Table of Contents

ABSTRACT

Background: Untreated Tetralogy of Fallot (TOF) may lead to polycythemia and may result in other cardiovascular complications. Palliative options are frequently used to ease the symptoms of TOF before definitive repair. Late-presentation TOF poses major comorbidities, which increase the risk of surgery. We report two cases of late-presenting TOF treated with non-surgical transcatheter palliation due to high-risk for surgical repair.

Case Illustration: A 41-year-old (Case 1) and 19-year-old man (Case 2) were admitted to the emergency room due to chief complaint of dyspnea and severe headache with previous history of hypoxic spell, respectively. Both patients had presented with signs of right ventricular hypertrophy and cardiomegaly from physical examination. Echocardiography had confirmed TOF in both cases. Non-surgical palliation for both cases was performed with right ventricular outflow tract stenting and balloon pulmonary valvuloplasty, respectively. Both patients had shown clinical and systolic function improvement after both interventions.

Conclusion: Late-presentation TOF is associated with major comorbidities with high-risk surgery features not amenable to surgery. Palliative non-surgical intervention in late-presentation TOF may be considered as a bridging procedure prior to the definitive surgical repair.

Keywords: complications, congenital heart disease, palliative, Tetralogy of Fallot