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JAMA Cardiology Clinical Challenge
April 2017

Thirty-Two-Year-Old Woman With Corrected Tetralogy of Fallot

Author Affiliations
  • 1Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
JAMA Cardiol. 2017;2(4):449-450. doi:10.1001/jamacardio.2017.0240

A 32-year-old, asymptomatic woman with history of tetralogy of Fallot (TOF) presented for evaluation of her congenital heart disease. Surgical history consisted of a Blalock-Taussig shunt in early childhood and subsequent TOF repair at age 3 years. On examination, venous pressure was visualized 4 cm above the clavicle at 45° with a prominent a wave. A parasternal lift was present. Auscultatory findings at the left upper sternal border are provided in the corresponding Audio. An electrocardiogram (Figure 1A) revealed sinus rhythm with a right bundle branch block. Findings from a transthoracic echocardiogram (TTE) are shown in Figure 1B and Video 1. Right ventricular diastolic volume index, quantitated by cardiac magnetic resonance, was 161 mL/m2.

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