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Late results in patients with tetralogy of Fallot repaired during infancy
E P Walsh1, S Rockenmacher, J F Keane
1Department of Cardiology, Children's Hospital, Boston, MA 02115.
Insights
Infants undergoing Tetralogy of Fallot (TOF) repair showed good hemodynamic results and low ventricular ectopy. Early surgical repair of TOF in infancy is safe and effective, with minimal long-term arrhythmia concerns.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Cardiac Electrophysiology
Background:
- Tetralogy of Fallot (TOF) is a complex congenital heart defect.
- Surgical repair in infancy is a critical intervention.
- Long-term outcomes, particularly regarding arrhythmias, require thorough investigation.
Purpose of the Study:
- To evaluate the long-term hemodynamic outcomes of early Tetralogy of Fallot repair.
- To assess the incidence of ventricular ectopy and conduction defects post-infancy TOF repair.
- To determine the safety and efficacy of surgical repair in the first 18 months of life.
Main Methods:
- Retrospective review of 220 infants undergoing TOF repair (1973-1985).
- Follow-up of 184 survivors (mean 60 months) assessing hemodynamic status and arrhythmias.
- Analysis of electrocardiograms (ECGs) and Holter monitoring data.
Main Results:
- 17% of patients required reoperation or intervention.
- Low incidence of ventricular ectopy (2/184 patients on ECG) and significant arrhythmias.
- No significant difference in conduction defects compared to later repair.
- Three late deaths, none arrhythmia-related.
Conclusions:
- Infant repair of Tetralogy of Fallot yields acceptable hemodynamic results.
- Early surgical intervention is associated with a low risk of ventricular ectopy and sudden death.
- Infancy repair of TOF is a viable strategy with favorable long-term outcomes.
Abstract:
Between 1973 and 1985, 220 infants (age 1 day to 18 months, mean = 7 months) underwent repair of tetralogy of Fallot (TOF) or TOF/pulmonary atresia with 17 early deaths. Follow-up status was ascertained for 184 of 203 survivors (91%) at a postoperative interval of 2 to 185 months (mean = 60 months). Significant residual hemodynamic lesions included ventricular septal defect in three, and right ventricular outflow gradient in excess of 40 mm Hg in 24. Reoperation or interventional catheter procedures were performed in 31 of 184 (17%) patients. All postoperative electrocardiograms were reviewed; only two of 184 patients had ventricular ectopy on any tracing. Holter data from 41 patients revealed one with sinus node dysfunction, 12 with Lown grade 1 ectopy, and one with Lown grade 2 or greater. Conduction defects, evaluated by electrocardiographic and electrophysiologic measurements, were not different from those reported for TOF patients undergoing repair at later ages. No study patient received antiarrhythmic medication, although one required a pacemaker for sinus node dysfunction. There were three late deaths, all unrelated to arrhythmia. TOF repair in infancy appears to be associated with an acceptable hemodynamic outcome, and a low incidence of ventricular ectopy and sudden death at 5 year follow-up.