Delayed Presentation of Tetralogy of Fallot with Isolated Cyanosis

Figure 2

2D image in the subcostal right anterior oblique plane (“Tet view”) demonstrating the large VSD produced by anterior and superior malalignment of the infundibulum, which completely obstructs the RVOT producing profound cyanosis and the need for an emergent BT shunt. PV, MPA, and branches are hypoplastic, each measuring approximately 3 mm at the time of presentation. RA: right atrium, LA: left atrium, IAS: interatrial septum, TV: tricuspid valve, RV: right ventricle, LV: left ventricle, VSD: ventricular septal defect, RVOT: right ventricular outflow tract, PV: pulmonary valve, MPA: main pulmonary artery, RPA: right pulmonary artery, and LPA: left pulmonary artery.