title: A critical increase in right-to-left shunt after acute myocardial infarction in a 68-year-old male with tetralogy of Fallot.
abstract: A 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.
authors.affiliation: First Department of Internal Medicine, Shinshu University School of Medicine, Nagano, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Izawa
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Sekimura
authors.forename: Shin-ichiro
authors.initials: S
authors.lastname: Uchikawa
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Yazaki
authors.forename: Osamu
authors.initials: O
authors.lastname: Kinoshita
authors.forename: Mafumi
authors.initials: M
authors.lastname: Owa
authors.forename: Keishi
authors.initials: K
authors.lastname: Kubo
authors.forename: Uichi
authors.initials: U
authors.lastname: Ikeda
authors.forename: Morie
authors.initials: M
authors.lastname: Sekiguchi
authors.forename: Hiroto
authors.initials: H
authors.lastname: Kitahara
authors.forename: Jun
authors.initials: J
authors.lastname: Amano
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Imamura
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D004452:Echocardiography; D004562:Electrocardiography; D006345:Heart Septal Defects, Ventricular / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications / Q000503:physiopathology*; D013771:Tetralogy of Fallot / Q000150:complications* / Q000601:surgery*