4 months.
CONCLUSIONS: Even in adults with unrepaired TOF, favorable outcomes can be achieved when surgical indications are carefully evaluated and procedures are tailored to the individual anatomy and hemodynamics.
CASE PRESENTATION: A 51-year-old woman, who had been followed up a ventricular septal defect (VSD) since childhood, was diagnosed with TOF and with right ventricular failure due to progressive fatigue and peripheral edema. Cardiac imaging revealed overriding aorta, a membranous VSD with a pouch, hypoplastic pulmonary valve annulus, and right ventricular outflow tract (RVOT) obstruction caused by anomalous muscular bundles, suggesting TOF anatomy. 4D flow MRI (Time resolved 3D cine phase contrast MRI) demonstrated accelerated systolic flow across the RVOT with minimal pulmonary regurgitation. Surgical repair consisted of a bioprosthetic pulmonary valve replacement with RVOT reconstruction using a bovine pericardial patch, VSD patch closure, and tricuspid valvuloplasty. The postoperative course was uneventful, and RV pressure was significantly reduced. She was discharged on postoperative day 13 and remained asymptomatic at 4 months.
CONCLUSIONS: Even in adults with unrepaired TOF, favorable outcomes can be achieved when surgical indications are carefully evaluated and procedures are tailored to the individual anatomy and hemodynamics.