Heart failure complicating tetralogy of Fallot

Heart failure is considered to be an unusual complication of uncorrected tetralogy of Fallot. Three adolescents with tetralogy of Fallot, presenting in congestive cardiac failure are presented. Two died. Myocardial infarction was found in the only patient that underwent autopsy, and is thought to be an important aetiological factor in the development of the heart failure in the patients. The cases presented illustrate the fact that heart failure complicating tetralogy of Fallot may not be as uncommon as was previously thought to be the case, especially in older children. There is a need for early diagnosis and expeditious institution of appropriate management before such complications occur.