Abstract
Late presentation of tetralogy of Fallot (TOF) poses unique diagnostic and management challenges, differing significantly from those diagnosed and treated in infancy. This review discusses the definition and natural history of late-presenting TOF, emphasizing the surgical and perioperative considerations specific to this population. We also explore the role of phlebotomy in managing polycythemic patients, a practice not universally adopted, and highlight postoperative challenges, including residual defects and complications. While discussing the surgical correction of TOF, we analyse the outcomes of specific strategies and the role of elective pulmonary valve replacement in adult patients. This comprehensive overview aims to shed light on the nuances of managing these complex cases.