Late Presentation of Tetralogy of Fallot with Major Aortopulmonary Collateral Arteries in the Postpartum Period: A Case Report

Tetralogy of Fallot (TOF) with Pulmonary Atresia (PA) and Major Aortopulmonary Collateral Arteries (MAPCAs) represents the most severe expression of TOF. In this condition, instead of pulmonary stenosis, there is complete pulmonary valve atresia. Consequently, blood flow to the lungs occurs through collateral vessels that arise from the systemic circulation. The survival rate for patients with TOF and MAPCAs without surgery is low: approximately 50% at one year and 8% at 12 years. TOF accounts for about 3.5% of all congenital heart diseases, occurring in one in 3,600 live births, or 0.28 per 1,000 live births. Both genders are equally affected. Most patients present with symptoms in early childhood, which include fatigue, cyanosis, and shortness of breath, necessitating prompt medical intervention. The present case report is of a 25-year-old female who remained asymptomatic until the postpartum period of a third pregnancy.