Tetralogy of Fallot with absent pulmonary valve, supracardiac total anomalous pulmonary venous connection, and infradiaphragmatic systemic to pulmonary collateral artery

A 2-year-old boy was referred for cyanosis and clinical heart failure. Transthoracic echocardiography showed Tetralogy of Fallot (TOF) with a large malalignment type ventricular septal defect (VSD) and features typical of absent pulmonary valve syndrome (APVS). There was severe pulmonary stenosis (Sten) (peak systolic gradient of 85 mmHg) with diastolic regurgitation, …