Cyanotic Congenital Heart Disease—A Diagnostic Dilemma and Role of Intraoperative Echocardiography: A Case Report

REPORTradiograph showed increased pulmonary vascular markings and TTE demonstrated features of tetralogy of Fallot (TOF), computed tomography (CT) angiography was planned to rule out major aortopulmonary collaterals (MAPCAs).CT angiography demonstrated a large subaortic VSD, aortic override, right ventricular hypertrophy, and infundibular stenosis with confluent pulmonary arteries, and without significant MAPCAs.The dimensions of the main, right, and left pulmonary arteries were 30 mm (reference range: 29.5-18.5 mm), 28 mm (19.8-12.4mm), and 23 mm (22.1-14.3mm), respectively.The ascending aorta measured 26 mm.Based on these findings, the surgical plan was intracardiac repair for TOF correction. IntroductIonCongenital cyanotic heart disease (CCHD) is associated with multiple complex congenital anomalies that have various physiological implications.A single imaging modality may miss some anomalies; therefore, multimodal diagnostic techniques are advised.Transthoracic echocardiography (TTE) is the primary diagnostic technique and clearly detects anatomical malformations.Computed tomography (CT) angiography additionally evaluates coronary, pulmonary artery, and aortic vascular anomalies, and is also helpful in identifying complex anatomy.Transesophageal echocardiography (TEE) plays an additional role during the intraoperative period.It not only reconfirms and supplements TTE findings but also demonstrates anomalies missed by TTE, thereby potentially altering surgical management.The authors report a case of CCHD diagnosed preoperatively as tetralogy of Fallot (TOF) by TTE and CT angiography, and posted for intracardiac repair.The management plan changed intraoperatively based on TEE findings and other clinical assessments.