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Case Reports
. 2020 Dec 16;2(15):2289-2294.
doi: 10.1016/j.jaccas.2020.09.017. eCollection 2020 Dec.

Incidental Diagnosis After a Car Accident: A Rare Case of Asymptomatic Uncorrected Tetralogy of Fallot

Monica Verdoia  1   2 , Rocco Gioscia  2 , Pier Luigi Soldà  1 , Federica Marrara  1 , Borejda Xhyheri  1 , Stefano Leuzzi  1 , Giuseppe De Luca  2 , Caterina Masia  3 , Ermanno Spagarino  3 , Mimii Emanoela Pascu  3 , Umberto Colageo  3 , Marco Marcolongo  1
Affiliations
Case Reports

Incidental Diagnosis After a Car Accident: A Rare Case of Asymptomatic Uncorrected Tetralogy of Fallot

Monica Verdoia et al. JACC Case Rep. .

Abstract

Tetralogy of Fallot (TOF) is a heterogeneous congenital heart disease that is occasionally diagnosed during adulthood. However, although they are often asymptomatic, adult patients with uncorrected TOF often have a poor prognosis. Poor outcomes indicate the importance of the identification and management of these patients, especially in the context of intercurrent disease or noncardiac surgery. We describe a case of clinically silent TOF in a 51-year-old woman. TOF was unmasked during a major noncardiac surgery for a polytrauma and successfully treated with the cooperation of a multidisciplinary team. (Level of Difficulty: Advanced.).

Keywords: CHD, congenital heart disease; CT, computed tomography; RV, right ventricle; SVR, systemic vascular resistance; TOF, tetralogy of Fallot; congenital heart defect; cyanotic heart disease; hemodynamics; tetralogy of Fallot.

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Conflict of interest statement

The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

Figure 1
Figure 1
Angio-Computed Tomography Scan Pulmonary embolism was excluded, showing the enlargement of the ascending aorta (37 mm, ∗) and hypertrophy and dilatation or the right heart chamber (A, arrow) and interstitial pulmonary edema with atelectasis of the inferior lobes (B, dashed arrow).
Figure 2
Figure 2
Electrocardiogram at Admission
Figure 3
Figure 3
Transesophageal Echocardiogram Ventricular septal defect with a modest passage of sonicated contrast is shown (arrow).
Figure 4
Figure 4
Elevated Transtricuspid Gradient Continuous Doppler measurement at transesophageal echocardiogram is shown.
Figure 5
Figure 5
Chest Radiograph at Admission A normal distribution of the pulmonary vessels (∗) and no enlargement of the cardiac shape (arrow), hindering the hypothesis of pulmonary hypertension, is represented.
Figure 6
Figure 6
Diagnostic Findings Consistent With Diagnosis of Tetralogy of Fallot Transthoracic echocardiogram showing the left-right shunt at continuous Doppler (A), the color Doppler flow through the septal defect (B, dashed arrow), the pulmonary outflow gradient at continuous Doppler (C), and the presence of a subpulmonary muscular sleeve at CT scan (D, arrow).
Figure 7
Figure 7
Pericardial Effusion Chest X-ray showing the enlargement of pericardial shadow (arrow).
See this image and copyright information in PMC

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