Case Presentation
A Tetralogy Fallot (TOF) patient underwent a classic Blalock-Taussig
Shunt (BTS) at 2 years of age. Despite no medication, he had a long
asymptomatic life. At 53 years of age, he started to complain of
dizziness and recurrent attacks of syncope due to complete heart block
(CHB) and inserted a permanent pacemaker. 2D and 3D Echocardiography
(Figure 1, Video 1) showed uncorrected TOF with an overriding aorta, two
ventricular septal defects (VSDs) were seen; a large inlet type VSD and
another small muscular one with marked right ventricular hypertrophy
with marked infundibular stenosis. Cardiac Computed Tomography (Cardiac
CT) (Figure 2, Video 2) showed DORV-TOF type with noted severely
stenotic right ventricular outflow tract and pulmonary flow was
maintained through a patent classical BTS between left subclavian artery
(SCA) and the left pulmonary artery (LPA) and a noted accessory LAD
arises from RCC and passing in front of the RVOT. Due to stable
condition of the patient, he was discharged on close up follow-up.
Survival of uncorrected TOF patients is rarely reported and frequently
associated with a well-developed left ventricle, mild pulmonary
stenosis, or well-maintained pulmonary blood flow by systemic to
pulmonary collaterals or persistent patent ductus arteriosus. The
prognosis of TOF treated only with classical BTS remains unclear. In our
case may the causes for the long-term survival although severe pulmonary
stenosis was the well-formed BTS shunt with non-significant stenosis and
the aorto-pulmonary collaterals. This case shows that classical BTS has
a potential of long-term patency with good functional capacity resulting
in appropriate pulmonary blood flow by BTS resulting in long-term
survival.
Disclosure : Authors declare no conflict of interest