A 62-year-old woman with the tetralogy of Fallot (TOF) diagnosed at 24 years of age, was admitted with fever and dyspnea. She also had cyanosis and heart failure and was categorized as New York Heart Association (NYHA) functional class IV. Echocardiography showed TOF with a-grade III tricuspid valve regurgitation. Cardiac catheterization revealed major aorto-pulmonary collateral arteries (MAPCAs) for the left upper pulmonary circulation. After coil embolization of MAPCAs to reduce abnormal intracardiac return as well as postoperative left ventricular volume overload, the patient underwent total surgical correction (i.e., right ventricular outflow tract reconstruction using Medtronic FreeStyle Valve and transannular patch, ventricular septal defect closure, and tricuspid annuloplasty). Postoperatively, the patient had a satisfactory course during the 10-year follow-up period with a grade-I NYHA classification. In conclusion, intracardiac repair of TOF in case over 60 years of age can be performed safely by preoperative MAPCAs embolization and subsequent TOF repair with a strategy to abolish pulmonary and tricuspid valve regurgitation.

Purpose: This study was performed to evaluate the prognostic value of preoperative C-reactive protein to albumin ratio (CAR) in older patients with colorectal cancer (CRC) undergoing curative resection. Methods: We retrospectively analyzed 244 older patients (aged 75 years or higher) with pathological stage II or III CRC who underwent curative surgery between 2008 and 2016. The optimal value of CAR was calculated and its correlation with the clinicopathological factors and prognosis was examined. Results: The optimal cutoff value of the CAR was 0.085. High preoperative CAR was significantly associated with high carcinoembryonic antigen levels (P=0.001), larger tumor size (P<0.001), and pT factor (P=0.001). On multivariate analysis, high CAR was independent prognostic factor for relapse-free survival (P=0.042) and overall survival (P=0.001). Conclusion Preoperative elevated CAR could be considered as an adverse predictor of both relapse-free survival and overall survival in older patients with CRC undergoing curative surgery.