title: Functional health status in adult survivors of operative repair of tetralogy of fallot.
abstract: We aimed to determine late functional health status of the growing adult population with repaired tetralogy of Fallot (TOF). We studied all 840 patients with TOF born from 1927 through 1984 who survived to adulthood (> 18 years of age). Clinical follow-up was by chart review, telephone interview (n = 706), and echocardiographic reports (n = 339). Functional health status was assessed using Short Form-36 (SF-36) surveys (n = 396) indexed to normative data. Risk of reoperation was low (≈ 1%/year) but increased beyond age 40 years. At latest follow-up moderate or severe pulmonary regurgitation was common (54%) and right ventricular outflow tract stenosis presented in 1/3. Consequently, evidence of right ventricular dilatation and dysfunction and tricuspid regurgitation was typical. Left-sided abnormalities were also common: hypertrophy (p < 0.0001) and outflow tract dilation (p < 0.0001) with at least mild aortic regurgitation in > 50%. Cardiorespiratory symptoms were reported in 45% (palpitations 27%, dyspnea 21%, chest pain 17%). SF-36 scores were significantly below normal for 4 physical domains (p < 0.001). Decrements in physical functioning were associated particularly with older age at follow-up (p < 0.0001), associated syndromes/lesions, reoperations, ventricular dysfunction, tricuspid regurgitation, residual septal defects, and cardiorespiratory symptomatology. Echocardiographic abnormalities were more common in older patients (p < 0.0001). All 3 SF-36 domains specific to psychosocial well-being were normal. In conclusion, despite excellent survival prospects, physical compromise is common in adults with repaired TOF. Greater decrements in older patients may reflect late deterioration with advancing age or cohort effects related to historical management. Efforts to limit ventricular and outflow tract dysfunction may translate into improved late functional status.
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, University of Toronto, Hospital for Sick Children, Toronto, Ontario, Canada. edward.hickey@sickkids.ca
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Hickey
authors.forename: Gruschen
authors.initials: G
authors.lastname: Veldtman
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Bradley
authors.forename: Aungkana
authors.initials: A
authors.lastname: Gengsakul
authors.forename: Gary
authors.initials: G
authors.lastname: Webb
authors.forename: William G
authors.initials: WG
authors.lastname: Williams
authors.forename: Cedric
authors.initials: C
authors.lastname: Manlhiot
authors.forename: Brian W
authors.initials: BW
authors.lastname: McCrindle
mesh_terms: D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D011788:Quality of Life; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D017741:Survivors / Q000706:statistics & numerical data*; D013771:Tetralogy of Fallot / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016276:Ventricular Function / Q000502:physiology*; D055815:Young Adult