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. 2008 Apr 28:2:127.
doi: 10.1186/1752-1947-2-127.

Tetralogy of Fallot with rheumatic mitral stenosis: a case report

Cheemalapati Sai Krishna  1 , Gangireddy Venkateswara Reddy, Mohan Debta, Nanda Kishore Panigrahi
Affiliations

Tetralogy of Fallot with rheumatic mitral stenosis: a case report

Cheemalapati Sai Krishna et al. J Med Case Rep. .

Abstract

Introduction: Rheumatic and congenital heart diseases account for the majority of hospital admissions for cardiac patients in India. Tetralogy of Fallot is the most common congenital heart disease with survival to adulthood. Infective endocarditis accounts for 4% of admissions to a specialized unit for adult patients with a congenital heart lesion. This report is unique in that a severe stenotic lesion of the mitral valve, probably of rheumatic aetiology, was noted in an adult male with Tetralogy of Fallot.

Case presentation: An unusual association of rheumatic mitral stenosis in an adult Indian male patient aged 35 years with Tetralogy of Fallot and subacute bacterial endocarditis of the aortic valve is presented.

Conclusion: In this case report the diagnostic implications, hemodynamic and therapeutic consequences of mitral stenosis in Tetralogy of Fallot are discussed. In addition, the morbidity and mortality of infective endocarditis in adult patients with congenital heart disease are summarized. The risk of a coincident rheumatic process in patients with congenital heart disease is highlighted and the need for careful attention to this possibility during primary and follow-up evaluation of such patients emphasized.

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Figures

Figure 1
Figure 1
Parasternal long axis view showing the malaligned ventricular septal defect, aortic override (Ao), vegetation on the right coronary cusp (Vrcc) and thickened mitral valve (M).
Figure 2
Figure 2
Parasternal long axis view demonstrating the papillary muscles (1 and 2), doming of the anterior mitral leaflet (daml) and fixed posterior mitral leaflet (pml); IVS, interventricular septum; LA, left atrium.
Figure 3
Figure 3
RVOT morphology and Doppler study of the mitral valve. (A) Short axis image demonstrating the subaortic ventricular septal defect (arrow), hypoplastic right ventricular outflow tract (RVOT), main pulmonary artery (M) with confluent branch pulmonary arteries. L, left pulmonary artery; RA, right atrium; LA, left atrium. (B) Image demonstrating Doppler gradients across the mitral valve.
See this image and copyright information in PMC

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