5th International Conference on Heart and Cardiovascular Diseases

Felipe Terpin-Ayvar is a medical graduate from the Alberto Hurtado School of Medicine at Universidad Peruana Cayetano Heredia in Lima, Peru. His academic and research interests are focused on cardiovascular medicine, with particular emphasis on congenital heart disease and the clinical consequences of delayed diagnosis and untreated cardiac conditions. He has participated in research evaluating the prevalence of congenital heart diseases and has been involved in the development and presentation of cardiovascular research at national and international scientific meetings, including the American College of Cardiology. His current academic work includes the study of unusual presentations and complications of congenital heart disease in adult patients. He has a particular interest in understanding how delayed diagnosis and limited access to specialized cardiovascular care can influence clinical outcomes, especially in resource-limited populations. He intends to pursue further training in cardiology while continuing to develop his experience in clinical research, scientific communication, and cardiovascular medicine.

Background:

Tetralogy of Fallot (TOF) is a cyanotic congenital heart disease usually treated in childhood. Survival to middle age without repair is rare, and complete atrioventricular (AV) block is an uncommon complication.

Objectives:

To describe the presentation and management of complete AV block in an adult with unrepaired TOF.

Methodology:

We report the case of a 45-year-old woman with recurrent syncope, progressive dyspnea (NYHA class II), and chronic chest pain. Evaluation included electrocardiography, chest radiography, transthoracic echocardiography, and transesophageal echocardiography.

Key Results/Findings:

Electrocardiography showed complete AV block with AV dissociation. Echocardiography identified a perimembranous ventricular septal defect, severe infundibular pulmonary stenosis, right ventricular hypertrophy, an overriding aorta, and severe tricuspid regurgitation; left ventricular ejection fraction was 67%. A permanent dual-chamber pacemaker provided effective ventricular capture and hemodynamic stabilization. Syncope resolved and dyspnea improved to NYHA class I. Corrective surgery for TOF was not performed during this hospitalization.

Conclusion:

In adults with unrepaired TOF, complete AV block can cause syncope and hemodynamic compromise. This case supports timely assessment of conduction abnormalities and coordinated follow-up for adult congenital heart disease.