Introduction: Advances in surgical techniques have significantly improved the prognosis of patients with operated congenital heart malformations. However, late complications pose a challenge to therapeutic management. Although the Rastelli procedure has brought substantial benefits in the surgical correction of transposition of the great arteries in pediatric patients, it carries the burden of numerous complications into adulthood.
Case presentation: We present the case of a 35-year-old man diagnosed at birth with D-transposition of the great arteries, atrial septal defect, ventricular septal defect and severe pulmonary stenosis. His medical history revealed two previous operations: a Blalock-Taussing shunt at the age of 4 months and a Rastelli procedure at the age of 3 years. The patient presented to the emergency room with fever and congestive heart failure symptoms. Subsequent investigations revealed two late complications of the Rastelli procedure: stenosis of the homograft connecting the pulmonary artery to the right ventricle and infective endocarditis.
Conclusions: Although the clinical context may lead to the assumption that this is a case of congestive heart failure due to homograft stenosis, we must not overlook the possibility of overlapping infective endocarditis, which may also contribute to the development of heart failure.