A successful repair of tetralogy of Fallot with aortic valve regurgitation, coronary artery-pulmonary artery fistula and absent pulmonary valve in a 54-year-old man

A 54-year-old man suffered from tetralogy of Fallot associated with aortic valve regurgitation, coronary artery-pulmonary artery fistula and absent pulmonary valve underwent intracardiac repair. The operation was completed with ligation of the fistula, aortic valve replacement using a SJM 27 A, patch closure of ventricular septal defect (perimembranous outlet type) and right ventricular outflow reconstruction using a large transannular monocusped-patch, 4 cm x 6 cm in size. Postoperative course was uneventful and he is doing well now. There was no previous reports about TOF associated with AR, the absent pulmonary valve and the coronary anomaly in the adults in the literature.