A 72-year-old woman with an uncorrected tetralogy of Fallot presenting with possible pulmonary endocarditis: a case report

Abstract

Introduction: Tetralogy of Fallot is one of the most common forms of cyanotic congenital heart disease and in the absence of surgical correction it has an elevated early mortality, with most patients dying in childhood.The authors reported this case because of the unusual course of an uncorrected tetralogy of Fallot. There are only a few reports of patients with an uncorrected tetralogy of Fallot who reach an advanced age and to the best of our knowledge this is the first case report of a possible endocarditis in a patient with an uncorrected tetralogy of Fallot who is older than 70 years.

Case presentation: The authors present a case of a 72-year-old Caucasian woman with uncorrected tetralogy of Fallot who was admitted with fever and heart failure to our Cardiology Department with possible infective endocarditis.

Conclusions: The longevity of this patient is probably due to the association between a large ventricular septal defect, a balanced subpulmonary stenosis and to the presence of systemic hypertension. After empiric antibiotic therapy, the patient was discharged and no surgical intervention was performed due to her previous benign evolution.

Figure 1

Cardiac magnetic resonance imaging confirming the diagnosis of tetralogy of Fallot. A: Ventricular septal defect and overriding aorta over the septum. B: Right ventricular hypertrophy and subpulmonary stenosis.

Figure 2

Transthoracic echocardiogram revealing some of the characteristics of tetralogy of Fallot. A: Five chamber view with the presence of the ventricular septal defect (VSD) and the overriding aorta over the septum. B: Parasternal long axis view revealing the VSD, the overriding of the aorta over the septum and also the right ventricle (RV) hypertrophy. AO, aorta; IVS, interventricular septum; LA, left atrium; LV, left ventricle.

Figure 3

Transthoracic echocardiogram revealing an erratic structure in the pulmonary valve suggestive of vegetation. AoV, aortic valve; PA, pulmonary artery; PV, pulmonary valve.

Figure 4

Transthoracic echocardiogram showing the pulmonary valve at discharge, after 4 weeks of empiric antibiotherapy. AoV, aortic valve; PA, pulmonary artery; PV, pulmonary valve.