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Late Presentation of Tetralogy of Fallot and Uncommon Survival in A 31-Year-Old Patient

Maryam O. Usman^1*, Haruna A. Abubakar², Yekeen A. Ayoola^3
1Department of Paediatrics (Paediatric cardiology unit), Federal Teaching Hospital Gombe, Gombe State, Nigeria
²Department of Internal medicine (Cardiology unit), State Specialist Hospital Gombe, Gombe State, Nigeria
³Department of Internal Medicine (Cardiology unit), Federal Teaching Hospital Gombe/Gombe State University, Gombe State, Nigeria

Corresponding Author: Maryam O. Usman
Address: Department of Pediatrics, Federal Teaching Hospital Gombe, Gombe State 760001, Nigeria.
Received date: 23 August 2025; Accepted date: 02 October 2025; Published date: 09 October 2025

Citation: Usman MO, Abubakar HA, Ayoola YA. Late Presentation of Tetralogy of Fallot and Uncommon Survival in A 31-Year-Old Patient. Asp Biomed Clin Case Rep. 2025 Oct 09;8(3):276-81.

Copyright © 2025 Usman MO, Abubakar HA, Ayoola YA. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium provided the original work is properly cited.

Keywords: Tetralogy of Fallot, Late Presentation, Survival

Abstract

Background: Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease encountered in clinical practice. It consists of ventricular septal defect (VSD), overriding aorta, right ventricular outflow tract obstruction (RVOTO), and right ventricular hypertrophy (RVH). Clinical severity depends on the degree of RVOTO, presence or absence of extracardiac shunts or collaterals, and other factors. Only 10% of untreated patients survive into adulthood.
Objective: To describe late presentation of TOF and uncommon survival in a 31-year-old patient.
Case Report: A 31-year-old male presented at the cardiology clinic of a secondary healthcare facility in Gombe, Gombe State, Nigeria, with complaints of exercise intolerance. His symptoms started at 4 years of age, and he did not have any significant limitation in day-to-day activities. He had no history of prior cardiac investigation or care. Significant examination findings were plethora, central cyanosis, grade 4 finger clubbing, height 170 cm, weight 70 kg, body mass index 24.2 kg/m², grade 3/6 systolic murmur at the left upper sternal border, and blood pressure of 110/70 mmHg. Packed cell volume was 71%, SPO₂ was 84%; chest X-ray showed a normal-sized heart with boot-shaped appearance, presence of pulmonary bay, and lung oligemia. Electrocardiographic findings were in keeping with RVH. Transthoracic echocardiography revealed a large subaortic VSD, overriding aorta, severe valvular pulmonary stenosis, and right ventricular hypertrophy.
Conclusion: There should be a high index of suspicion for CHDs in adults presenting with dyspnea on exertion and cyanosis. Also, there is a need for early diagnosis of CHD through prompt referral of patients with respiratory or cardiac symptoms to centers that can perform echocardiography.