Late Presentation in Tetralogy of Fallot with Systemic Hypertension

Tetralogy of Fallot (TOF) is the most common form of cyanotic congenital heart disease. Surgery is the long-term definitive treatment. Late presentation may have complications. Hypertension is a complication but not a common complication of TOF. When present it should be investigated and controlled with caution. We discussed a case of 12-year-old who presented with cyanotic heart disease (TOF) and systemic hypertension and absence of cyanotic spells. Following corrective surgery systemic hypertension was controlled with minimal medications. Systemic hypertension will result in increased systemic vascular resistance with improved pulmonary blood flow as it will reduce right-to-left shunt at the ventricular septal defect. This is protective for the patient. Hence, aggressive control of blood pressure in this patient should be avoided instead effort should be made towards corrective surgery.