Untreated Tetralogy of Fallot With Pulmonary Atresia in a 55-Year-Old Woman
Findings From Magnetic Resonance Imaging
A 55-year-old woman with congenital heart disease and increasing dyspnea at low levels of exertion was referred to our department for imaging. Clinical findings were cyanosis of the lips and clubbing of the fingers. The past medical history included several hospitalizations for dyspnea, tachycardia, recurrent pulmonary embolism, and suspected cerebral embolism.
Despite several conventional angiographic studies, the exact classification of the congenital heart disease and the vascular abnormalities had not been made because of the complex cardiovascular morphology. The presumptive diag- nosis was truncus arteriosus type IV. Differential diagnosis included tetralogy of Fallot with pulmonary atresia.
To reevaluate the morphology and to assess acute pulmonary, cardiac, and thoracic vessel problems, MRI was performed (Figures 1 to 4⇓⇓⇓). It revealed a ventricular septal defect with overriding aorta, pulmonal atresia with collateral blood supply by major aortopulmonary collateral arteries, and collateral arteries originating from the right phrenic arteries and intercostal arteries. These findings are consistent with tetralogy of Fallot with pulmonary atresia.
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