Washington University - Cardiovascular Division

Featured Case

Unrepaired Tetrology of Fallot (Submitted by B. Kurian, M.D.)

A 64 year old African American was admitted with a history of back pain, fevers and positive blood cultures. He noted a history of having a heart murmur as a child which required surgery at the age of 12 but had not seen a physician in years. Examination revealed an O2 sat 92% on RA, BP 114/68 HR 70. Cardiac exam revealed a harsh 4/6 holosystolic murmur best heard at the lower sternal border. Imaging of his back did not reveal any evidence of infection. A TEE was performed to evaluate for endocarditis. There was no gross evidence of endocarditis. He was, however, noted to having an overriding aorta, infundibular pulmonic stenosis, RVH and a large VSD consistent with an Unrepaired Tetrology of Fallot. We hypothesize that he may have had dilation of infidibular pulmonic stenosis as a child which had over time recurred but was otherwise left alone surgically. Interestingly he was not grossly hypoxic and reported to have living a fairly active lifestyle.

Video (18 MB)


· About the Division · Clinical Programs · Research Activities · Educational Programs Clinical Training Research Training Fellows Conferences Advanced Fellowships Our Fellows Application Process Fellowship Program Contacts Hospital Visit Forms Fellows Login · Centers of Excellence · Faculty · Links · Contact Us · Donors	Featured Case Unrepaired Tetrology of Fallot (Submitted by B. Kurian, M.D.) A 64 year old African American was admitted with a history of back pain, fevers and positive blood cultures. He noted a history of having a heart murmur as a child which required surgery at the age of 12 but had not seen a physician in years. Examination revealed an O2 sat 92% on RA, BP 114/68 HR 70. Cardiac exam revealed a harsh 4/6 holosystolic murmur best heard at the lower sternal border. Imaging of his back did not reveal any evidence of infection. A TEE was performed to evaluate for endocarditis. There was no gross evidence of endocarditis. He was, however, noted to having an overriding aorta, infundibular pulmonic stenosis, RVH and a large VSD consistent with an Unrepaired Tetrology of Fallot. We hypothesize that he may have had dilation of infidibular pulmonic stenosis as a child which had over time recurred but was otherwise left alone surgically. Interestingly he was not grossly hypoxic and reported to have living a fairly active lifestyle. Video (18 MB) Video (18 MB)