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Total Correction of Tetralogy of Fallot at Early Age: A Study of 183 Cases
Mohamed Alassal1, Bedir M Ibrahim2, Hany M Elrakhawy3
1Cardiothoracic Surgery Department, Benha University, Egypt; King Salman Heart Center, King Fahd Medical City (KFMC), Riyadh, Saudi Arabia; Prince Abdullah Bin Abdulaziz Bin Musaed Cardiac Center (PAAMCC), Arar, Saudi Arabia.
Insights
Early surgical repair of tetralogy of Fallot (TOF) in infants is safe and effective. This study found low mortality and acceptable complication rates for early complete TOF repair.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Tetralogy of Fallot Management
Background:
- Debate exists regarding the optimal timing for surgical repair of Tetralogy of Fallot (TOF).
- The optimal timing for repair in asymptomatic infants remains a topic of discussion.
Purpose of the Study:
- To evaluate the outcomes of early complete surgical repair of Tetralogy of Fallot (TOF).
- To compare the results of early repair (≤1 year) versus later repair (>1 year) in TOF patients.
Main Methods:
- A retrospective study of 183 patients with Tetralogy of Fallot (TOF) who underwent complete repair.
- Patients were divided into two groups: Group 1 (≤1 year) and Group 2 (>1 year).
- Clinical examination, oxygen saturation, ECG, chest x-ray, laboratory tests, echocardiography, and cardiac catheterization were utilized for assessment.
Main Results:
- Early repair (Group 1) had a mortality rate of 2.04%, while Group 2 had no early mortality.
- Group 1 experienced higher rates of reoperation for residual stenosis, shunt, tricuspid regurgitation, and pulmonary valve regurgitation compared to Group 2.
- Fewer reoperations for restenosis and shunt were noted in Group 2, with some patients requiring pacemaker implantation in both groups.
Conclusions:
- Early complete surgical repair of Tetralogy of Fallot (TOF) can be performed with low mortality.
- While early repair shows acceptable outcomes, careful monitoring for residual defects and complications is essential.
Background:
Opinions regarding the optimal time for the repair of tetralogy of Fallot vary. A debate also exists about the timing of repair for the asymptomatic infant.
Methods:
This study included 183 patients with tetralogy of Fallot. All patients were subjected to clinical examination with measurement of oxygen saturation, 12-lead ECG, plain chest x-ray, and complete laboratory investigation. Echocardiography and cardiac catheterisation were indicated if there was an inability to reach diagnosis by echocardiography, suspicion of coronary anomaly, evaluation of distal pulmonary arteries or suspicion of major aorto-pulmonary collaterals. Complete repair was done in all patients. Patients were divided into two groups for comparison. Group 1 (147 patients, 1-year-old or less), and Group 2 (36 patients older than 1 year).
Results:
Three patients died in Group1 (2.04%) while there was no early mortality in Group 2 patients. Six patients in Group 1 (4.08%) were reoperated for significant residual or recurrent right ventricular outflow stenosis, three patients (2.04%) were reoperated for residual significant shunt, and three patients (2.04%) were reoperated for residual significant stenosis and residual significant shunt. That is in addition to three patients (2.04%) who had significant tricuspid regurgitation, three more patients (2.04%) who needed a permanent pacemaker implantation, and nine patients (6.1%) who had significant postoperative pulmonary valve regurgitation. On the other hand, for Group 2 patients, there were only three patients who were reoperated for postoperative restenosis and significant shunt, three patients who were reoperated for permanent pacemaker implantation, and another two patients who had insignificant restenosis to be followed up.
Conclusions:
Early complete tetralogy of Fallot repair can be accomplished with a low mortality.
