Unrepaired tetralogy of Fallot in a 61-year-old woman: a rare example of excellent natural palliation

Abstract

Before the advent of surgical intervention, approximately 50% of TOF patients died in the first few years of life and it was highly unusual for a patient to survive longer than 30 years. Thus far, only 12 cases of long-term survival without surgical correction have been described, of which all had cardiovascular complaints. in this case report, we present a 61-year-old female patient with unrepaired and unpalliated TOF with 15 years of follow-up in our medical center. Despite her very active working and social life and having been pregnant 2 times, she has remained completely asymptomatic over the course of years. Now, at age 61, she still has an excellent clinical condition and exercise tolerance. For this reason, she refuses (surgical) intervention for her progressive pulmonary stenosis, as improvement beyond her present condition can rightfully be discussed. Long-term survival of unrepaired and unpalliated TOF without any clinical symptoms is extremely rare, though not impossible. Our case even presented without any cardiovascular complaints and has remained in excellent clinical condition.