Key result
Unexpected dextrocardia ECG pattern in a TOF patient reveals situs inversus totalis.
Case Report (n=1)
No
Unexpected ECG changes in patients with tetralogy of Fallot should prompt investigation for additional defects or compromised repair.
May prompt diagnostic vigilance in congenital heart disease; leaves open prospective validation of clinical utility.
CASE SUMMARY: A 19-year-old female with a history of tetralogy of Fallot (TOF) with prior right ventricle (RV)-pulmonary artery conduit, RV outflow tract aneurysm, intermittent ventricular arrhythmia, Chiari malformation, and scoliosis presented to establish care at our institution. Electrocardiogram (ECG) demonstrated an unexpected pattern consistent with dextrocardia and right axis deviation. Further investigation noted TOF with situs inversus totalis, a rare TOF variant only previously described several times. She underwent longitudinal monitoring with progression of RV dysfunction and ventricular arrhythmias. TAKE-HOME MESSAGE: TOF produces characteristic ECG changes that have utility in monitoring RV remodeling, arrhythmogenesis, and RV volume load. When ECG presents unexpected changes, additional defects or compromised repair should be interrogated.
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Cotter et al. (2026) conducted a case report in Tetralogy of Fallot with situs inversus totalis (n=1). Electrocardiogram (ECG) was evaluated. An unexpected ECG pattern of dextrocardia and right axis deviation in a patient with tetralogy of Fallot revealed situs inversus totalis, highlighting the need to investigate unexpected ECG changes.
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