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CLINICAL STUDIES

Early age at repair prevents restrictive right ventricular (RV) physiology after surgery for tetralogy of Fallot (TOF)

Diastolic RV function after TOF repair in infancy

^a Department of Pediatric Cardiology, University Hospital of Lund, Lund, Sweden
^b Department of Thoracic Surgery, University Hospital of Lund, Lund, Sweden
^c Department ofCardiology, Great Ormond Street Hospital for Sick Children, NHS Trust and the Institute of Child Health, London, United Kingdom
^d Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Sick Children, NHS Trust and the Institute of Child Health, London, United Kingdom

Manuscript received October 30, 1997; revised manuscript received June 8, 1998, accepted June 17, 1998.

Address for correspondence: Dr Gunnar Norgård, Department of Pediatrics, 5021 Haukeland Hospital, N-5021 Bergen, Norway
gunnar.norgard{at}bkb.haukeland.no

Objectives. To assess diastolic right ventricular (RV) physiology after tetralogy of Fallot repair in infancy.

Background. Restrictive RV physiology after tetralogy of Fallot repair is related to type of repair, pulmonary regurgitation, and late arrhythmias.

Methods. Forty-seven patients were investigated, 27 and 20 patients in Lund and London, respectively. Median age at repair was 0.78 years (0.08–0.99) and median follow-up was 3.0 years (0.08–10.4). Restrictive RV physiology was assessed by Doppler echocardiography.

Results. Thirteen patients (28%) had restrictive RV physiology at follow-up, three of 19 patients (16%) with transatrial repair and 10 of 28 patients (32%) with transventricular repair, respectively (p = 0.1). Ten percent of the patients repaired before 6 months of age were restrictive at follow-up, increasing to 38% with repair after 9 months. Transannular patch (TAP) repair was performed in 55% of the patients, including eight of 10 patients (80%) with repair before 6 months of age. Thirty-one percent of the patients with TAP repair were restrictive. These restrictive patients had more severe preoperative pulmonary stenosis (p < 0.05), were older at repair (p < 0.05), and had shorter duration of pulmonary regurgitation (p < 0.001) at follow-up.

Conclusions. Restrictive RV physiology is inversely related to age at repair and independent of type of outflow tract repair. Since TAP repair is more common in early repair, and restriction seems to be less frequent, long-term follow-up to assess adverse effects of pulmonary regurgitation is mandatory.

Abbreviations and Acronyms   AV = atrioventricular   ECG = electrocardiogram   PA = pulmonary artery   PR = pulmonary regurgitation   PV = pulmonary valve   RV = right ventricle   RVOT = right ventricular outflow tract   TAP = transannular patch   TOF = tetralogy of Fallot   VSD = ventricular septal defect

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