1308 - Unrepaired Tetralogy of Fallot in an Older Adult: A Rare Case Requiring Tailored Rehabilitation

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

JM

John Paul Mauriello, DO

Resident Physician PGY-3
Memorial Healthcare System
Dania Beach, Florida, United States

Co-Author(s)

TH

Tahreem Hashmi, D.O.

Resident Physician PGY-3
Memorial Healthcare System
Cooper City, Florida, United States

Corresponding Author(s)

NC

Neenu Cherian, MD

Attending Physician
Memorial Healthcare System
Hollywood, Florida, United States

Submitter(s)

JM

John Paul Mauriello, DO

Memorial Healthcare System
Dania Beach, Florida, United States

Case Diagnosis: Unrepaired Tetralogy of Fallot

Case Description: 60-year-old Cuban female with history of Tetralogy of Fallot (ToF) was admitted to acute inpatient rehabilitation (AIR) after a 41-day hospital stay due to acute cholecystitis secondary to cholelithiasis. She developed diffuse weakness, left foot drop, and left foot sensory deficits after 14 days of intubation secondary to respiratory failure. No evidence of CVA on neuroimaging. Neurological deficits were considered to be secondary to critical illness neuropathy. In AIR, the patient was on continuous pulse oximetry and telemetry. Given the pathophysiology of ToF, acceptable exercise parameters for BP (permissive hypertension) and oxygen saturation (recovery breaks for SpO2 below 70 and dyspnea present) were established in collaboration with congenital heart specialists. After education about parameters and clinical management, the rehabilitation staff better recognized the concerning signs/symptoms of ToF, and the patient was able to have a tailored therapy program that advanced her functional status.

Discussions: ~5/10,000 babies are born with ToF. Studies show a 3% survival rate at age 40 without corrective surgery, and there are few cases of survival beyond the age of 40. Unrepaired ToF presents with hypercyanotic episodes in children; however, this disappears by the age of 5. Dyspnea and exercise intolerance are common symptoms in adults. Co-morbidities such as hypertension, arrhythmias, pulmonary hypertension, and hypoxia can occur in ToF and limit physical activity. There are no established guidelines on vital sign surveillance at rest/exercise or an optimal therapy program.

Conclusions: This case highlights the importance of involving congenital/pediatric cardiology early in AIR to establish a treatment plan for related co-morbidities and exercise intolerance in older patients with ToF. Acceptable vital sign parameters at rest and during exercise should also be discussed with these specialists. The rehabilitation team should be educated on this information to allow for an optimal therapy plan for this patient population.