Tetralogy of Fallot in teenagers and adults: surgical experience and follow-up.
OBJECTIVE
The aim of this study was to review short- and long-term outcomes following total correction in patients with tetralogy of Fallot that presented during adulthood.


METHODS
It was a retrospective analysis of 284 patients (aged 14-50 years, mean 19.4 +/- 2.5 years) with tetralogy of Fallot who underwent total correction at our institution between January 1991 and December 2001. Thirty patients were subjected to postoperative first-pass radionuclide angiocardiography scans. A Hindi version of the standard World Health Organization quality of life proforma was mailed to 120 patients operated on during the first half of the study period.


RESULTS
Altogether, 45 (15.8%) patients had palliative shunts, and 32 (11%) had preoperative coil embolization. The transatrial/transpulmonary artery approach was used in 62 (22%) patients, the transventricular approach in 86 (30%) patients, and a combined approach in 136 (48%) patients. A transannular pericardial patch was used in 200 (70%) patients. A total of 61 (21%) patients had nonfatal complications. There were 28 hospital deaths. Follow-up ranged from 1 month to 10 years (mean 4.6 +/- 2.3 years). There were 7 (2.5%) late deaths and 6 (2.1%) reoperations. Altogether, 94% of patients were in New Yk Heart Association (NYHA) class I. Radionuclide angiocardiography showed normal right ventricular and left ventricular function in 18 (60%) and 22 (73%) patients, respectively. All of the 66 respondents perceived an improved quality of life. The actuarial survival and freedom from reoperation at 10 years were 82.88% +/- 3.80% and 92.82% +/- 3.40%, respectively.


CONCLUSIONS
Total correction in this subset of patients offers the best option for long-term symptom-free survival.
Bisoi
Akshay Kumar
AK
Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India. bisoiak@rediffmail.com
Murala
John Santosh Kumar
JS
Airan
Balram
B
Chowdhury
Ujjwal Kumar
UK
Kothari
Shyam Sunder
SS
Pal
Hemraj
H
Patel
Chetan D
CD
Sai Krishna
Cheemalapati
C
Cheemalapati
Sai Krishna
SK
Chauhan
Sandeep
S
Panangipalli
Venugopal
V
D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D006348:Cardiac Surgical Procedures; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D011877:Radionuclide Imaging; D012086:Reoperation; D012107:Research Design; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D013771:Tetralogy of Fallot / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome