title: 5-year serial follow-up of clinical condition and ventricular function in patients after repair of tetralogy of Fallot.
abstract: OBJECTIVE
  To study the changes over time in biventricular size and function, and clinical parameters in patients after repair of tetralogy of Fallot (TOF) without subsequent pulmonary valve replacement (PVR).
  
  
  METHODS
  We prospectively included 78 non-PVR patients (age 20(6-60)years at baseline), who were studied twice with a 5-year interval. Patients underwent magnetic resonance imaging for assessment of biventricular size and function. Exercise testing and electrocardiography were performed to determine peak oxygen uptake (peak VO2) and QRS duration. N-terminal prohormone brain natriuretic peptide (NT-proBNP) was assessed additionally.
  
  
  RESULTS
  Pulmonary regurgitation (PR), right ventricular (RV) volumes and QRS duration increased during 5-year follow-up (RV end-diastolic volume (EDV) 130 ± 30 ml/m(2) to 138 ± 34 ml/m(2); QRS 132 ± 27 msec to 139 ± 27 msec); peak VO2 decreased (96 ± 19% to 91 ± 17%). RV ejection fraction, RV effective stroke volume (eff.SV), and NT-proBNP levels remained unchanged. The slope of RVEDV increase was 1.6 ± 3.0 ml/m(2)/year, and depended on RVeff.SV, not on RVEDV, at baseline. Increase in RVEDV correlated with increase in QRS duration over time (r=0.28, p=0.016), and with decrease in RV mass/EDV ratio over time (r=-0.42, p<0.001), not with decrease in peak VO2. In subgroup analysis, patients with larger RVs at baseline showed larger increase in PR during follow-up and larger decrease in NYHA class over time.
  
  
  CONCLUSIONS
  In TOF patients with moderate RV dilatation, RVEDV increased by 1.6 ± 3.0 ml/m(2)/year, irrespective of RV size at baseline, but depended on RVeff.SV at baseline. Despite limited progression in RV size, unfavourable changes occurred during 5 years follow-up, which suggests there is a need for close follow-up.
authors.affiliation: Department of Pediatrics, Division of Cardiology, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands; Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Saskia E
authors.initials: SE
authors.lastname: Luijnenburg
authors.forename: Willem A
authors.initials: WA
authors.lastname: Helbing
authors.forename: Adriaan
authors.initials: A
authors.lastname: Moelker
authors.forename: Lucia J M
authors.initials: LJ
authors.lastname: Kroft
authors.forename: Maarten
authors.initials: M
authors.lastname: Groenink
authors.forename: Jolien W
authors.initials: JW
authors.lastname: Roos-Hesselink
authors.forename: Yolanda B
authors.initials: YB
authors.lastname: de Rijke
authors.forename: Mark G
authors.initials: MG
authors.lastname: Hazekamp
authors.forename: Ad J J C
authors.initials: AJ
authors.lastname: Bogers
authors.forename: Hubert W
authors.initials: HW
authors.lastname: Vliegen
authors.forename: Barbara J M
authors.initials: BJ
authors.lastname: Mulder
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005080:Exercise Test / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013771:Tetralogy of Fallot / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D013997:Time Factors; D016278:Ventricular Function, Right / Q000502:physiology*; D055815:Young Adult
keywords: Exercise capacity; Long-term outcome; Magnetic resonance imaging; Serial follow-up; Tetralogy of Fallot