title: Late complications following tetralogy of Fallot repair: the need for long-term follow-up.
abstract: BACKGROUND
  We report a series of operated tetralogy of Fallot (TOF) patients focusing on complications and outcomes.
  
  
  METHODS
  Data from TOF patients seen at our centre's adult congenital heart disease clinic was analysed.
  
  
  RESULTS
  There were 21 patients: the mean age was 32.2 +/- 12.4 years; the age at first operation was 9.0 +/- 7.9 years; the mean postoperative follow-up duration was 23.5 +/- 12.1 years; and the current New York Heart Association (NYHA) status: I, 82%; II, 4%; III, 14%. Fourteen patients had complete operative notes. All these patients underwent total TOF correction; 2 had staged aortopulmonary shunt with total correction at a mean of 3.2 years later, pulmonary artery patch augmentation in 8 patients and pulmonary valvotomy in 8 patients. Three patients required pulmonary valve homograft replacement for severe pulmonary regurgitation (PR) at 13, 28 and 36 years after the initial corrective operation.
  RBBB on ECG (91%), QRS duration 137 +/- 29 ms. Echocardiography showed dilated right ventricular end-diastolic (RVED) diameters (3.2 +/- 0.8 cm); severe PR (67%), residual right ventricular outflow tract obstruction (RVOTO) (42%) and VSD patch leakage (9%). Cardiac magnetic resonance (CMR) (8 patients) showed dilated RVED volumes 252.6 +/- 93.8 mL, indexed RV volume 165.7 +/- 34.8 mL; RV systolic function was preserved in most patients with a RV ejection fraction of 49.5 +/- 5.7%. One patient had atrial tachycardia and another had frequent non-sustained ventricular tachycardia that required radiofrequency ablation.
  
  
  CONCLUSIONS
  Patients with TOF who had full corrective surgery during childhood are now surviving into adulthood. Many challenges arising from complications in the postoperative period remain. It is imperative that adult TOF patients should have regular followup to monitor development and subsequent management of these complications.
authors: Department of Cardiology, National Heart Centre, Singapore.
authors: Kay Woon
authors: KW
authors: Ho
authors: Ru San
authors: RS
authors: Tan
authors: Keng Yean
authors: KY
authors: Wong
authors: Teng Hong
authors: TH
authors: Tan
authors: Sriram
authors: S
authors: Shankar
authors: Ju Le
authors: JL
authors: Tan
mesh_terms: D000328:Adult; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000503:physiopathology; D012846:Singapore / Q000453:epidemiology; D013771:Tetralogy of Fallot / Q000601:surgery*