Abstract
Right ventricular (RV) dysfunction has adverse effects on long-term outcome in patients
with repaired tetralogy of Fallot (TOF). We employed serial radionuclide angiography
(RNA) to examine RV and left ventricular (LV) systolic function in adults late after
TOF repair and its relation to clinical outcome. We reviewed 10-year records of 95
patients (53 men) with TOF followed in our clinic (mean age at repair 12.6 ± 10.5
years, mean age at last follow-up 37.7 ± 9.8 years) who underwent at least 2 RNAs
between 1987 and 1997. Most patients were well by the end of the study (80% were New
York Heart Association class I, 17% were class II, and 3% were in class III). Sixteen
patients experienced sustained tachyarrhythmias (8 had atrial; 8 patients had ventricular).
One patient died suddenly. Fifteen patients underwent RV outflow reoperations (15
underwent pulmonary valve replacement; 7 had relief of RV outflow obstruction); RV
systolic function during exercise in these 15 patients was significantly impaired
before and returned to similar levels after surgery, compared with the rest of the
patients. Overall, RV and LV function remained stable in the whole group at a mean
interval of 5.7 ± 2.2 years between first and last RNA. This group of closely followed
adults with TOF remained well over 10 years with a low incidence of sudden death and
stable RV and LV systolic function, despite a relatively large number of RV outflow
reoperations. Aggressive intervention for right-sided hemodynamic abnormalities may
have contributed to this outcome. Preserved ventricular function may herald a favorable
long-term outlook in this group.
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Article Info
Footnotes
☆Dr. Gatzoulis was supported in part by a 1997 Department of Medicine, Postgraduate Fellowship Award, University of Toronto, Toronto, Ontario, Canada. Dr. Liu was supported in part by a grant from the Heart & Stroke Foundation of Ontario, Toronto, Ontario, Canada. Manuscript received March 22, 2000; revised manuscript received and accepted June 29, 2000.
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Copyright
© 2000 Excerpta Medica Inc. Published by Elsevier Inc. All rights reserved.
