A Case of uncorrected Tetralogy of Fallot presenting with Po
A 72-year-old woman with a history of controlled hypertension, reported to the cardiology consultation for uncorrected TOF.

During Consultation, she underwent a cardiac magnetic resonance imaging, which revealed a large subaortic VSD, with a diameter of 26mm; a marked hypertrophy of the RV with subpulmonary stenosis (maximum gradient of 31mmHg) and moderate pulmonary regurgitation; a dilatation of the pulmonary artery and its branches. It also revealed the absence of patent ductus arteriosus.

Five months prior to admission, she reported persistent predominantly vespertine low-grade fever episodes associated with asthenia and weight loss. Given the persistence of fever and progressive worsening of heart failure, she was brought to a hospital.

At admission, she was in class III of the NYHA(New York Heart Association) and presented with fever, slight peripheral cyanosis, finger clubbing despite oxygen saturation of 91%, a regular pulse of 95 beats per minute and a blood pressure of 149/70mmHg. Cardiac examination revealed a single second heart sound, a systolic thrill and loud systolic ejection murmur (grade IV) at the base of her heart.

Transthoracic echocardiography (TTE) showed the components of TOF and an echodense, irregular and mobile mass, 10mm long and 3mm wide, adherent and downstream to the pulmonary valve suggestive of vegetation without associated regurgitation.

After 4 weeks of antibiotic therapy, the fever and the elevation of the inflammation markers had resolved, the patient was back in class II of the NYHA and no images suggestive of vegetation were detected on TTE. Therefore, the patient was discharged.

Source: https://jmedicalcasereports.biomedcentral.com/articles/10.1186/1752-1947-7-150
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