Echo: LVH, RVH with preserved systolic function of both ventricles, mild pulmonary valve stenosis.
MPS was indicated to rule out associated CAD.
Teaching points:
TF is the most common cyanotic heart defect seen in children beyond infancy, the most common cyanotic congenital lesion likely to result in survival to adulthood, and currently the most common complex lesion to be encountered in adults after repair.
TID can be the consequence of segmental or diffuse ischemia. Lack of proportionate microvascular growth in myocardial hypertrophy leaves the myocardium vulnerable to ischemia even in the absence of atherosclerotic plaques (diffuse vs. segmental ischemia).
In addition to RV hypertrophy, LVH can develop due to LV overload in TF.
Patients with acyanotic TF (or pink TF) may be asymptomatic or may show signs of heart failure from a large left-to-right shunt.
Occasionally, an individual reaches adulthood without any surgical repair, although this is not common.
Echocardiography is the modality of choice for the postoperative follow-up evaluation of patients with palliated or repaired TF.
Residual abnormalities range from nearly normal heart to substantial RV dysfunction and residual RV outflow tract obstruction.
MPS can be indicated in adult cases in which symptoms may resemble those from coronary artery disease.
