Central Shunt as Palliation in a 30-Year-Old with Unrepaired Tetralogy of Fallot and Pulmonary Atresia: A Case Report

Late presentation of complex congenital heart disease is uncommon in adults, particularly in regions with established paediatric cardiac services. We report a case of a 30-year-old male with unrepaired tetralogy of Fallot (TOF) and pulmonary atresia (PA) who presented with severe shortness of breath. Imaging revealed TOF with atresia of the proximal main pulmonary artery and multiple aortopulmonary collateral arteries (MAPCAs). Given the severely hypoplastic pulmonary arteries, unfavourable anatomy, and prohibitive risk for complete repair, a central aortopulmonary shunt was performed as a palliative measure. Postoperatively, oxygen saturation improved from 65% to 90%, and the patient reported significant symptomatic relief. This case highlights the role of central shunt as a viable palliative option in adult patients with late-presenting complex congenital heart disease where complete repair is not feasible.