A 42yo lady had corrective surgery for cyanotic congenital heart disease at the age of 3y, after a
palliative operation during infancy. There is a parasternal impulse and an early diastolic murmur.
What is the most probable dx?
a. Aortic regurgitation
b. Ischemic mitral regurgitation
c. Aortic stenosis
d. Pulmonary stenosis
e. Pulmonary regurgitation
Ans. The key is E. Pulmonary regurgitation. [In the present day, some patients with tetralogy of Fallot have survived for longer than 15-20 years after their first operation. The major problem encountered by these individuals is the development of pulmonary valvular regurgitation. It appears that a number of these individuals require pulmonary valve replacement (ref: Medscape)].