Clinical, echocardiographic and humoral status of patients following repair of tetralogy of Fallot: comparison of the second to the first decade.
BACKGROUND
Surgical repair of tetralogy of Fallot may leave the patient with pulmonary regurgitation, causing eventual right ventricle dilatation and dysfunction. Predicting clinical deterioration may help to determine the best timing for intervention.


OBJECTIVE
To assess whether the clinical and humoral status of patients in the second decade after repair of ToF is worse than that of patients in the first decade after repair.


METHODS
Twenty-one patients with repaired ToF underwent clinical assessment, electrocardiogram, echocardiogram and measurement of plasma B-type natriuretic peptide and N-terminal pro-BNP as well as the 6 minute walk distance test. Patients were divided into two groups: group A - less than 10 years after repair (n=10, age < 12 years old), and group B - more than 10 years after repair (n=11, age > 12 years old). The age at repair was similar in both groups.


RESULTS
In all but one patient the distance in the 6 min walk test was less than the minimum for age. RV end-diastolic volume and the 6 min walk test correlated with age. NT-proBNP levels were significantly higher in the ToF group compared to 26 healthy controls (P < 0.0001) and were inversely correlated with RV ejection fraction. Comparison of the two groups showed no difference in RV end-diastolic volume indexed for body surface area, pulmonary regurgitation severity, right or left ventricular myocardial performance index, RV ejection fraction, QRS duration, or 6 min walk indexed to minimum for age.


CONCLUSIONS
In this group of patients with similar age at operation and pulmonary regurgitation severity, most clinical, echocardiographic and humoral parameters were not worse in the second decade after repair of ToF. These data suggest that very early pulmonary valve replacement may not be of benefit.
Wand
Ori
O
Hebrew University-Hadassah Medical School, Hadassah Medical Center, lerusalem, Israel.
Perles
Zeev
Z
Rein
Azaria J J T
AJ
Algur
Nurit
N
Nir
Amiram
A
D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D011665:Pulmonary Valve Insufficiency / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology; D018709:Statistics, Nonparametric; D013771:Tetralogy of Fallot / Q000097:blood / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome
D020097:Natriuretic Peptide, Brain