The Revelation of Spontaneous Correction of Malalignment Ventricular Septal Defect and Overriding of the Aorta in a Child with Pink Tetralogy of Fallot

Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. The presentation and treatment approach depends on the severity of the right ventricular outflow tract obstruction, and most cases require a surgical correction. We describe a neonate with pink TOF who exhibited typical echocardiographic characteristics such as aortic overriding, and a large VSD with minimal or no pulmonary outflow tract obstruction. The patient lost to follow-up, and a repeat 5-year echocardiogram revealed the absence of aortic overriding and significantly restricted VSD with a left-to-right shunt (pressure gradient ~50 mmHg across the VSD). There is no previous evidence of spontaneous correction of the defects associated with TOF which makes this case so intriguing.