{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,12]],"date-time":"2026-07-12T06:18:50Z","timestamp":1783837130694,"version":"3.55.0"},"reference-count":22,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,4,11]]},"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:p>Tetralogy of Fallot (TOF) is the most common form of cyanotic congenital heart disease beyond the age of 3\u2009months. Complete heart block (CHB) is rare but a serious sequalae post-repair of TOF. We present a case of an 18-month-old child who developed late CHB after around 1\u2009year of the corrective surgery of the congenital anomaly. On the regular follow-up visit, the patient assessment was unremarkable. However, there was bradycardia, 55 beats\/min. The ECG showed complete atrioventricular dissociation. Echocardiogram was done and demonstrated severe tricuspid regurgitation (TR). The patient required a permanent pacemaker and he is currently well. We are presenting this case as a late unexpected CHB, with a possibility of progressive right-side dilatation as a contributing factor to CHB due to severe TR.<\/jats:p>","DOI":"10.1136\/bcr-2018-228642","type":"journal-article","created":{"date-parts":[[2019,4,25]],"date-time":"2019-04-25T05:57:55Z","timestamp":1556171875000},"page":"e228642","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Late complete heart block post-tetralogy of Fallot repair: a possible new predicting, precipitating factor and review of related cases"],"prefix":"10.1136","volume":"12","author":[{"given":"Rayan","family":"Hejazi","sequence":"first","affiliation":[{"name":"National Guard Health Affairs, Jeddah, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marwan","family":"Balubaid","sequence":"additional","affiliation":[{"name":"Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jameel","family":"Alata","sequence":"additional","affiliation":[{"name":"National Guard Health Affairs, Jeddah, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahaf","family":"Waggass","sequence":"additional","affiliation":[{"name":"National Guard Health Affairs, Jeddah, Saudi Arabia"},{"name":"Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,4,24]]},"reference":[{"key":"2025082623120628000_12.4.e228642.1","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1111\/j.1747-0803.2011.00614.x","article-title":"Incidence of severe congenital heart disease at the province of Al-Qassim, Saudi Arabia","volume":"7","author":"Al-Mesned","year":"2012","journal-title":"Congenit Heart Dis"},{"key":"2025082623120628000_12.4.e228642.2","first-page":"375","article-title":"Report of the New England regional infant cardiac program","volume":"65","author":"Anon","year":"1980","journal-title":"Pediatrics"},{"key":"2025082623120628000_12.4.e228642.3","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1016\/S0022-3476(95)70471-X","article-title":"The clinical recognition of congenital heart disease. 4th ed","volume":"126","author":"Perloff","year":"1995","journal-title":"The Journal of Pediatrics"},{"key":"2025082623120628000_12.4.e228642.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2010.03.110"},{"key":"2025082623120628000_12.4.e228642.5","doi-asserted-by":"crossref","first-page":"984","DOI":"10.12669\/pjms.334.12891","article-title":"Tetralogy of Fallot repair in patients presenting after Infancy: A single surgeon experience","volume":"33","author":"Waqar","year":"2017","journal-title":"Pak J Med Sci"},{"key":"2025082623120628000_12.4.e228642.6","doi-asserted-by":"crossref","first-page":"1344","DOI":"10.1007\/s00246-015-1163-z","article-title":"Repair of Tetralogy of Fallot in Children Less Than 4 kg Body Weight","volume":"36","author":"Gerrah","year":"2015","journal-title":"Pediatr Cardiol"},{"key":"2025082623120628000_12.4.e228642.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejcts.2010.02.030"},{"key":"2025082623120628000_12.4.e228642.8","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1161\/01.CIR.52.4.691","article-title":"Unexpected cardiac arrest in patients after surgical correction of tetralogy of Fallot","volume":"52","author":"James","year":"1975","journal-title":"Circulation"},{"key":"2025082623120628000_12.4.e228642.9","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1007\/s00246-007-9034-x","article-title":"Late onset of heart block after open heart surgery for congenital heart disease","volume":"29","author":"Liberman","year":"2008","journal-title":"Pediatr Cardiol"},{"key":"2025082623120628000_12.4.e228642.10","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1161\/01.CIR.49.2.214","article-title":"Late postoperative conduction distrubances after repair of ventricular septal defect and tetralogy of Fallot. 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