Tetralogy of Fallot, Bicuspid Valves and a Single Origin Coronary: Uncorrected and Asymptomatic

A 79-year-old asymptomatic man was referred to our clinic for routine immigration screening. His past medical history was significant only for remote treated pulmonary tuberculosis and heavy tobacco use. Examination revealed oxygen saturations of 90%, blood pressure of 150/90 mmHg, and a prominent right ventricular heave. There was no digital clubbing. Chest X-ray demonstrated an enlarged cardiothoracic ratio with a prominent right heart border and left hilar enlargement (Figure 1A ). His electrocardiograph (ECG) showed atrial fibrillation, right axis deviation and anterior T-wave inversion consistent with right ventricular strain (Figure 1B).