A Critical Increase in Right-to-Left Shunt After Acute Myocardial Infarction in a 68-year-old Male With Tetralogy of Fallot

Abstract

SUMMARYA male patient with tetralogy of Fallot accompanied by aortic regurgitation had maintained sufficient exercise capacity for a number of decades with the status of acyanotic tetralogy of Fallot. When he was 67 years old, he suffered a posterior wall acute myocardial infarction and direct percutaneous coronary angioplasty successfully revascularised the target lesion in the left circumflex artery. However, a few months after the onset of the myocardial infarction, his shortness of breath became clinically significant and was associated with increased right-to-left shunt and increased right ventricular end-diastolic pressure, as well as hypoxia. At 68 years old, therefore, total corrective repair of the tetralogy with replacement of the aortic and pulmonary valves was performed. The patient was asymptomatic after the successful operation. This report suggests that coronary artery disease can be one of the potential factors in inducing critical hemodynamic changes in aging patients with congenital heart disease, especially those who have a shunt between the right and left chambers. The unique clinical course is described with some discussion of the repair of tetralogy in adults. (Int Heart J 2005; 46: 167-174)

Acute myocardial infarction in a patient with uncorrected tetralogy of Fallot accompanied by coronary artery ectasia: A case report

“…Izawa at al. reported an AMI case with uncorrected TOF and that had a critical increase in right-to-left shunt in the period after AMI [2]. In our case, echocardiography after the second AMI event showed an increase in right-to-left shunt and a decrease in Qp/Qs ratio as compared with after the first AMI event (from 1.18 to 1.0), the same as in Izawa's report [2].…”

“…reported an AMI case with uncorrected TOF and that had a critical increase in right-to-left shunt in the period after AMI [2]. In our case, echocardiography after the second AMI event showed an increase in right-to-left shunt and a decrease in Qp/Qs ratio as compared with after the first AMI event (from 1.18 to 1.0), the same as in Izawa's report [2]. Dabizzi et al reported that 36% of TOF cases were associated with anomalies in coronary course or/and distribution, and sometimes had enlarged conus branch or aberrant vessel crossing over the RVOT [9].…”

“…Tetralogy of Fallot (TOF) is known well as one of cyanotic congenital heart diseases, which develop a compensatory erythrocytosis as a result of chronic hypoxemia. Previous studies have reported that erythrocytosis of cyanotic heart disease and coronary artery ectasia (CAE) heighten blood viscosity and activate coagulation, eventually increasing the risk of acute myocardial infarction (AMI) due to coronary thrombosis, regardless of the absence of coronary stenosis or atrial fibrillation [1][2][3][4][5]. In this case study, we report a very rare case of AMI in an adult patient with uncorrected TOF accompanied by CAE.…”

Prevalence of cardiovascular risk factors in adults with congenital heart disease

“…Several publications have reported coronary artery disease in patients with or without repair for tetralogy of Fallot [14–21]. Whether the risk of developing coronary heart disease is higher in patients with tetralogy of Fallot than in the general population is unknown [16]. For sure, tetralogy of Fallot was one of the first complex heart defects with which patients could survive beyond the fourth decade of life.…”