Objective:

To highlight the diagnostic value of multimodal cardiovascular imaging in detecting unrecognized cyanotic congenital heart disease in adults, specifically in the context of a case study involving a 50-year-old woman with uncorrected Tetralogy of Fallot and 13 pregnancies, and to demonstrate the safety and effectiveness of late repair of Tetralogy of Fallot (TOF).

Approach:

• Patient Presentation: A 50-year-old woman with progressive dyspnea and cyanosis, previously undiagnosed with TOF, underwent comprehensive cardiovascular imaging.
• Imaging Techniques: Multimodal imaging included transthoracic and transesophageal echocardiography, color Doppler, contrast studies, cardiac catheterization, and chest radiography.
• Surgical Intervention: The patient underwent corrective surgery involving VSD patch closure, pulmonary valve commissurotomy, and pulmonary artery plasty.
• Postoperative Assessment: Post-surgery, oxygen saturation normalized, and echocardiography showed significant improvements in cardiac dimensions and RVOT gradients.

Key Findings:

• The patient had classic TOF anatomy with severe RVOT obstruction and right-sided dilation.
• Postoperative echocardiography indicated substantial reduction in RV/RA dimensions and improvement in RVOT gradients.
• Residual RVOT obstruction persisted at 6 months post-surgery.

Interpretation:

This case highlights the importance of recognizing low oxygen saturation in adults and the need for awareness of congenital heart disease in this population.

Limitations:

• Incomplete obstetric and neonatal records limited the assessment of the patient's pregnancy history in relation to her cardiac condition.
• The imaging study for patent foramen ovale was not definitive in this case.

Conclusion:

Late repair of TOF can be safe and effective, emphasizing the role of advanced imaging in adult congenital heart disease.