# Surgically repaired tetralogy of Fallot in the 7th decade: a late presentation of severe pulmonic regurgitation

## TL;DR

An elderly patient with surgically repaired tetralogy of Fallot experienced late-onset heart failure due to severe pulmonic regurgitation, successfully treated with a transcatheter pulmonic valve.

## Contribution

This case highlights successful transcatheter pulmonic valve implantation in elderly TOF patients with late-onset severe regurgitation.

## Key findings

- Late-onset severe pulmonic regurgitation can lead to right-sided heart failure in elderly TOF patients.
- Transcatheter pulmonic valve implantation resolved symptoms and improved tricuspid regurgitation in this patient.
- Medical optimization is crucial before surgical intervention in such cases.

## Abstract

Surgically repaired tetralogy of Fallot (TOF) is a congenital heart disease with a cumulative survival rate of 72% in the 4th decade of life in longitudinal single-cohort studies. Debate surrounds conservative versus surgical management in adults with TOF once pulmonary regurgitation occurs.

A 73-year-old male with surgically corrected TOF presented with heart failure symptoms. He underwent ToF repair with a classic right Blalock–Taussig shunt at 2 years of age with transannular patching at 18 years of age. Echocardiography revealed elevated right ventricular systolic pressures, severe right ventricular dilatation, and pulmonary regurgitation. Our patient’s new-onset right-sided heart failure was managed medically with diuresis. He received a new pulmonic valve via percutaneous approach on a later planned hospitalization with resolution of symptoms and improved tricuspid regurgitation.

It is a class I recommendation for pulmonic valve intervention once greater than moderate PR occurs; however, medical optimization should take place first. Following adequate RV load optimization, our patient underwent successful transcatheter pulmonic valve implantation with resolution of symptoms and cessation of diuretic.