Tetralogy of Fallot (TOF) is the commonest congenital heart abnormality beyond the age of one year. Cases of Tetralogy of Fallot can present during pregnancy following successful surgical repair in childhood or occasionally as uncorrected TOF presenting for the first time during pregnancy, indeed the most frequently encountered congenital cyanotic heart lesion during pregnancy is cyanotic TOF. Most adult congenital heart disease in Africa is uncorrected due to widespread unavailability of cardiothoracic surgical services on the continent. Pregnancy is associated with significant haemodynamic alterations affecting both the systemic and pulmonary circulatory beds. These are more likely to have deleterious effects in pregnant women with underlying heart disease or with risk factors for pulmonary hypertension. We describe here the case of a 22 year old pregnant woman with acyanotic tetralogy of Fallot and HIV infection who had an uncomplicated parturition. We discuss possible reasons why this potentially fatal combination was well tolerated by the patient.
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