Late complications following tetralogy of Fallot repair: the need for long-term follow-up.
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.
Ho
Kay Woon
KW
Department of Cardiology, National Heart Centre, Singapore.
Tan
Ru San
RS
Wong
Keng Yean
KY
Tan
Teng Hong
TH
Shankar
Sriram
S
Tan
Ju Le
JL
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*