Tetralogy of Fallot and coarctation of the aorta: a rare combination and its clinical implications.

A neonate with tetralogy of Fallot and aortic coarctation is described. The clinical course was remarkable, with early congestive heart failure followed by rapidly progressive left ventricular myocardial thickening and the presentation of hypercyanotic spells. Primary repair of tetralogy without correction of coarctation was attempted unsuccessfully at 1 month of age. Death followed postoperative bradycardia, hypotension, and low cardiac output. Fetal and neonatal hemodynamics and the clinical implication of this rare combination of defects are discussed. Initial surgical intervention should relieve left-sided obstruction.