# Multiple Major Aortopulmonary Collateral Arteries With Tetralogy of Fallot and Other Congenital Cardiac Disorders Detected in the Fourth Decade: A Report of a Rare Case

## TL;DR

A rare case of a 41-year-old man with multiple aortopulmonary collateral arteries and tetralogy of Fallot is reported, highlighting unusual clinical presentation and surgical challenges.

## Contribution

This report highlights a rare combination of congenital cardiac anomalies and the need for surgical intervention in an asymptomatic middle-aged patient.

## Key findings

- The patient presented with MAPCAs, TOF, and bilateral hypoplastic pulmonary arteries.
- The case is notable for being asymptomatic until acute cardiac symptoms emerged.
- The patient's condition is associated with a right-sided aortic arch and aplastic left subclavian artery.

## Abstract

The occurrence of MAPCAs (major aortopulmonary collateral arteries) with TOF (tetralogy of Fallot) and bilateral hypoplastic pulmonary arteries together is a rare condition. Patients are typically middle-aged men who usually present with acute signs of cardiac manifestations. The anomalies have survival up to the fourth decade of life and are fraught with clinical challenges. Additionally, various congenital syndromic associations, such as DiGeorge syndrome, are associated with these anomalies. We report an extremely rare case of a 41-year-old male who came with complaints of chest pain, dyspnea on exertion, and headaches. The patient had a previous history of tuberculosis and a rare combination of MAPCAs with TOF and bilateral hypoplastic pulmonary arteries, with a right-sided aortic arch with an aplastic left subclavian artery. The importance of the case comes from the need to perform surgery on a middle-aged male who was completely asymptomatic prior to this.