{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T06:20:45Z","timestamp":1783405245284,"version":"3.54.6"},"reference-count":7,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T00:00:00Z","timestamp":1783382400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Survival into adulthood without repair of Tetralogy of Fallot (TOF) is exceedingly rare, with only 3%\u20135% of patients reaching 40 years without intervention. Cardiovascular imaging is central to establishing late diagnoses and planning complex surgical repair.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Summary<\/jats:title>\n                    <jats:p>We report a 50-year-old woman with no prior cardiac diagnosis who presented with progressive dyspnea and profound cyanosis. Despite 13 pregnancies and 11 successful deliveries, she had never been evaluated for congenital heart disease. Multimodal cardiovascular imaging, including transthoracic (TTE) and transesophageal echocardiography (TEE), color Doppler, contrast studies, cardiac catheterization, and chest radiography, demonstrated classic TOF anatomy: a large sub-aortic VSD, overriding aorta, severe right ventricular outflow tract (RVOT) obstruction, hypoplastic pulmonary annulus, and secondary right-sided dilation.<\/jats:p>\n                    <jats:p>The patient underwent successful corrective surgery with VSD patch closure, pulmonary valve commissurotomy, and pulmonary artery plasty. Postoperatively, oxygen saturation normalized, and serial echocardiography over 6 months showed substantial reduction in RV\/RA dimensions and improvement in peak RVOT gradients, although significant residual RVOT obstruction persisted at 6 months. (RV diameter 4.38 \u2192 3.98\u2005cm, RA area 23.4 \u2192 17.9\u2005cm\u00b2, RVOT gradient 124 \u2192 67 mmHg).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case highlights the diagnostic value of multimodal cardiovascular imaging in detecting unrecognized cyanotic congenital heart disease in adults and demonstrates that late TOF repair can be safe and effective. It underscores the need for routine interpretation of unexpectedly low oxygen saturation in adults and strengthened awareness among cardiologists, echocardiographers, and general physicians of congenital heart disease beyond childhood.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1763017","type":"journal-article","created":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T05:46:19Z","timestamp":1783403179000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Unrepaired Tetralogy of Fallot in a 50-year-Old woman with 13 pregnancies: multimodal cardiovascular imaging, surgical repair, and longitudinal remodeling"],"prefix":"10.3389","volume":"13","author":[{"given":"Moath","family":"Hattab","sequence":"first","affiliation":[{"name":"Department of Pediatric Cardiology and Cardiothoracic Surgery, Palestinian Medical Complex","place":["Ramallah, Palestine"]},{"name":"Department of Medicine, Faculty of Medicine and Allied Medical Sciences, An-Najah National University","place":["Nablus, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yahya","family":"Ismail","sequence":"additional","affiliation":[{"name":"Department of Medicine, Faculty of Medicine and Allied Medical Sciences, An-Najah National University","place":["Nablus, Palestine"]},{"name":"Department of Cardiology, An-Najah National University Hospital","place":["Nablus, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Darsalim","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology and Cardiothoracic Surgery, Palestinian Medical Complex","place":["Ramallah, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nour","family":"Deek","sequence":"additional","affiliation":[{"name":"Department of Medicine, Faculty of Medicine and Allied Medical Sciences, An-Najah National University","place":["Nablus, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Abed","sequence":"additional","affiliation":[{"name":"Department of Medicine, Faculty of Medicine and Allied Medical Sciences, An-Najah National University","place":["Nablus, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adham","family":"Abderrazeq","sequence":"additional","affiliation":[{"name":"Department of Cardiology, An-Najah National University Hospital","place":["Nablus, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abelhalim","family":"Abuhaltam","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology and Cardiothoracic Surgery, Palestinian Medical Complex","place":["Ramallah, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"SalahAldin","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology and Cardiothoracic Surgery, Palestinian Medical Complex","place":["Ramallah, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Abutaqa","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology and Cardiothoracic Surgery, Palestinian Medical Complex","place":["Ramallah, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nizar","family":"Hijjeh","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology and Cardiothoracic Surgery, Palestinian Medical Complex","place":["Ramallah, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,7]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1462","DOI":"10.1016\/S0140-6736(09)60657-7","article-title":"Tetralogy of Fallot","volume":"374","author":"Apitz","year":"2009","journal-title":"Lancet"},{"key":"B2","first-page":"33","volume-title":"Congenital Heart Disease. Perspective in Pediatric Cardiology Epidemiology of Congenital Heart Disease, the Baltimore-Washington Infant Study 1981\u201389","author":"Perry","year":"1993"},{"key":"B3","doi-asserted-by":"publisher","first-page":"208","DOI":"10.1111\/j.1747-0803.2010.00402.x","article-title":"Update on tetralogy of Fallot for the adult cardiologist including a brief historical and surgical perspective","volume":"5","author":"Kalra","year":"2010","journal-title":"Congenit Heart Dis"},{"key":"B4","doi-asserted-by":"publisher","first-page":"238","DOI":"10.14797\/mdcj-13-4-238","article-title":"Congenital heart disease and reproductive risk: an overview for obstetricians, cardiologists, and primary care providers","volume":"13","author":"Phillips","year":"2017","journal-title":"Methodist Debakey Cardiovasc J"},{"key":"B5","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1186\/1750-1172-4-2","article-title":"Tetralogy of Fallot","volume":"4","author":"Bailliard","year":"2009","journal-title":"Orphanet J Rare Dis"},{"key":"B6","doi-asserted-by":"publisher","first-page":"183","DOI":"10.11604\/pamj.2022.42.183.34851","article-title":"Longstanding unrepaired tetralogy of Fallot","volume":"42","author":"Moolla","year":"2022","journal-title":"Pan Afr Med J"},{"key":"B7","doi-asserted-by":"publisher","first-page":"556","DOI":"10.1053\/j.jvca.2018.03.035","article-title":"Tetralogy of Fallot: perioperative management and analysis of outcomes","volume":"33","author":"Townsley","year":"2019","journal-title":"J Cardiothorac Vasc Anesth"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1763017\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T05:46:20Z","timestamp":1783403180000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1763017\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,7]]},"references-count":7,"alternative-id":["10.3389\/fcvm.2026.1763017"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2026.1763017","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,7]]},"article-number":"1763017"}}