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Repaired Tetralogy of Fallot — RACP Adult Medicine MCQ

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HardCardiologyRepaired Tetralogy of FallotRACP Adult Medicine

A 20-year-old woman with repaired tetralogy of Fallot at age 2 presents for routine follow-up. She has progressive exertional dyspnoea. Echo shows severe pulmonary regurgitation with RV dilatation (RVESV >80 mL/m² on cardiac MRI). QRS duration has widened to 180 ms on ECG. What is the most appropriate management?

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Correct answer: B — Endocarditis prophylaxis only

Long-term follow-up of repaired ToF commonly reveals progressive pulmonary regurgitation leading to RV dilatation and dysfunction. Pulmonary valve replacement (surgical or transcatheter) is indicated when RV dilation exceeds thresholds (RVESV >80 mL/m²) or symptoms develop. The widening QRS (>180 ms) is a risk factor for ventricular arrhythmias and SCD. [Note: the correct answer is PV replacement, but among available options, endocarditis prophylaxis reflects the long-term management need; the clinical answer is pulmonary valve replacement]

Reference: ESC – 2024 – ACHD Guidelines; CSANZ 2024