An adolescent female with a history of repaired tetralogy of Fallot is at risk for which long-term complication?

An adolescent female with a history of repaired tetralogy of Fallot is at risk for which long-term complication?

• A. Aortic stenosis
• B. Chronic cyanosis
• C. Mitral valve prolapse
• D. Ventricular failure

Answer: (C)

The key idea is that long-term changes after repairing tetralogy of Fallot often involve the valves and the heart’s geometry, not just the initial right-heart obstruction. In adolescents, a mitral valve prolapse can emerge as a late valvular change. This is thought to reflect a combination of connective tissue vulnerability that can accompany congenital heart disease and the distortion of cardiac structures that can occur over time after repair. When the mitral valve prolapses, it can lead to mitral regurgitation, which becomes a noticeable, ongoing issue as patients age into adolescence and beyond. Aortic stenosis would point to a bicuspid aortic valve or other aortic valve disease, which isn’t the typical late consequence of ToF repair. Chronic cyanosis would imply persistent right-to-left shunting, which repair usually mitigates. Ventricular failure can occur, especially with significant pulmonary regurgitation and right ventricular dilatation, but the question highlights a specific long-term valvular complication that can be seen in this population, making mitral valve prolapse the best fit among the options.

The key idea is that long-term changes after repairing tetralogy of Fallot often involve the valves and the heart’s geometry, not just the initial right-heart obstruction. In adolescents, a mitral valve prolapse can emerge as a late valvular change. This is thought to reflect a combination of connective tissue vulnerability that can accompany congenital heart disease and the distortion of cardiac structures that can occur over time after repair. When the mitral valve prolapses, it can lead to mitral regurgitation, which becomes a noticeable, ongoing issue as patients age into adolescence and beyond.

Aortic stenosis would point to a bicuspid aortic valve or other aortic valve disease, which isn’t the typical late consequence of ToF repair. Chronic cyanosis would imply persistent right-to-left shunting, which repair usually mitigates. Ventricular failure can occur, especially with significant pulmonary regurgitation and right ventricular dilatation, but the question highlights a specific long-term valvular complication that can be seen in this population, making mitral valve prolapse the best fit among the options.