Description

Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart defect in children worldwide. Surgical correction is required in early childhood and non-operative survival past the fourth decade is rarely described. We report an interesting case demonstrating the utility of multimodality imaging, including Transthoracic Echocardiography (TTE), Computed Tomography Pulmonary Angiography (CTPA) and Cardiac Magnetic Resonance imaging (CMR), in the assessment of a symptomatic patient in his 40s with unrepaired TOF. Together, these three imaging modalities provided complementary information of the patient’s cardiac and valvular anatomy, morphology and function. CTPA was performed to accurately visualise the confluence of the pulmonary arteries which TTE and CMR had failed to do, revealing extensive systemic-pulmonary artery collateral vessels and pulmonary atresia. These investigations enabled more accurate prognostication and facilitated further planning of management.