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Twenty-nine year old man with a history of complete repair of Tetralogyof Fallot (TOF) at the age of 5 was seen at outpatient clinic sufferingfrom exertional dyspnea. His blood pressure was 110/70 mmHg, pulse82 beats per minute and respiratory rate of 16 breaths per minute. Hisoxygen saturation was 90 % under room air. Auscultation exposed a 3/6systolic ejection murmur at the left sternal border. Electrocardiogram(ECG) showed sinus rhythm with right ventricular hypertrophy (RVH)and right bundle branch block (RBBB). The transthorasic echocardiography(TTE) was applied. RVH and stenosis of the right ventricularoutflow tract (RVOT) with a pressure gradient of 45 mmHg were obtained.Mass shaped lesion was seen in right ventricular apex duringTTE examination. Right ventricular papillary muscle hypertrophy wasthe final diagnosis after transeosephageal echocardiography (TEE) andrepeated TTE (Figure 1 and 2). Tetralogy of Fallot is the most commoncyanotic congenital heart disease, consisting 10% of all congenitalheart malformations. TOF includes four major component which areventricular septal defect (VSD), overriding aorta, RVOT obstructionand RVH. Echocardiography is an indispensable method for organizingtreatment and diagnosis of the disease.

Hypertrophic Papillary Muscle Mimicking Mass in Right Ventricular Apex