Case Report: Unrepaired Tetralogy of Fallot in a 50-year-Old woman with 13 pregnancies: multimodal cardiovascular imaging, surgical repair, and longitudinal remodeling - Report - MDSpire

Case Report: Unrepaired Tetralogy of Fallot in a 50-year-Old woman with 13 pregnancies: multimodal cardiovascular imaging, surgical repair, and longitudinal remodeling

  • By

  • Moath Hattab

  • Yahya Ismail

  • Ahmed Darsalim

  • Nour Deek

  • Mohammad Abed

  • Adham Abderrazeq

  • Abelhalim Abuhaltam

  • Mohammed SalahAldin

  • Mohammed Abutaqa

  • Nizar Hijjeh

  • July 7, 2026

  • 0 min

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Clinical Report: A 50-Year-Old Woman with Uncorrected Tetralogy of Fallot

Overview

This case study presents a 50-year-old woman with uncorrected Tetralogy of Fallot (TOF) who underwent successful corrective surgery after presenting with severe symptoms. Multimodal cardiovascular imaging was utilized in diagnosing her condition and planning the surgical intervention.

Background

Tetralogy of Fallot is the most common form of cyanotic congenital heart disease. The rarity of survival into adulthood without surgical intervention is noted. This case emphasizes the need for awareness of congenital heart disease in adults, particularly in those with unexplained symptoms.

Data Highlights

ParameterPreoperativePostoperative (6 months)
RV Diameter4.38 cm3.98 cm
RA Area23.4 cm²17.9 cm²
RVOT Gradient124 mmHg67 mmHg

Key Findings

  • The patient had no prior cardiac diagnosis despite 13 pregnancies and 11 live births.
  • Multimodal cardiovascular imaging confirmed classic TOF anatomy.
  • Successful surgical intervention included VSD patch closure and pulmonary valve commissurotomy.
  • Postoperative echocardiography showed significant improvements in RV/RA dimensions and RVOT gradients.
  • Residual RVOT obstruction persisted at 6 months post-surgery.

Clinical Implications

This case illustrates the role of comprehensive cardiovascular imaging in diagnosing congenital heart disease in adults.

Conclusion

The management of this case highlights the need for recognizing congenital heart disease in adults, particularly those with unexplained symptoms and a history of multiple pregnancies.

Related Resources & Content

  1. Survival to the age of 87 years in a woman with unoperated tetralogy of Fallot - PMC, 2011 -- Survival to the age of 87 years in a woman with unoperated tetralogy of Fallot
  2. 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease (ACHD) Slide Set, 2018 -- 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease (ACHD)
  3. Pediatric Cardiology — Resection of Ross-Konno and Endocardial Fibroelastosis Following Hybrid Stage I Palliation in Infants: Effective Staged Rehabilitation of the Left Ventricle and Transition to Biventricular Circulation Post Fetal Diagnosis of Aortic Stenosis
  4. Clinical Research in Cardiology — A Case of Newly Diagnosed ALCAPA Syndrome in a 39-Year-Old Pregnant Woman
  5. Pediatric Cardiology — Interventional Treatment for Tetralogy of Fallot Expected to Advance Within the Next Twenty Years
  6. Pediatric Cardiology — Fetal Hypoplastic Left Heart Syndrome and Turner Syndrome Presenting with Nutmeg Lung Pattern on MRI
  7. Rarity and diagnosis in late-presenting TOF
  8. Surgical decision-making and cardiac remodeling
  9. 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease (ACHD) Slide Set
  10. 2025 ESC Guidelines for the management of cardiovascular disease and pregnancy | European Heart Journal | Oxford Academic

Original Source(s)

Case Report: Unrepaired Tetralogy of Fallot in a 50-year-Old woman with 13 pregnancies: multimodal cardiovascular imaging, surgical repair, and longitudinal remodeling

  • by Moath Hattab, Yahya Ismail, Ahmed Darsalim, Nour Deek, Mohammad Abed, Adham Abderrazeq, Abelhalim Abuhaltam, Mohammed SalahAldin, Mohammed Abutaqa, Nizar Hijjeh

  • July 7, 2026

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