Tetralogy of Fallot

Case contributed by Mohammad A. ElBeialy


Cyanotic baby.

Patient Data

Age: 1 year.
Gender: Male

Conventional radiograph shows typical boot-shaped heart with upturned cardiac apex indicative of right ventricular hypertrophy as well as concave pulmonary arterial segment indicative of pulmonary hypoplasia.

  • large subaortic ventricular septal defect (VSD) with an over-riding aorta. The over-riding aorta is dilated and measures 1.6 cm in its maximal diameter at the level of the main pulmonary artery (MPA)
  • antegrade continuity between the right ventricle (RV) and MPA with severe infandibular and valvular pulmonary stenosis
  • confluent relatively small sized MPA with fair caliber of its major branches
  • left-sided aortic arch with common bovin origin of the left CCA and the brachiocephalic artery
  • mild cardiomegaly with right ventricular hypertrophy
  • situs solitus, apex to the left
  • atrio-ventricular and ventriculoarterial concordance
  • no evident anomalous pulmonary venous drainage
  • no PDA
  • No major aorto-pulmonary collaterals (MAPCAs).

Case Discussion

A typical case of tetralogy of Fallot (TOF) with subaortic VSD, over-riding aorta, pulmonary stenosis and right ventricular hypertrophy.

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