Untreated Tetralogy of Fallot With Pulmonary Atresia
Giant Aneurysm of an Aortopulmonary Collateral Artery Demonstrated by Magnetic Resonance Imaging
A 41-year-old man with untreated tetralogy of Fallot and pulmonary atresia was referred to our department for imaging. His diagnosis had been established in early infancy, but cardiac surgery was repeatedly refused over the years. In addition to central cyanosis and clubbing of the fingers, the patient started experiencing worsening exertional dyspnea, cough, and pain in the back and left shoulder within the last 2 years. A transthoracic echocardiogram revealed, in addition to the findings consistent with his congenital heart disease, a large paracardiac mass in the left hemithorax. To evaluate the cardiac morphology in greater detail and to better characterize the paracardiac mass, magnetic resonance imaging was performed (Figure 1 through Figure 3⇓⇓ and Data SupplementMovie I through Movie III). The typical features of tetralogy of Fallot, such as outlet ventricular septal defect, overriding aorta, right ventricular (RV) hypertrophy, and obstruction to the RV outflow, were readily identified. In addition, this patient displayed extensive aortopulmonary collateral circulation, with a large aneurysmatic dilatation of the left internal mammary artery (a major aortopulmonary collateral vessel in this case).
The online-only Data Supplement can be found at http://circ.ahajournals.org/cgi/content/full/113/8/e293/DC1.