Surviving Unrepaired Tetralogy of Fallot to 43 Years in a Low-Resource Setting: The Oldest Reported Case from Somalia.

Introduction: Tetralogy of Fallot (ToF) is a congenital heart defect characterized by a combination of four anomalies: right ventricular hypertrophy, ventricular septal defect (VSD), right ventricular outflow tract (RVOT) obstruction, and an overriding aorta. While surgical interventions have significantly improved the prognosis of ToF, cases of undiagnosed or untreated ToF in adulthood remain, particularly in low-resource settings. This report highlights the case of an adult patient with uncorrected ToF, underscoring the challenges individuals face in such environments. Case Report: A 43-year-old male from Somalia presented with recurrent syncope, exertional dyspnea, and a history of congenital heart disease diagnosed in childhood. Due to financial constraints and limited healthcare access, he was unable to undergo surgery. On clinical examination, the patient exhibited cyanosis, grade 3 clubbing, and a pansystolic murmur. Investigations showed secondary polycythemia, right ventricular hypertrophy on ECG, and a large VSD with an overriding aorta. Echocardiography confirmed these findings, revealing the anatomical abnormalities typical of ToF. Discussion: Untreated ToF often leads to significant morbidity, including worsening cyanosis, syncope, and heart failure. In this case, delayed surgical intervention and lack of resources contributed to the progression of symptoms. The patient's case emphasizes the importance of early diagnosis and surgical repair, particularly in resource-limited settings where access to advanced care is limited. Conclusion: This case highlights the critical need for early intervention and improved healthcare access for individuals with congenital heart defects in low-income settings. Timely diagnosis, surgical repair, and ongoing care can substantially improve outcomes for patients with ToF.